Abstract

PIP: In the 20 years since the revolution, Cuba has gone from the health profile of an underdeveloped country to that of a developed one. Heart disease and cancer are the leading causes of death. Infant mortality has been drastically reduced. Maternal mortality is lower than any other Latin American country. Improvements have been accomplished through better nutrition, a medical system that is national, free, accessible, and well-organized, and health education and immunization programs. The health system is doctor-dominated. The nurse is subservient to the doctor, who has acquired technical skills and status comparable to his American counterparts. Curative, rather than preventive, medicine is emphasized. The diet is high in fat and sugar. Many in the population, including the medical profession, smoke cigarettes. The medical profession and the revolutionary leaders are in a struggle to shift emphasis from further improvements in curative medical care to an expansion of the role of mass organizations. Yielding to the idea that only doctors could deliver good health care, Cuba has created a generation of doctors who believe that they make the primary contribution to the people's health. Although most physicians support the ideals of the revolution, status is still accorded to those with diagnostic acumen, specialized qualifications, and academic credentials.