Health and wellbeing: Qualitative impressions from a brief APHA-MEDICC trip to Cuba

Background: The Cuban health system is highly structured, based in prevention, and has produced positive community health outcomes. Infant-mortality is lower and life expectancy is higher than in the US. Vaccination rates are among the highest in the world. The APHA-MEDICC delegation to Cuba in January 2014 was designed to increase understanding of the Cuban approach to health, healthcare provision, and equity.

Methods: Over the course of one week, total of 12 venues (e.g., polyclinics, provider training programs, and community-based organizations) were visited. Venues included multiple Cuban presenters and discussants and opportunities for dialogue.

Handwritten fieldnotes were maintained and analyzed using inductive qualitative content analysis to identify themes.

Results: Eleven themes, which characterize the Cuban system, emerged, including: extensive use of data to guide priorities; appreciation of inter-sectorality (all sectors contribute to, and are responsible for, health); focus on community health; local orientation to health (e.g., providers know individuals and families and conduct daily outreach, and volunteers are relied on to support efforts); and use of complementary medicine.

Challenges also emerged, including: limited ability to evaluate efforts (e.g., HIV prevention efforts among Cuban men who have sex with men [MSM]); racism; potentially reduced confidentiality of health records (particularly pertinent for those with HIV); decreased environmental health; increased access to unhealthy food contributing to obesity among well-resourced Cubans; and US embargo against Cuba.

Conclusions: The Cuban system has much to teach; however, more research is needed. Increased understanding will be facilitated by considering both culture and ideology to increase thorough understanding.