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Universal Health Coverage (UHC): Cuba, Politics, and the Economics of Illness

There is no doubt that with the assistance of technology, great strides have been made in healthcare. As our world has become even more closely connected, universal health interests are of even greater importance, especially when considering the impact of global health threats as seen in the recent Ebola and Zika outbreaks.

 

An Introduction to Universal Health Coverage (UHC)

Recognizing the need for stronger health systems on a global level, the concept of Universal Health Coverage (UHC) was born. UHC was also developed by the World Health Organization (WHO) in consideration of the impact of health outcomes on social and economic development, as well as poverty reduction.  

In the words of WHO, “Universal health coverage is defined as ensuring that all people have access to needed promotive, preventive, curative and rehabilitative health services, of sufficient quality to be effective, while also ensuring that people do not suffer financial hardship when paying for these services.” 

 

The Politics of Health Coverage

Under the WHO Sustainable Development Goal 3, Universal Health Coverage includes access to safe, effective, quality and affordable healthcare. As with any other mandates stemming from international organizations such as WHO, the effectiveness of implementing such changes relies on the governance and reform in-country.  However, healthcare reform globally, including the United States and other developed countries falls far behind this goal.

For Universal Health Coverage to move beyond the conception stage and into practice, health, must be treated as a necessity, not a luxury. This ideology is particularly important in regard to health care expenses for patients.

 

Prevention, Health, and the Economics of Illness

It is easier to prevent people from getting sick than it is to cure people who are ill. Similarly, more money goes into healthcare from those that are sick than those that are healthy.

Why is this? Routine health care visits in combination with regular prevention and wellness outside of the health system, by the patient themselves, reduces the amount of money said patient will generate in health care costs.

Why is this important? Care for chronic, preventable illnesses such as diabetes, obesity, hypertension, etc. is expensive. Unnecessary urgent care visits are also expensive. However, in the eyes of economics, spending is good. Likewise, for those that generate profit from health care expenses, illness generates more money. This does not necessarily mean that health care providers actively want for people to be sick, nor does this mean our system is setup to encourage illness. What it does mean is that illness, at least the cost of health care related to illness, results in economic expenditure. While health and wellness reduces the economic burden of healthcare, it does not pay into the system. This is what we mean by the “economics of illness”.

While Universal Health Coverage is important in relation to health care, there must also be a focus on the health and well-being of populations, in addition to just caring for their illness. While this may not be so popular economically, prevention and wellness is a more sustainable approach to reducing morbidity and mortality than caring for illness alone.

 

Lessons learned from Cuba

While much can be said about Cuba, both negative and positive, there is much to say about the Cuban healthcare system. In fact, the Cuban healthcare system has been recognized by WHO as a model for the world, placed far ahead of that of the United States and other developed countries. Not only is the Cuban healthcare system efficient and effective, but it is one that is operating in a low-resource setting.

What makes the Cuban system so great? Two key component of the effectiveness of the Cuban system are 1) the support of the government in keeping the system strong and 2) a focus on prevention rather than cure. Healthcare in Cuba is free for citizens, yet providers are some of the best trained in the world. At the very least, perhaps we can look to the Cuban healthcare system for tips on how to use prevention to more sustainably provide low cost, high-quality healthcare services and maintain a well-trained health workforce.  

 

For more on the Cuban Health System:

Cuba’s Health Care System: a Model for the World

http://www.huffingtonpost.com/salim-lamrani/cubas-health-care-system-_b_5649968.html

How Cubans Live as Long as Americans at a Tenth of the Cost

https://www.theatlantic.com/health/archive/2016/11/cuba-health/508859/

Fidel Castro’s Health Care Legacy

http://www.commonwealthfund.org/publications/blog/2016/nov/fidel-castros-health-care-legacy

 

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Why International Issues Must be Addressed with Cross-Disciplinary Responses: The Case of Ebola

Ebola has taken over media as an international health concern in 2014. With questions mounting over whether Ebola will become widespread and how to contain the disease, it is time to bridge the gap between the natural and social sciences. More specifically, it is essential to integrate research in key areas such as public health and epidemiology with key information in fields such as anthropology.

My first encounter with a story that expressed the bridge between the Ebola outbreak and anthropologists was in NPR publication, “The Experts The Ebola Response May Need: Anthropologists”. In the article, NPR staff point out that anthropologists may be key in addressing the Ebola outbreak, given their knowledge of local traditions as related to the spread of the disease, as well as the understanding of how fear plays a role in the epidemic.

In this post, I suggest that anthropology does not stop short of providing assistance in the realm of knowledge of local customs or fears of Ebola – anthropologists provide a wealth of knowledge through the use of ethnographic research and observation that is key to addressing a number of issues, Ebola included.

The reality is that in many cases, through in-depth understanding and wholistic studies, anthropologists are aware of potential widespread issues, whether they be social, political, or public health concerns, well before others in separate fields. The Ebola outbreaks acts as no exception.

Aside from providing an anthropological analysis of the 2014 Ebola outbreak, a more direct message must be expressed: Ebola not only represents a failure of a number of health systems and the weakness of the international community in responding to global health issues. The 2014 Ebola outbreak represents the failure to address the desperate need to find cross-disciplinary solutions to global issues.

Anthropology is unique in that it provides an understanding of groups, interactions, phenomenon, ideas, and a number of other factors that are encompassed in the “study of mankind”. The gap between social and natural sciences must be bridged to provide for the free-flow of knowledge across fields. As we recognize the need for sustainable solutions, “sustainability” must become synonymous with “cross-disciplinary”.

Suggested Reading: “Notes from Case Zero: Anthropology in the time of Ebola“; “Ebola in Perspective

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