[an error occurred while processing this directive]
BBC TwoNewsnight
Last Updated: Tuesday, 1 August 2006, 10:50 GMT 11:50 UK
Keeping Cuba healthy
By John Harris

In the first part of Newsnight's world's best public services series, we ask what Britain and the rest of the world can learn from Cuba's medical system.

Cuban couple on porch

Last week, when the crisis in Lebanon and the demands of Rupert Murdoch had yet to grab all of his attention, Tony Blair gave a speech in Nottingham. His subject was the worrying state of Britain's health, and its drain on our national funds. Crudely put, the PM's message was that the NHS could simply not afford the cost of treating people afflicted by obesity, alcohol abuse, smoking and general bad living.

By way of an example, he cited diabetes: "Ten per cent of NHS resources today are used to treat diabetes. By 2010 the estimate is that this could double... and it's avoidable. Three quarters of diabetics are Type 2 diabetics, and two thirds of them have a disease which could be preventable with exercise, diet and more healthy choices."

Five days later, Mr Blair arrived at Mr Murdoch's News Corp bunfight in Pebble Beach, California. He told his audience that the age of tribal politics was over, and when it came to policy ideas, left-right definitions were increasingly useless.

So how about this: to really get to grips with his health worries, shouldn't he have a look at the medical system in Fidel Castro's Cuba?

Select Committee

Consultorio in Jaruco, Cuba
Cuban healthcare
256 hospitals
13 medical research centres
445 24-hour clinics
13,857 family doctors
Health care spending per person per annumn: Cuba $251; UK $2,389; US $5,711
Before anyone starts sending in irate emails, this is not intended as any kind of endorsement of Cuba's wider political system or human rights record. In any case, having an admiring look at the country's surgeries, clinics and hospitals is hardly controversial: in 2001, members of the House Of Commons Health Select Committee travelled there and issued a report that paid tribute to "the success of the Cuban health care system", based on its "strong emphasis on disease prevention" and "commitment to the practice of medicine in a community".

The underlying logic of the Cuban system is amazingly simple. Thanks chiefly to the American economic blockade, but partly also to the web of strange rules and regulations that constrict Cuban life, the economy is in a terrible mess: national income per head is miniscule, and resources are amazingly tight.

Healthcare, however, is a top national priority, for reasons that draw on the romantic (Che Guevara, the Communist Party's icon, was a doctor), but have much more to do with pragmatism: the population's admirable health is surely one of the key reasons why Castro is still in power.

The challenge, then, is to not so much treat illness as to stop people getting sick in the first place.


Dr Ana Maria Fuentes, talks to John Harris in Jaruco
Dr Ana Maria Fuentes is one of nearly 14,000 Cuban family doctors
During four days on the island, Newsnight examined how all this works in practice.

The first place we visited - in Jaruco, a small town about 30 minutes outside Havana - was a Cuban doctor's surgery, or consultorio. Here, patients are divided into five categories, from high-maintenance to perfectly healthy, and the amount of attention they require is decided accordingly.

But here's the crucial point: even if you've got a clean bill of health, your local GP will still pay you a visit once a year. The idea is not just to check on your physical health, but to have a look at your wider lifestyle and home environment.

According to the doctor we met, there is also one particularly important thing : your annual house-call will probably take you by surprise.


We also spent time at a Policlinic - an ingenious invention, aimed at providing services like dentistry (around the clock!), minor surgery, vasectomies and X-rays, without the need for a visit to a hospital.

We paid a visit to the Latin American Medical School, which trains would-be doctors from all over the world - including, somewhat improbably, 71 from the USA - the Cuban way.

And we came across the small social details that play their role in making a big difference: platoons of pensioners exercising each morning in Havana's parks, and the 120 club, a national organization for anyone who fancies getting to 60 years old and thinking of it as life's half-way point.


Jaruco, Cuba
Cuba may be poor but it is not in poor health
If you want quick proof of how well all this works, consider Cuba's health indicators.

Its life expectancy and infant mortality rates are pretty much the same as the USA's. Its doctor-to-patient ratios stand comparison to any country in Western Europe.

Its annual total health spend per head, however, comes in at $251; just over a tenth of the UK's.

Mr Blair's aforementioned speech, it should be noted, was partly aimed at launching the government's latest bolt-on innovation to an NHS that seems to be fragmenting at speed: surgeries located inside branches of Boots. Will they fancy doing surprise house calls? Can they root themselves in communities the way the Cuban consultorios do? Could they fit in with the kind of organizational simplicity that seems to hold the key to Cuba's success?

If left-right prejudices really are as redundant as the prime minister reckons, his best-advised policy shift should be rather different.

Within reason - and though hell will freeze over, while pigs cruise over Downing Street - he should go Cuban.

Castro steps aside after surgery
01 Aug 06 |  Americas
Country profile: Cuba
01 Aug 06 |  Country profiles

Has China's housing bubble burst?
How the world's oldest clove tree defied an empire
Why Royal Ballet principal Sergei Polunin quit

banner watch listen bbc sport Americas Africa Europe Middle East South Asia Asia Pacific