May 27, 2007
‘Sicko,’ Castro and the ‘120 Years Club’
By ANTHONY DePALMA
CUBA works hard to jam American TV signals and keep out decadent Hollywood films. But it’s a good bet that Fidel Castro’s government will turn a blind eye to bootleg copies of “Sicko,” Michael Moore’s newest movie, if they show up on the streets of Havana.
“Sicko,” the talk of the Cannes Film Festival
last week, savages the American health care system — and along the way
extols Cuba’s system as the neatest thing since the white linen
guayabera.
Mr. Moore transports a handful of sick Americans to Cuba for
treatment in the course of the film, which is scheduled to open in the
United States next month, and he is apparently dumbfounded that they
could get there what they couldn’t get here.
“There’s a reason Cubans live on average longer than we do,” he told
Time magazine. “I’m not trumpeting Castro or his regime. I just want to
say to fellow Americans, ‘C’mon, we’re the United States. If they can
do this, we can do it.’ ”
But hold on. Do they do it? Live longer than, or even as long as, we
do? How could a poor developing country — where annual health care
spending averages just $230 a person compared with $6,096 in the United
States — come anywhere near matching the richest country in the world?
Statistics from the World Health Organization, the C.I.A.
and other sources all show that the people of Cuba and the United
States have about the same life expectancy — 77 years, give or take a
few months — while infant mortality in Cuba is significantly lower than
in the United States.
Of course, many people regard any figures about Cuba as at least
partly fiction. But even if the longevity statistics are correct, they
are open to interpretation. Carmelo Mesa-Lago, a professor emeritus of
economics at the University of Pittsburgh, said statistics also show that Cuba has a high rate of abortion,
which can lower infant mortality rates and improve life expectancy
figures. The constant flow of refugees also may affect longevity
figures, since those births are recorded but the deaths are not.
Despite such skepticism, many medical experts say they do believe
that average Cubans can live as long as Americans, and the reason may
lie in a combination of what Cuba does well and the United States does
poorly, if at all.
Dr. Robert N. Butler, president of the International Longevity Center in New York and a Pulitzer Prize-winning
author on aging, has traveled to Cuba to see firsthand how doctors are
trained. He said a principal reason that some health standards in Cuba
approach the high American level is that the Cuban system emphasizes
early intervention. Clinic visits are free, and the focus is on
preventing disease rather than treating it.
Dr. Butler said some of Cuba’s shortcomings may actually improve its
health profile. “Because they don’t have up-to-date cars, they tend to
have to exercise more by walking,” he said. “And they may not have a
surfeit of food, which keeps them from problems like obesity, but
they’re not starving, either.”
Cuban markets are not always well stocked, but city streets are
dotted with hot dog and ice cream vendors. Bellies are full, but such
food can cause problems in the future, as they have in the United
States.
Dr. Butler has just completed a study that shows it is possible that
because of the epidemic of obesity in children, “this may be the first
generation of Americans to live less long than their parents.”
There could be one great leveler for Cubans and Americans. While all
Cubans have at least minimal free access to doctors, more than 45
million Americans lack basic health insurance. Many are reluctant to
seek early treatment they cannot afford, Dr. Butler said. Instead, they
wait to be admitted to an emergency room.
“I know Americans tend to be skeptical,” he said, “but health and
education are two achievements of the Cuban revolution, and they
deserve some credit despite the government’s poor record on human
rights.”
Universal health care has long given the Cuban regime bragging
rights, though there is growing concern about the future. In the
decades that Cuba drew financial and military support from the Soviet
Union, Mr. Castro poured resources into medical education, creating the
largest medical school in Latin America and turning out thousands of
doctors to practice around the world.
But that changed after the collapse of the Soviets, according to
Cuban defectors like Dr. Leonel Cordova. By the time Dr. Cordova
started practicing in 1992, equipment and drugs were already becoming
scarce. He said he was assigned to a four-block neighborhood in Havana
Province where he was supposed to care for about 600 people.
“But even if I diagnosed something simple like bronchitis,” he said,
“I couldn’t write a prescription for antibiotics, because there were
none.”
He defected in 2000 while on a medical mission in Zimbabwe and made
his way to the United States. He is now an urgent-care physician at
Baptist Hospital in Miami.
Having practiced medicine in both Cuba and the United States, Dr. Cordova has an unusual perspective for comparison.
“Actually there are three systems,” Dr. Cordova said, because Cuba
has two: one is for party officials and foreigners like those Mr. Moore
brought to Havana. “It is as good as this one here, with all the
resources, the best doctors, the best medicines, and nobody pays a
cent,” he said.
But for the 11 million ordinary Cubans, hospitals are often ill
equipped and patients “have to bring their own food, soap, sheets —
they have to bring everything.” And up to 20,000 Cuban doctors may be
working in Venezuela, creating a shortage in Cuba.
Still Cuban officials assert that free health care, a variety of
sports programs, a healthy, if limited, diet and cultural activities
have kept enough Cubans healthy enough well into old age to warrant
starting the 120 Years Club, which enrolls people who are 80 and older
and strives to help them reach an even riper old age.
Until he had to have emergency surgery last year, Fidel Castro — who
turned 80 this year — was considered a model of vibrant long life in
Cuba. But it was only last week that he acknowledged in an open letter
that his initial surgery by Cuban doctors had been botched. He did not
confirm, however, that a specialist had been flown in from Spain last
December to help set things right.
