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Sen. Tom Harkin, D-Iowa, recently spent three days in Cuba -- the longtime socialist adversary of the United States -- to learn more about the island nation’s health care system.
For years, some health policy specialists in the United States have been intrigued by Cuba’s health care system. Cuba produces a disproportionate number of doctors, and it has posted relatively strong health statistics in international comparisons, especially considering the country’s shortage of material goods and economic wealth.
For some liberals, Cuba’s health care system has offered an alternative to the one in the United States, where millions of Americans have struggled without insurance in recent years. Notably, Michael Moore’s 2007 health care documentary Sicko includes scenes where Americans in need of medical attention travel to Havana and are treated for free at a high-quality hospital. Critics have countered that such free, quality care is available only to the communist elite, not to ordinary Cubans.
Harkin certainly saw something promising in Cuba’s health care system. During a press conference upon his return to Washington on Jan. 29, 2014, Harkin -- who chairs the Senate Health, Education, Labor, and Pensions Committee -- said that Cuba is a "poor country, but they have a lower child mortality rate than ours. Their life expectancy is now greater than ours. It's interesting — their public health system is quite remarkable."
We wondered whether these statistics are accurate, and what they say about health care in Cuba.
Child mortality statistics
On child mortality, we found a few data sources that are generally considered credible. According to the CIA Factbook, Cuba infant mortality rate is indeed lower -- an estimated 4.76 deaths per 1,000 live births in 2013, compared to 5.90 for the United States.
And more precisely given the phrase Harkin chose, Cuba also has a better child mortality rate -- that is, the likelihood of death under 5 years of age. According to the World Health Organization, Cuba had 6 deaths under age 5 per 1,000 live births between 2005 and 2010, compared to 8 deaths for the United States.
So on child mortality, Harkin had his numbers right.
Life expectancy statistics
The data for life expectancy appears to be mixed. According to both the CIA Factbook, the estimated life expectancy for both sexes in 2013 was 78.62 in the United States, compared to 78.05 years in Cuba. And according to the World Health Organization, life expectancy in 2011 was 79 years in the United States and 78 in Cuba.
By these sources, Harkin would be wrong. But when we contacted Harkin’s office, they pointed us to data from Pan American Health Organization that backed up their claim. For 2012, the group found that life expectancy was 79.2 years in Cuba, compared to 78.8 years in the U.S.
So for life-expectancy numbers, the data is varied, with some supporting Harkin and some not.
How reliable is this data?
We wondered, however, whether the data from Cuba’s authoritarian government could be trusted. As we looked into it, we heard a measure of skepticism.
We did find one area of agreement: Cuba puts a lot of emphasis on its health data. Richard H Streiffer, dean of the College of Community Health Sciences at the University of Alabama, said his conclusion from two visits to Cuba is that Cuban health practitioners are "very compulsive about collecting data and reporting it regularly."
On a recent trip, Streiffer said, he spent time with a family doctor in a neighborhood clinic. "Family doctors are mandated to collect certain data," he said. "He had right on his wall a ‘dashboard’ of data characterizing his practice -- an age/sex distribution; an age/sex distribution of the top 10 chronic diseases in his practice; a map of where his patients lived in the neighborhood. You don't find that in the US."
However, some experts said that this obsession with statistics can be a two-edged sword when it comes to reliability. Some say Cuba is so concerned with its infant mortality and life-expectancy statistics that the government takes heavy-handed actions to protect their international rankings.
"Cuba does have a very low infant mortality rate, but pregnant women are treated with very authoritarian tactics to maintain these favorable statistics," said Tassie Katherine Hirschfeld, the chair of the department of anthropology at the University of Oklahoma who spent nine months living in Cuba to study the nation's health system. "They are pressured to undergo abortions that they may not want if prenatal screening detects fetal abnormalities. If pregnant women develop complications, they are placed in ‘Casas de Maternidad’ for monitoring, even if they would prefer to be at home. Individual doctors are pressured by their superiors to reach certain statistical targets. If there is a spike in infant mortality in a certain district, doctors may be fired. There is pressure to falsify statistics."
Hirschfeld said she’s "a little skeptical" about the longevity data too, since Cuba has so many risk factors that cause early death in other countries, from unfiltered cigarettes to contaminated water to a meat-heavy diet. In a more benign statistical quirk, Carmelo Mesa-Lago, a professor emeritus of economics at the University of Pittsburgh, suggests that the flow of refugees could skew longevity statistics, since those births are recorded but the deaths are not.
Transparency would help give the data more credibility, but the Cuban government doesn’t offer much, experts said.
"I would take all Cuban health statistics with a grain of salt," Hirschfeld said. Organizations like the Pan-American Health Organization "rely on national self-reports for data, and Cuba does not allow independent verification of its health claims."
Rodolfo J. Stusser -- a physician and former adviser to the Cuban Ministry of Public Health's Informatics and Tele-Health Division who left for Miami at age 64 -- is another skeptic. While Stusser acknowledges that Cuba has improved some of its health numbers since the revolution, the post-revolution data has been "overestimated," he said. "The showcasing of infant mortality and life expectancy at birth has been done for ideological reasons," he said.
Harkin said that Cuba has "a lower child mortality rate than ours. Their life expectancy is now greater than ours."
According to the official statistics, Cuba does beat out the United States for both infant and child mortality, and on life expectancy, the data is mixed, with a slight edge to the United States. However, the combination of the Cuban government’s heavy-handed enforcement of statistical targets and the lack of transparency has led some experts to suggest taking the numbers with a grain of salt. On balance, we rate Harkin’s claim Half True.
National Journal, "Sen. Tom Harkin Visits Cuba, Is Pretty Impressed With Its Public Health System," Jan. 29, 2014
CIA World Factbook, Infant mortality rate, 2013
World Health Organization, under-5 mortality table, 2012
World Health Organization, life expectancy at birth table, 2012
CIA World Factbook, life expectancy at birth table, 2013
World Health Organization, life expectancy at birth table, 2011
Pan-American Health Organization, "Health Situation in the Americas: Basic Indicators," 2012
Rodolfo J. Stusser, "Demystifying the Cuban Health System: An Insider's View," 2011
C. William Keck and Gail A. Reed, "The Curious Case of Cuba," American Journal of Public Health, June 14, 2012
New York Times, "‘Sicko,’ Castro and the ‘120 Years Club,'" May 27, 2007
Miami Herald, "Cuban healthcare is painted rosy in 'Sicko,' critics say," June 23, 2007
Email interview with Richard H Streiffer, dean of the College of Community Health Sciences at the University of Alabama, Jan. 30, 2013
Email interview with Carmelo Mesa-Lago, a professor emeritus of economics at the University of Pittsburgh, Jan. 30, 2014
Email interview with Rodolfo J. Stusser, physician and former adviser to the Cuban Ministry of Public Health's Informatics and Tele-Health Division, Jan. 30, 2014
Email interview with Tassie Katherine Hirschfeld, chair of the department of anthropology at the University of Oklahoma and author of Health, Politics and Revolution in Cuba since 1898, Jan. 30, 2014
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