BY JESSICA A. LOPEZ.
Photography by Kara Sheppard-Jones and Adam Jones.
Cuba’s economic crisis in the 1990’s, known as the Special Period, saw the enactment of the most concentrated health reforms in a single decade. These reforms were prompted by the 1989 collapse of the Soviet block; Cuba’s most important trading partner at the time. Imports decreased by 75 percent overall and oil imports by 53 percent. The Cuban government, facing a U.S. embargo, had to quickly enact reforms that would save the country from economic and political chaos.
Efforts to gain international influence and domestic legitimization via health did not start only after the fall of the Soviet bloc. There are various speeches of Castro declaring Cuba would become a “world medical power” well before the fall. His words more readily imply the goal of political power and influence for the government than health and wellbeing for the domestic population; his phrasing evokes goals of “socioeconomic development, scientific achievement, a model health system, and international influence.” By focusing national efforts on health reform, Castro could simultaneously demonstrate Cuban power and legitimize the government.
The U.S. Embargo, imposed in the 1960s, made it difficult to obtain essential items. Its reinforcement during the Special Period proved critical in creating an enemy Castro could utilize in promoting his health reforms. He could easily and correctly accuse the United States for the lack of medical materials and food shortages. Thus, health reforms became a metaphor for the Cuban struggle against imperialism. They became tainted with political goals hidden behind a “moral architecture” that divided the world “into us and them, good and evil, healthy and diseased.”
After the collapse of the Soviet bloc in 1989, Cuban dependency on Soviet foodstuffs meant the country had to quickly devise a plan to provide its citizens with basic agricultural products. From 1990 to 1994, food production decreased by about 40 percent. A tightening of the US trade embargo in 1992, through the Cuban Democracy Act as well as hurricanes in 1993, 1996, and 2001, further devastated the vulnerable Cuban economy. Starvation and malnutrition became a common experience for many Cubans, who were forced to cut calorie-intake.
In addition to a changed diet, the 1990’s subjected Cubans to a change in lifestyle as the majority of citizens were forced to walk or bike to their destination due to the unavailability of fuel. Because of the presence of organic food and increased bicycle use, there was a decrease in deaths linked to obesity. Between 1997 and 2002 deaths caused by diabetes declined by 51%, coronary heart disease mortality dropped 35%, and stroke mortality by 20%. Obesity in the southern coastal city of Cienfuegos tumbled from 14.3% in 1991 to 7.2% in 1995.
There were also major public health problems caused by insufficient nutrition. The most notable of these problems was the optic neuropathy of the 1990s. Food was strictly rationed, and the state was supposed to provide six pounds of rice, six pounds of sugar, twenty ounces of beans, fourteen eggs, and twelve ounces of meat substitute called picadillo texturizado. Picadillo consists of small amounts of meat mixed with large amounts of soy and animal blood for weight and protein. The government was also supposed to provide “Cerelac,” a soy-based milk-substitute. Maria, a Cuban woman who lived in Havana in 1996 told a World Affairs reporter that she believed eating so much soy caused her friend’s optic neuropathy problems.
Maria’s friend’s optic neuropathy problems were not an isolated case. Reports of a mysterious disease that blinded people began in 1993. Physicians from the Pan American Health Organization (PAHO) determined that 50,000 of 11 million inhabitants were suffering from optic neuropathy, deafness, sensory neuropathy, and a spinal cord disorder that impaired walking and bladder control. They determined the cause was a spare diet caused by food shortages combined with physical exertion cased by an inefficient transportation system. This caused a severe thiamine deficiency and the outbreak of blindness. Although lack of meat was an evident health problem, if someone was discovered with beef or pork in the refrigerator, the individual could be sentenced to jail for up to four years.
Because the agricultural revolution affected the cuisine and the health of Cuba, it also affected the social fabric of the Special Period. The increased use of human resources and increased privatization in agriculture caused a shift in social practices. The population was collectively subjected to these changes while undergoing an economic crisis, thus increasing the importance of human interactions and relationships. The Special Period is sometimes referred to in Cuba as La temporada de vaca flaca, “the skinny cow period,” in reference to the shortage of food during this period. The shortage of food led to moral dilemmas for people who were torn between sharing with their neighbors and providing only for their immediate family. The importance of honorable behavior and hospitality in Cuban culture caused futher dilemmas regarding food’s power to incite feelings of shame in Cubans. The collective experience of a hungry society defined the creation of a national identity rooted in struggle – physical, mental, and moral.
Cuba’s achievement in the health level of its population through agricultural reform is undeniable, yet inapplicable to most nations. The government’s central control over the economy and its attempt to allocate resources equitably is unique to Cuba’s socialist regime. In addition to agricultural reform, Cuba’s physician-based high-technology system also contributed to the improvement of Cuban health statistics. Other developing nations often do not focus their resources on the heath sector in the way Cuba has. For them, a paramedic-based, low-technology system is a cheaper and more realistic alternative.
While it can be argued that the goals of the government are irrelevant to the success in improvements in population health, it is imperative to notice it has a direct effect on the quality of life of every Cuban individual. Castro’s focus on health statistics as keys to international recognition and influence caused the Cuban government to neglect sectors that equally affected Cubans. If the government had been concerned with the overall wellbeing of its people or with socioeconomic development, sectors such as housing and transportation would have received the supplemental investments that were instead directed to the health sector. Country health indicators trivialized the health of an individual to a generalization that became a metaphor for the health of the “body politic.” Because of this view of health indicators, Cuban officials regard countries with poor health indicators as “diseased” countries with less interest in improving their population’s health.
Cuba’s achievements during the Special Period are admirable because they demonstrate that a Third World country can achieve First-World health statistics even during a crisis; however, Cuba’s approach cannot be fully endorsed because health success extends beyond statistics. The success of Cuba in health statistics does not make up for its failures in housing or medical provisions. Admirable health statistics do little to mask the poverty of the nation. Paul Farmer, a prominent health care activist, during a discussion with fellow Harvard professors, complemented Cuba’s public health. While other professors argued that Scandinavian countries were the best example of how to provide great public health and political freedom, Farmer said they “were talking about managing wealth” and in Cuba’s case, he “was talking about managing poverty.” Cuba’s successes then stem from effectively treating one very superficial determinant of health (statistics) in a country perpetually in la lucha.
 Hugh Warwick, “Cuba’s Organic Revolution,” Forum for Applied Research and Public Policy, 16 (2001): 54.
 Julie M. Feinsilver, Healing The Masses: Cuban Health Politics at Home and Abroad, (Los Angeles: Berkeley: University of California Press, 1993), 5.
 Julie M. Feinsilver, Healing The Masses: Cuban Health Politics at Home and Abroad, 22.
 Hugh Warwick, “Cuba’s Organic Revolution,” 54.
 Rory, Caroll. ” Economic crisis boost to health of Cubans.”The Guardian, September 26, 2007. http://www.guardian.co.uk/world/2007/sep/27/cuba.international (accessed March 10, 2013).
 Ibid., 72.
 John Sweeney, “Seven Days in Havana: How Castro’s Market Socialism Works,” World Affairs, 159, no. 1 (1996): 16.
 Sergio Diaz-Briquets, and Jorge F. Perez-Lopez, “The Special Period and The Environment,” 289.
 Ibid., 17.
 Christiane Paponnet-Cantat, “The Joy of Eating: Food and Identity in Contemporary Cuba,” 26.
 Julie M. Feinsilver, Healing The Masses: Cuban Health Politics at Home and Abroad, 198.
 Julie M. Feinsilver, Healing The Masses: Cuban Health Politics at Home and Abroad, 199.
 Ibid., 23.
 Tracy Kidder, Mountains Beyond Mountains, (New York: Random House, 2003), 194.