Crisis Brings Opportunity

After economic collapse in 1991, Cuba invested in caring for its ailing population. Today, the country has the best doctor-to-patient ratio in the world.

Amidst the current global financial crisis we face an enormous global health crisis that has left close to a billion people without any access to affordable health care. The inequality between those who can afford care and those who go without has never been worse. Consider that while Canada struggles to improve its ratio of one doctor for every 440 people, Malawi has only one physician for every 50,000 people. Despite predictions that global health inequity will worsen in a time of economic peril, we actually stand in front of a great opportunity to make the world healthier for all. It won’t happen by bailing out banks and automakers or by stimulating developing-world economies with more t-shirt factories. It won’t even happen by conquering flu pandemics. It will only occur if we choose to invest in public-health systems to build a prosperous global health economy. Impossible? Hardly. Consider the story of one small, poor, nation that, in the middle of a total economic collapse, took bold steps to improve health care for its own citizens and for millions more around the world.

In 1991, Cuba’s economy fell apart after the Soviet Union went to pieces. The country’s GDP dropped by 35 per cent within two years, and exports fell by 87 per cent. By 1993, the average Cuban male shed 25 lbs due to lacking foodstuffs and 35,000 people went temporarily blind from poor nutrition. This was no fiscal downturn; it was one of the worst economic collapses in modern history. Coping with growing public-health challenges, Cuba did not close a single hospital, medical clinic, or university. Instead, the state scaled up the number of spaces in medical and nursing schools and offered thousands of free scholarships for Cuban and foreign medical students alike. Resources were strapped, and it was a challenge to keep the lights on, let alone enough materials in hospitals. Still, by 1999, Cuba’s major health indicators were equal to the United States.

Graduating over 3,500 physicians per year, Cuba has achieved the best doctor-to-patient ratio anywhere on the planet. The country has one physician for every 169 people and has more than 31,000 of its own health-care workers serving on cooperation missions in 71 countries. For providing the only available primary health care in poor regions, Cuba has gained economic remuneration from countries like Venezuela and South Africa, and it has gained political favour with once-hostile nations like Uruguay and Guatemala. In a time of crippling economic chaos the decision to strengthen health care at home and abroad staved off domestic disaster, it garnered much-needed political and economic support, and it served up medical outreach for poor people in poor countries who never in their lives had seen a doctor.

Since the 1993 collapse, the country’s economy has grown steadily (from $4,670 dollars per capita in 1993 to $8,948 in 2007), largely due to increasing tourism dollars, but also thanks to international collaborations for which medical internationalism laid foundations. Considering what we are up against today, is it possible to conceive of rich countries investing in a global health workforce to improve global health and to emerge out of financial crisis?

Indeed it is, but the task is tall. We need 4.3 million health-care workers by tomorrow morning, and each day that passes without them we experience a daily death toll of 50,000 from preventable causes. Morally, there is no reason to ignore this. As much as these figures reveal disaster they also show incredible potential. Certainly rich and poor nations alike, international organizations, and even the private sector can uncover the economic logic and moral compassion to bolster public health systems for a global need, much like Cuba has done. A global health-care workforce offering much-needed care for billions, even if charging only pennies per patient, musters more economic potential, humanity and long-term strategic interests than any products currently on offer from Wall Street or Detroit.

For far too long the architects of global capital have tried to make something out of nothing, be it hedge funds, derivatives or oversized cars that we don’t really need. Surely it is time to make something out of something, by flourishing from making health care a right for all.