title: The impact of the economic crisis and the US embargo on health in Cuba.
abstract: OBJECTIVE
  This paper examines the combined effects of a severe economic decline since 1989 and a tightening of the US embargo in 1992 on health and health care in Cuba.
  
  
  METHODS
  Data from surveillance systems for nutrition, reportable diseases, and hospital diagnoses were reviewed. These sources were supplemented with utilization data from the national health system and interviews with health leaders.
  
  
  RESULTS
  Changes in Cuba include declining nutritional levels, rising rates of infectious diseases and violent death, and a deteriorating public health infrastructure. But despite these threats, mortality levels for children and women remain low. Instead, much of the health impact of the economic decline of Cuba has fallen on adult men and the elderly.
  
  
  CONCLUSIONS
  To be consistent with international humanitarian law, embargoes must not impede access to essential humanitarian goods. Yet this embargo has raised the cost of medical supplies and food Rationing, universal access to primary health services, a highly educated population, and preferential access to scarce goods for women and children help protect most Cubans from what otherwise might have been a health disaster.
authors.affiliation: Columbia University School of Nursing, New York, NY 10032, USA.
authors.forename: R
authors.initials: R
authors.lastname: Garfield
authors.forename: S
authors.initials: S
authors.lastname: Santana
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003462:Cuba / Q000453:epidemiology; D003695:Delivery of Health Care / Q000592:standards / Q000639:trends*; D003709:Democracy; D004467:Economics / Q000331:legislation & jurisprudence / Q000639:trends*; D005260:Female; D006304:Health Status; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007391:International Cooperation; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009749:Nutrition Surveys; D011159:Population Surveillance; D011634:Public Health; D014481:United States