Improving birth outcomes in Cuba: Lessons for the US

Positive birth outcomes are considered a strong indication of a country’s health. In the 1970’s the Cuban government began developing a singly public health system under the following public health principles: health is a right, the responsibility of the state, preventative and curative services are integrated, the public participates, activities are integrated with economic and social development, and global health cooperation is a fundamental obligation of the health system. The public health system looks like a pyramid with a strong foundation of prevention stating at the community level (consisting or about 1,500 residents). These families are served by family doctor-nurse teams who live within the communities they serve. Nearly 90% of medical school graduates go into family practice medicine. This family doctor-nurse model has been the most important reform Cuba has instituted and is the pillar of primary care. The first line of specialty service provision is the polyclinic where more specialized services are provided. The required neighborhood health diagnosis is to key to establishing work priorities for the family medicine teams. Analyses of diseases, risk factors, and environmental influences on health are updated twice a year. Findings are used to set local priorities.

Infant mortality rates have been lower than the US since 2001.and is now ranked 24^th among developed nations despite ranking 117^th in per capita gross domestic product. As American health professions debate how to ensure universal coverage and positive health outcomes for all, the Cuban experience can provide important lessons for us to consider.