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Public health services, an essential determinant of health during crisis: lessons from Cuba, 1989-2000

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Abstract
During the 1990s, Cuba was able to overcome a severe crisis, almost without negative health impacts. This national retrospective study covering the years 19892000 analyses the countrys strategy through essential social, demographic, health process and health outcome indicators. Gross domestic product (GDP) diminished by 34.76% between 1989 and 1993. In 1994 slow recuperation started. During the crisis, public health expenses increased. The number of family doctors rose from 9.22 to 27.03 per 104 inhabitants between 1989 and 2000. Infant mortality rate and life expectancy exemplify a series of health indicators that continued to improve during the crisis years, whereas low birth weight and tuberculosis incidence are among the few indicators that suffered deterioration. GDP is inversely related to tuberculosis incidence, whereas the average salary is inversely related to low birth weight. Infant mortality rate has a strong negative correlation with the health expenses per inhabitant, the number of maternal homes, the number of family doctors and the proportion of pregnant women receiving care in maternal homes. Life expectancy has a strong positive correlation with health expenses, the number of nursing personnel and the number of medical contacts per inhabitant. The Cuban strategy effectively resolved health risks during the crisis. In times of serious socio-economic constraints, a well conceptualized public health policy can play an important role in maintaining the overall well-being of a population.
Keywords
determinants of health, public health, health services, economic crisis, Cuba, international health, sante publique, determinants de la sante, services de sante, crise economique, sante internationale, Salud publica, determinantes de salud, servicios sanitarios, crisis economica, salud internacional, ECONOMIC-CRISIS, US EMBARGO, CARE, IMPACT, SYSTEM, 1990S, TRANSITION, MORTALITY, REFORM

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Chicago
De Vos, Pol, Anai García-Fariñas, Adolfo Álvarez-Pérez, Armando Rodríguez-Salvá, Mariano Bonet-Gorbea, and Patrick Van Der Stuyft. 2012. “Public Health Services, an Essential Determinant of Health During Crisis: Lessons from Cuba, 1989-2000.” Tropical Medicine & International Health 17 (4): 469–479.
APA
De Vos, Pol, García-Fariñas, A., Álvarez-Pérez, A., Rodríguez-Salvá, A., Bonet-Gorbea, M., & Van Der Stuyft, P. (2012). Public health services, an essential determinant of health during crisis: lessons from Cuba, 1989-2000. TROPICAL MEDICINE & INTERNATIONAL HEALTH, 17(4), 469–479.
Vancouver
1.
De Vos P, García-Fariñas A, Álvarez-Pérez A, Rodríguez-Salvá A, Bonet-Gorbea M, Van Der Stuyft P. Public health services, an essential determinant of health during crisis: lessons from Cuba, 1989-2000. TROPICAL MEDICINE & INTERNATIONAL HEALTH. 2012;17(4):469–79.
MLA
De Vos, Pol, Anai García-Fariñas, Adolfo Álvarez-Pérez, et al. “Public Health Services, an Essential Determinant of Health During Crisis: Lessons from Cuba, 1989-2000.” TROPICAL MEDICINE & INTERNATIONAL HEALTH 17.4 (2012): 469–479. Print.
@article{4126636,
  abstract     = {During the 1990s, Cuba was able to overcome a severe crisis, almost without negative health impacts. This national retrospective study covering the years 19892000 analyses the countrys strategy through essential social, demographic, health process and health outcome indicators. Gross domestic product (GDP) diminished by 34.76\% between 1989 and 1993. In 1994 slow recuperation started. During the crisis, public health expenses increased. The number of family doctors rose from 9.22 to 27.03 per 104 inhabitants between 1989 and 2000. Infant mortality rate and life expectancy exemplify a series of health indicators that continued to improve during the crisis years, whereas low birth weight and tuberculosis incidence are among the few indicators that suffered deterioration. GDP is inversely related to tuberculosis incidence, whereas the average salary is inversely related to low birth weight. Infant mortality rate has a strong negative correlation with the health expenses per inhabitant, the number of maternal homes, the number of family doctors and the proportion of pregnant women receiving care in maternal homes. Life expectancy has a strong positive correlation with health expenses, the number of nursing personnel and the number of medical contacts per inhabitant. The Cuban strategy effectively resolved health risks during the crisis. In times of serious socio-economic constraints, a well conceptualized public health policy can play an important role in maintaining the overall well-being of a population.},
  author       = {De Vos, Pol and Garc{\'i}a-Fari{\~n}as, Anai and {\'A}lvarez-P{\'e}rez, Adolfo and Rodr{\'i}guez-Salv{\'a}, Armando and Bonet-Gorbea, Mariano and Van Der Stuyft, Patrick},
  issn         = {1360-2276},
  journal      = {TROPICAL MEDICINE \& INTERNATIONAL HEALTH},
  keyword      = {determinants of health,public health,health services,economic crisis,Cuba,international health,sante publique,determinants de la sante,services de sante,crise economique,sante internationale,Salud publica,determinantes de salud,servicios sanitarios,crisis economica,salud internacional,ECONOMIC-CRISIS,US EMBARGO,CARE,IMPACT,SYSTEM,1990S,TRANSITION,MORTALITY,REFORM},
  language     = {eng},
  number       = {4},
  pages        = {469--479},
  title        = {Public health services, an essential determinant of health during crisis: lessons from Cuba, 1989-2000},
  url          = {http://dx.doi.org/10.1111/j.1365-3156.2011.02941.x},
  volume       = {17},
  year         = {2012},
}

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