title: Public health services, an essential determinant of health during crisis. Lessons from Cuba, 1989-2000.
abstract: During the 1990s, Cuba was able to overcome a severe crisis, almost without negative health impacts. This national retrospective study covering the years 1989-2000 analyses the country's strategy through essential social, demographic, health process and health outcome indicators. Gross domestic product (GDP) diminished by 34.76% between 1989 and 1993. In 1994 slow recuperation started. During the crisis, public health expenses increased. The number of family doctors rose from 9.22 to 27.03 per 104 inhabitants between 1989 and 2000. Infant mortality rate and life expectancy exemplify a series of health indicators that continued to improve during the crisis years, whereas low birth weight and tuberculosis incidence are among the few indicators that suffered deterioration. GDP is inversely related to tuberculosis incidence, whereas the average salary is inversely related to low birth weight. Infant mortality rate has a strong negative correlation with the health expenses per inhabitant, the number of maternal homes, the number of family doctors and the proportion of pregnant women receiving care in maternal homes. Life expectancy has a strong positive correlation with health expenses, the number of nursing personnel and the number of medical contacts per inhabitant. The Cuban strategy effectively resolved health risks during the crisis. In times of serious socio-economic constraints, a well conceptualized public health policy can play an important role in maintaining the overall well-being of a population.
authors.affiliation: Institute of Tropical Medicine, Antwerpen, Belgium. pdevos@itg.be
authors.forename: Pol
authors.initials: P
authors.lastname: De Vos
authors.forename: Anaí
authors.initials: A
authors.lastname: García-Fariñas
authors.forename: Adolfo
authors.initials: A
authors.lastname: Álvarez-Pérez
authors.forename: Armando
authors.initials: A
authors.lastname: Rodríguez-Salvá
authors.forename: Mariano
authors.initials: M
authors.lastname: Bonet-Gorbea
authors.forename: Patrick
authors.initials: P
authors.lastname: Van der Stuyft
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003462:Cuba / Q000453:epidemiology; D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration*; D003906:Developing Countries; D057172:Economic Recession; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D018166:Health Care Reform / Q000191:economics / Q000458:organization & administration*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006305:Health Status Indicators; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics / Q000458:organization & administration*; D011157:Population Dynamics; D011247:Pregnancy; D015980:Public Health Practice / Q000191:economics / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D055815:Young Adult