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Public health can be maintained in times of crisis
10 February 2012
Institute of Tropical Medicine Antwerp
Even in dramatic times of crisis, when the Gross National Product collapses, it is still possible to assure a good level of public health. If one is prepared to strengthen the public system of healthcare. “Look for instance to Cuba in the nineties”, say scientists from the Antwerp Institute of Tropical Medicine. The scientific journal Tropical medicine and International Health made their analysis available on the internet, prior to the paper publication.
Since 2008 we experience a worldwide crisis and its economic and social consequences. Countries as Portugal and Greece suffer greatly, and are desperately seeking to cut down on expenditures. Sharp economies in social security and healthcare are in the pipeline. Upon which medical circles immediately warn that public health must not be endangered.
It doesn’t have to go like this, according to research of the epidemiology group of the Institute of Tropical Medicine on the previous crisis, during the nineties.
During the nineties – the first decade of globalisation – many (developing) countries were hit by a deep economic crisis. Their Gross National Product came down steeply: Argentina – 22%, Peru – 30%, Indonesia – 14%, Russia – 42%, Cuba – 38%. The shrinking economy led to huge unemployment, loss of purchasing power …
Cuttings in social expenditures and health care hit particularly the poorest and most vulnerable groups. In Russia between 1990 and 1994 the mortality among adults increased with 30%, due to social instability, malnourishment, depression, alcohol and the dismantlement of public healthcare. In January 1998 the Indonesian rupiah lost 80% of its value; the cost of private healthcare suddenly was prohibitive and the public health system could not cope. In Peru and Argentina child mortality increased sharply.
Cuba took another path, according to research by Pol De Vos and colleagues. In 1989 the Soviet Union, largest customer and investor, collapsed and shortly thereafter the United States tightened its embargo. Suddenly eighty percent of imports and of exports evaporated. The Gross National Product dropped 38.5 %. There were food shortages. Nevertheless Cuba could largely maintain the health and well-being of its population. It refused to accept the instructions of the IMF and held on to social redistribution.
In spite of the crisis, a series of health indicators even improved still, among them child mortality and life expectation. The scientists found a strong relation between the rise in public health expenditure and the decrease in child mortality and rise in life expectation. On the other side, the number of children with low birth weight rose temporarily (but in 2000 it again was lower than in 1989). Also the number of tuberculosis cases went up, peaking in 1995. Both were coupled to food shortage.
One would expect that the decline in Gross National Product led to a dramatic drop in Cuban health. But the government held on to assuring the basic needs of the population. The economic and social measures were broadly discussed at the workplaces and in the districts. Only those measures with a broad public support were implemented.
The analysis shows that it was essential to these, all in all very encouraging, results that Cuba also strengthened its public healthcare, especially the first line. Health services became a priority and remained free, the number of family doctors tripled, and the doctors emphasised prevention.
Belgium (or Greece) is not Cuba, De Vos emphasises, and every country has its own peculiar health system, but it doesn’t hurt to learn from examples.