DUCATION TO THE GENERAL PUBLIC ARE BETTER THATN THOSE OF MANY DEVELOPED COUNTRIES. HOW HAS IT MANAGEDTHIS?CUBA’S ACHIEVEMENTS IN PROVIDING HEALTH CARE AND EDUCATION TO THE GENERAL PUBLIC ARE BETTER THATN THOSE OF MANY DEVELOPED COUNTRIES. HOW HAS IT MANAGEDTHIS?
There may be some question over Fidel Castro’s achievements in providing economic success, or democracy to Cuba in the last forty five years or so. However Cuba’s record on providing egalitarian health care and education to the masses have generally been agreed as a success story, even by Castro’s old enemy the United States. “To be educated is to be free,” (Marti in Marshall, 1987, p146) has become one of the more popular revolutionary slogans and has been greatly adhered to by Castro’s government. While health care is articulated in the 1975 Cuban constitution as being “the right of all and the responsibility of the state” (Feinsilver, 1993, p26). The social political stance of Castro’s government has been the driving force behind the success in health care and education. Issues such as housing, employment, health care and education are viewed as a basic human right and are in theory guaranteed by the state to all. In Cuba, health care indicators are also seen as a measure of the government’s efficiency and performance. Other socialist states that have come and gone over the last century have also professed to put these issues at the forefront of priority. States such as Russia and China have to a lesser or greater degree failed to provide the standard of services provided in Cuba. “Until 1969 China’s health care system served only the urban population, which represented about 15 percent of the total population” (Feinsilver, 1993, p2). There are certainly factors that make this comparison unfair but Cuba’s achievements in providing these social services are still quite remarkable given its economic position. By truly placing education and healthcare as one of the fundamental priorities of the revolution, and developing specific programs and initiatives to deal with these two social issues, Cuba managed to succeeded where others more wealthy nations failed. The use of popular participation and central government control also were powerful tools in implementing these social policies. It would now be useful to look at some of these initiatives that have been taken by the Cuban government that enabled it to equal if no surpass education and health standards in many developed countries.
Before 1959 and Castro’s grip on power, Cuba education and health care systems were limited and based around Havana. Although Cubans had a relatively high income and an above average literacy rate compared to the rest of Latin America things were far from perfect. Under the Batista Regime the rich and the middle class tended to send their children to the private Catholic schools while the poor had to use the badly equipped and staffed general schools, or in more rural areas nothing at all. In 1953 the illiteracy rate was 24 per cent of the population. The difference between urban areas and rural areas showed that most of the limited resources were going to the big cities, with illiteracy rates in town being 11 per cent to 42 per cent in the country (Marshall, 1987, p146). Within two years of coming to power Castro had nationalised all private schools and started the first major education initiative, the literacy campaign. This campaign was established not just to educate the city dwellers but to prioritise education for those that had mainly been ignored in the countryside. Over a 100,000 young students travelled into the rural areas to live with and educate the peasant population. 1961 became known as the “Year of Education,” (Perez, 1995, 358) while the slogan of the day being, “If don’t know, learn. If you know, teach” (Marshall, 1987, p147). The campaign became a great success with official government figures suggesting that by 1962 96 per cent of the population was now literate which was the highest rate in Latin America at the time. Even if the official figure may have been some what over optimistic there was no denying the massive achievement. The Cuban government used mass popular participation to achieve the literacy goal Over 271,000 people were organised into four different educational brigades that focused on different groups of population. This first step was a massive one that touched all areas and groups of the Cuban people. The next education initiative the Third Grade Campaign came soon after. This was aimed at educating adults that had little formal education. Approximately 500,000 adults benefited from this scheme. The Worker-Peasant Educational program came later which helped to create the process and commitment to adult education that still continues today.
The government control over curricula pointed students in the direction of the specific needs of the state. Universities under the Batista generally concentrated on turning out law professionals and non technical graduates. Castro not only increased the amount of universities from three in 1959 to forty in the 1980s, but also adapted the curricula available towards subjects needed for the nation’s economic and social requirements. These included medicine, engineering and technical courses. There was a real attempt at occupational engineering which bore fruit in the graduates that were needed to combat Cuba’s main problems. “National priorities had reshaped the character of post-secondary education” (Perez, 1995, p361). It is interesting to point out that many writers such as Marshall argue that the curriculum was also politically driven. That Castro and Guevara were not simply making people literate but also creating a political consensus that would look down on decent or criticism of its teachings. The educational achievements made in Cuba over the last forty five years have been remarkable. Through popular participation and strict governmental control this was made possible, however the cost may have been some political and educational freedoms.
The health care situation under the Batista Regime was generally in an equally bad state as the educational system. It again was a case of if you could afford it and you lived in Havana, it was available. If not, to bad. After the revolution a large proportion of the mainly middle class medical staff fled Cuba, following their mainly middle class patients. This created an initial fall in health care standards that took the next ten years of training new physicians to rectify. Through government control of education medical training was prioritised to the extent that at the university of Havana in 1975 30 per cent of it graduates were medical students (Perez, 1995, p361). The health of the nation generally improved even through the 1960s because of the government’s tight grip over the population. Through the imposing of rationing that guaranteed the average Cuban a minimum calorific intake of 1,900 a day malnutrition was essentially eliminated. This was often achieved by free school and work canteen meals. The average daily calorific intake of Cubans gradually increased right up until the collapse of Soviet Russia. With large hospital building programs and the large amount of trained physicians starting to practice the life expectancy went from 59 years of age in 1955 to 76 in 1992. Infant mortality fell from 32 per 1000 in 1955 to 10 in 1992 (Eckstein, 1994, p226). Polyclinics were set up that would be the entry point for Cubans into the health service. These clinics would provide health care to around 25,000 people. Groups of physicians specialising in a range of expertise would be responsible for the care of around 3,000 to 4,000 of these people, giving an as near as possible egalitarian service no matter where you live in Cuba. This is now being replaced by the family doctor program which promises a Doctor and nurse team on every block who live and work with their patience’s. This in theory will give the medical teen intimate knowledge of their patience’s and make diagnosis easier.
Through popular participation health education has flourished. Education on health issues is seen as important as actually treating patients who are ill. Polyclinics are seen as an opportunity to teach not only student doctors but also the patients. Health lectures are often given in the waiting rooms as well as preventative information being a key part of the consultation. Through tight central control of the polyclinics this is made possible. Cuba’s grip on the media is also another tool in the fight for health education. Mass campaigns through the media highlighting issues such as HIV, nutrition and anti smoking are common and effective.
The education and health service that Castro inherited when he took power in 1959 was even worse than it was under the Batista regime. With the fleeing of many of the middle class large sections of the teaching and medical profession went also. Creating a temporary brain drain. However via the immense political social will of Castro and his party the education and health service was transformed into the envy of much of the world. To the point where Cuba has one of the highest literacy rates in the world, and on a par with the United States at 97% (CIA fact book). Cuba health care system in some areas beats the United States and probably beats the whole of the world in equal access to health care. This has been achieved through tight central control of educational and health programs, and through mass popular participation in these programs whether you wanted to participate or not. Good education and health care have been forced on the Cuban people with a certain amount of arm twisting. This however may have been the only way to obtain such great achievements in such a short time.
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