The Curious Case of Cuba
FRAMING HEALTH MATTERS The Curious Case of Cuba C. William Keck, MD, MPH, and Gail A. Reed, MS path to health. However, we may draw from As health professionals in the United States consider how to focus health care and coverage to ensure better, more equitable patient and population health the principles and practices in Cuba to good outcomes, the experience of Cuba’s National Health System over the last 5 end, and in particular we suggest the Account- decades may provide useful insights. Although mutual awareness has been able Care Community (ACC) concept as a via- limited by long-term political hostilities between the United States and Cuban ble model to apply such insights in our capi- governments, the history and details of the Cuban health system indicate that talist context.9 In this light, we describe Cuba’s their health system merits attention as an example of a national integrated health care conceptualization, delivery, and approach resulting in improved health status. More extensive analysis of the associated outcomes, and analyze how Cuban principles, practices, and outcomes in Cuba is warranted to inform health system approaches to health might be tailored to our transformation in the United States, despite differences in political-social environment to improve both health care systems and available resources. (Am J Public Health. 2012;102:e13–e22. doi: effectiveness and population health status. 10.2105/AJPH.2012.300822) THE BEGINNINGS OF CUBA’S There is a growing awareness in the United status can be found in the experience of Cuba, NATIONAL HEALTH SYSTEM States that major changes in health care’s despite differences in our political-social sys- conceptualization, organization, and delivery tems and available resources.
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