The Guardian (London), Monday Oct. 2, 2000

By Sarah Boseley, health correspondent

The NHS [British National Health Service] is turning to Cuba for

inspiration on how to improve its services. Officials from the

Department of Heath and 100 Gps [general practitioners] visited the

Caribbean island which, despite being short of medicines and money after

decades of a US-led economic embargo, manages to deliver excellent

healthcare at a fraction of our cost. Later this month a delegation of

Cuban doctors, led by Cuba's deputy health minister, will arrive in

Britain to share the secrets of their success.

The interest in Cuba comes at a time when the Labour government is

intent on radical reforms of the NHS to make it patient-centered and

more cost-effective. Cuba has a stunning record in both regards, with

patient representation at every level, helping to organize the way the

health service is run.

The health secretary, Alan Milburn, has repeatedly said he wants to see

GPs take a leading role in the reform of the NHS, and it is the quality,

dedication and large numbers of family doctors in Cuba that have

contributed most to its impressive health record.

When Fidel Castro came to power, Cuba's mortality rates matched many

other places in the developing world, with a life expectancy of 48 for

men and 54 for women. Now it rivals anywhere in Europe or the US.

Male life expectancy is 74 - the same as in the UK. Women can expect to

live to 76 years old (79 in the UK) and infant mortality is 7.1 per

100,000 births* (see note below) - not much higher than ours.

However, one major difference between Cuba's health statistics and ours

has caught the attention of officials: here, healthcare costs 750 a

head annually. In Cuba it costs 7.

Among those who went on the Cuban trip earlier this year were the

principal medical officer of the Department of Health, Phillip Leach,

the eminent academic Sir Brian Jarman and the president of the Royal

College of GPs, Sir Dennis Pereira Gray.

Patrick Pietroni, a dean of postgraduate general practice at London

University, who led the visit, said: "What we can learn is how they have

managed to produce these healthcare statistics which are sometimes

better than ours at 1% of the expenditure. They have more family

doctors, who are better trained than our GPs.

"When we went to Cuba what was so impressive were the three-story

buildings called consultorio. The ground floor was the practice, the

first floor was the doctor's flat and the second floor was the nurse's

flat. No Cuban lives more than 20 minutes or so from one of these."

They also have fewer patients. Cuba has 30,000 GPs, the same number as

Britain, but has only a fifth of the population. There is one family

doctor per 500 to 700 people in Cuba, compared to one for 1,800 to 2,000


Cuba has 21 medical schools, but Britain has only 12. Cuba has 37,000

practice nurses. The UK, which has a shortage of all nurses, has just


Some of the good health of the Cuban nation is, paradoxically, the

product of adversity. Food is rationed and meat is scarce, so much of

the diet is fruit and vegetables. Because there is relatively little

public or private transport, most people walk or cycle everywhere.

Immunization is compulsory and thanks to the interest and investment the

state is prepared to make in health, Cuba has a vaccine for meningitis

B, which is now being investigated in the UK - although the prevalent

strains in Cuba are not the same as here.

But despite the success insiders say many Cuban doctors use the

opportunities they have in traveling to conferences to make contacts and

leave Cuba for more money and better career prospects abroad.

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* Note, actually, the infant mortality rate is now under 7--6.9/1000

last year. And the number of doctors who seek employment in other

countries is amazingly low considering the large number who work and

travel outside the country and the harsh conditions they live in

compared to what they could be earning in industrialized countries.

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