Cuban health statistics appear to be a paradox. Wealth and health are correlated because greater wealth can buy better health care. Yet, Cuba remains desperately poor and appears to be healthy. Cuban life expectancies of 79.5 years and infant mortality rates of 4.3 per 1000 live births (2015) compare well with rich nations like the USA (78.7 years and 5.7 per 1, 000 live births) yet its per capita income of 7602.3$ make it one of the poorest economies in the hemisphere (World Development Indicators DataBank, 2017).
How is Cuba healthy while poor? Most attribute the fact to Cuba’s zero monetary cost health care system. There is some truth to that attribution. With 11.1% of GDP dedicated to health care and 0.8% of the population working as physicians, a substantial amount of resources is directed towards reducing infant mortality and increasing longevity. An economy with centralized economic planning by government like that of Cuba can force more resources into an industry than its population might desire in order to achieve improved outcomes in that industry at the expense of other goods and services the population might more highly desire.
This is from Gilbert Berdine, Vincent Geloso, and Benjamin Powell, “Cuban infant mortality and longevity: health care or repression?“, Health Policy and Planning, Vol. 33, Issue 6, 1 July 2018: 755-757.
When they write “zero monetary cost,” the authors clearly mean “zero monetary price.”
But then the authors look carefully behind the statistics and what they find is not pretty.
Centralized planning has disadvantages. Physicians are given health outcome targets to meet or face penalties. This provides incentives to manipulate data. Take Cuba’s much praised infant mortality rate for example. In most countries, the ratio of the numbers of neonatal deaths and late fetal deaths stay within a certain range of each other as they have many common causes and determinants. One study found that that while the ratio of late fetal deaths to early neonatal deaths in countries with available data stood between 1.04 and 3.03 (Gonzalez, 2015)—a ratio which is representative of Latin American countries as well (Gonzalez and Gilleskie, 2017).2 Cuba, with a ratio of 6, was a clear outlier. This skewed ratio is evidence that physicians likely reclassified early neonatal deaths as late fetal deaths, thus deflating the infant mortality statistics and propping up life expectancy.3 Cuban doctors were re-categorizing neonatal deaths as late fetal deaths in order for doctors to meet government targets for infant mortality.
Using the ratios found for other countries, corrections were proposed to the statistics published by the Cuban government: instead of 5.79 per 1000 births, the rate stands between 7.45 and 11.16 per 1000 births. Recalculating life expectancy at birth to account for these corrections (using WHO life tables and assuming that they are accurate depictions of reality), the life expectancy at birth of men [falls] by between 0.22 and 0.55 years (Gonzalez, 2015).
And:
Coercing or pressuring patients into having abortions artificially improve[s] infant mortality by preventing marginally riskier births from occurring help[s] doctors meet their centrally fixed targets. At 72.8 abortions per 100 births, Cuba has one of the highest abortion rates in the world.6 If only 5% of the abortions are actually pressured abortions meant to keep health statistics up, life expectancy at birth must be lowered by a sizeable amount. If we combine the misreporting of late fetal deaths and pressured abortions, life expectancy would drop by between 1.46 and 1.79 years for men. In Figure 1 below, we show that that with this adjustment alone, instead of being first in the ranking of life expectancy at birth for men in Latin America and the Caribbean, Cuba falls either to the third or fourth place depending on the range.7
H/T2 Vincent Geloso.
READER COMMENTS
Jairaj Devadiga
Dec 31 2018 at 7:48pm
As Aaron Levenstein somewhat colourfully put it, “Statistics are like a bikini. What they reveal is suggestive, but what they conceal is vital.”
This is not to say that statistics are always a tool of deception, but rather that we must always look at the underlying data; especially when we want the statistics to be true.
Robert Nicholas
Jan 1 2019 at 4:57pm
Wow that’s a great line! I finally can stop telling the too often repeated “There are three types of lies” joke
db
Dec 31 2018 at 8:41pm
There appears to be some important information missing in the quoted text…
db
Dec 31 2018 at 8:44pm
Note that the missing text, whatever it may be, is also missing from the original.
David Henderson
Dec 31 2018 at 11:43pm
Thanks, db. Good catch.
I’ve corrected it to reflect what they meant.
Andre
Jan 1 2019 at 8:43am
The answer is diet. In countries where cholesterol- and saturated fat laden foods are limited, cancer rates are low and heart disease non-existent. Those two alone kill over 1 million Americans per year.
Combine that with a literate population and access to basic healthcare and you have a recipe for easily outperforming the US system, longevity-wise.
I’d bet that if we dig into the data, Americans simply eat so much more of the killer foods that it more than accounts for the difference in life expectancy.
Matthias Goergens
Jan 1 2019 at 11:12am
Have you read the post?
Andre
Jan 1 2019 at 12:18pm
I hadn’t, no. I’m replying to the beginning of the quote, which appeared not to be properly addressed in the rest of the post. Instead, what I saw was a lot of rabbit chasing.
Now that I take a closer look, it’s still all rabbit chasing. If you make the adjustments listed, Cuba, with its *GDP per capita smaller than US health care spending per capita* still has a comparable life expectancy.
It’s like focusing on bugs on a leaf instead of taking in the forest. It’s ridiculous navel gazing. Cuba’s figures, even if you correct them in every way possible, still make US outcomes look embarrassing, given the enormous disparity in resources available.
And the reason for those disparities, I submit, is diet.
Fred in PA
Jan 1 2019 at 5:42pm
I suppose it depends on whether you read the original as a comment on U.S. healthcare or Cuban suppression.
I agree that Americans are probably fairly actively killing themselves with their forks. But, beyond efforts at consumer education, I don’t see how — in a free society — you stop them from eating what they want.
As for the Cubans, I’m reminded of that old quip about “It’s not the years in your life that count; it’s the life in your years.” Or the arguement that life-in-prison may be a crueler punishment than a quick & painless death. (I admit that I would probably choose life for myself, but the “death-with-dignity” advocates can give many examples where life has become a burden not justified.)
Matthias Goergens
Jan 2 2019 at 3:10am
Just forget about the US at all, and only think about how Cuba fits on (or above or below) the global regression lines between various health outcomes and GDP per capita.
Both Cuba and the US have enough problems on their own for their own posts each. No need to complicate matters by comparing them, or engaging in whataboutism.
Pajser
Jan 1 2019 at 3:03pm
Roughly half of deaths in stillbirths occur before actual birth. If Cuba relies on frequent exams, they might discover more late fetal deaths and induce premature births, counted as late fetal deaths instead of stillbirths (counted separately from neonatal, infant, child deaths.) Cuba has 6/1000 stillbirths, 2-3× less than Jamaica or Dominican Republic. (WHO) That interpretation does not require assumption that Cubans falsify the data. We cannot know the truth, but I tend to believe to CIA. Catholic priests know how many baptisms and child funerals they organized, they probably routinely report it to their superiors, it cannot be particularly impenetrable secret.
Todd Kreider
Jan 1 2019 at 10:53pm
Andre wrote: “If you make the adjustments listed, Cuba, with its *GDP per capita smaller than US health care spending per capita*”
Cuba’s GDP per capita is $21,000 (World Bank) and the U.S. per capita spending on health care is $10,000.
The article states: “Yet, Cuba remains desperately poor and appears to be healthy.”
A country with a GDP per capita of $21,000 is not desperately poor.
Matthias Goergens
Jan 2 2019 at 3:18am
https://data.worldbank.org/indicator/NY.GDP.PCAP.CD?locations=CU
Not quite sure where you are getting your data from. World Bank gives me a something around 7.73k USD when asked about Cuba’s GDP per capita.
I could not find a PPP adjusted version, though.
Now you can argue whether 7.73k USD is poor or desperately poor, of course. Or whether the number is to be trusted with saying anything about standard of living.
David Nieporent
Jan 2 2019 at 12:35am
I mean, maybe, but your data is… off. By a lot. See https://data.worldbank.org/indicator/NY.GDP.PCAP.CD?locations=CU.
Todd Kreider
Jan 2 2019 at 8:07am
Wikipedia states that the World Bank shows $22,000 GDP per capita (PPP), the measurement that correctly states the GDP per capita in dollars but the World Bank page leaves Cuba blank for some reason. Also, I now notice that the Wikipedia links don’t show $22,000.
However, Trading Economics shows $21,000 for 2017.
https://tradingeconomics.com/cuba/gdp-per-capita-ppp
Other sources list Cuba as 20% higher than the Dominican Republic in terms of non-PPP GDP per capita and their GDP per PPP capita is $17,000. 20% higher than $17,000 is $20,400 so in that area.
Pat
Jan 3 2019 at 8:52am
The older I get, the less energy I waste on arguing this stuff. Everyone knows that you can goose these stats with infant reclassification. The people who oppose single payer keep bringing it up and the people who want single payer pretend they don’t know about it. I used to give people more credit and try to persuade them but after this many years of the same conversation, I’m just exhausted. It’s really a shame.
Comments are closed.