The Lancet, Volume 382, Issue 9888
, Page 192, 20 July 2013
Offline: Four principles of social medicine
Although officially classed as an upper-middle-income country, the American embargo against Cuba continues, punishing not only a government but also an entire people. (Article 33 of the Fourth Geneva Convention states that “No persons may be punished for an offense he or she has not personally committed. Collective penalties…are prohibited.”) The Cuban Assets Control Regulations were established 50 years ago this month (on July 8, 1963) under the US Trading With The Enemy Act. It is a violation of those regulations if an American citizen travels to Cuba, engages in any kind of trade with Cuba, or even brings back goods of Cuban origin. There is a complex bureaucracy around the supply of medical products, which limits their supply and use. 50 years of trying to hurt 11 million people enough to encourage an insurrection to overthrow their government has taken its toll. Infrastructure in Cuba is fragile. Incomes are low. The Castro regime—Fidel or Raul, it is the same party that has been in power since the Revolution of 1959—is struggling to open up an economy without suffering the depredations that plunged its one-time banker, the Soviet Union, into criminal mayhem. (When the Soviet Union imploded, the GDP of Cuba collapsed by a third within 24 hours, a moment Cubans, with seemingly wry humour, call the “Special Period”.) Yet, despite Cuba's problems, there are few public protests. The government does not fire rubber bullets at its citizens. It does not need tear gas. Why? Could it at least partly be thanks to universal health coverage?
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