Human Resources for Health and Health Outcomes in Cuba: An Analysis of Their Distributions over Time and Space

• DOI: https://doi.org/10.13169/intejcubastud.11.2.0200
• Published date: 01 December 2019
• Date: 01 December 2019
• Pages: 200-227
• Author: Isaac Christiansen,David Leonard
• Subject Matter: Cuban healthcare,human resources for health,spatial inequality,health inequality,infant mortality,physician distribution

InternatIonal Journal of Cuban StudIeS 11.2 WInter 2019

ACADEMIC ARTICLE

HUMAN RESOURCES FOR HEALTH

AND HEALTH OUTCOMES IN CUBA: AN

ANALYSIS OF THEIR DISTRIBUTIONS OVER

TIME AND SPACE

Isaac Christiansen1

Midwestern State University, Texas, USA

David Leonard2

David Leonard Statistical Consulting, Texas, USA

Abstract

Developments in Cuba’s healthcare system, infant mortality rate (IMR) trends,

and commitment to universal healthcare have been examined by past research.

Nevertheless, reductions of spatial inequality in human resources for health (HRH)

distribution and IMR have received less attention. Drawing on Cuban Ministry of Health

data, we examine changes in HRH distribution by personnel type and inequality in IMRs

among Cuban provinces over time, emphasising the period since 1990. We contrast

these with global, OECD, and developing country HRH distributions. Our research

shows declining inequality in HRH and IMR across provinces in Cuba. A longitudinal

data analysis of IMR shows that IMR decreases significantly as physician density

increases within provinces. Within a global context of high between and within country

1 Isaac Christiansen is Assistant Professor in Sociology at Midwestern State University

in Wichita Falls, Texas. His primary interests are Marxist theory, social, economic

and health inequalities, social change and development, and the dynamics of eco-

nomic crises.

2 David Leonard is the head of David Leonard Statistical Consulting, which statistical

programming and advice to academic and non-profit organizations, primarily in fields

of preventive and paediatric medicine.

HUMAN RESOURCES FOR HEALTH AND HEALTH OUTCOMES IN CUBA 201

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disparities Cuba’s experience is salient given high levels of spatial inequality prior to

1959 and material resource scarcity during the ‘special period’ of the 1990s.

Keywords: Cuban healthcare, human resources for health, spatial inequality, health

inequality, infant mortality, physician distribution

Introduction

Past research has examined developments and transformations in Cuba’s health-

care system (Whiteford and Branch 2008; Feinsilver 1993; Iñiguez 2013; Ochoa

and Serrano 2000), national trends in infant mortality (Franco et al. 2007;

McGuire and Frankel 2005; Corteguera 2000; Corteguera and Henríquez 2001;

Álvarez 1999), and the government’s commitment to universal access to care in

the face of economic difficulties (Borowy 2013; Nayari and Lopez-Pardo 2005;

Chomsky 2000). Recent research examines the impact of the socio-economic

changes taking place on the nature of Cuba’s evolving socialist model (Piñeiro

Harneker 2014; Rodríguez 2014). However, little has been done to examine the

government’s goal of reducing spatial inequality of human resources for health

in the context of Cuba’s various shifts in healthcare provision strategies. We

examine Cuba’s efforts to reduce spatial disparities in human resources for

health (HRH) and the infant mortality rate (IMR), and the relationship between

them across provinces and over time.

Has the provincial distribution of HRH and outcomes in Cuba become more

equal over time, particularly since the economic crisis of the 1990s, and if so, to what

degree? Have the recent changes instituted in Cuba’s health sector led to an increase

in inequality in healthcare personnel distribution among provinces? Have provincial

differences in the IMR continued to narrow since 1989? Finally, has Cuba’s invest-

ment in training physicians led to a significant decrease in infant mortality?

The question of whether Cuba has been able to maintain or deepen health

equity amid economic pressures and certain adjustments to the Cuban economic

model (including a greater prominence of cooperatives, and more foreign invest-

ment) are relevant beyond Cuba’s borders. Cuba’s successes and challenges of

establishing a national healthcare system with a rights-based approach have pro-

ceeded within a context of resource scarcity. This work informs the larger debate

between those who advocate a distribution of healthcare services by market logic

and those who wish to promote healthcare as an inalienable human right.

Cuba and the Broader Context of HRH Imbalances

Severe inequality in the distribution of physicians, nurses, and health workers

in the health sector known as human resources for health (HRH) remains