Why did Cuba become healthier during the economic meltdown of the 1990s?

One should interpret anything about Cuba, or coming out of Cuban data, with extreme caution.  Nonetheless I thought this was interesting enough to pass along:

The economic meltdown should logically have been a public health disaster. But a new study conducted jointly by university researchers in Spain, Cuba, and the U.S. and published in the latest issue of BMJ says that the health of Cubans actually improved dramatically during the years of austerity. These surprising findings are based on nationwide statistics from the Cuban Ministry of Public Health, together with surveys conducted with about 6,000 participants in the city of Cienfuegos, on the southern coast of Cuba, between 1991 and 2011. The data showed that, during the period of the economic crisis, deaths from cardiovascular disease and adult-onset type 2 diabetes fell by a third and a half, respectively. Strokes declined more modestly, and overall mortality rates went down.

This “abrupt downward trend” in illness does not appear to be because of Cuba’s barefoot doctors and vaunted public health system, which is rated amongst the best in Latin America. The researchers say that it has more to do with simple weight loss. Cubans, who were walking and bicycling more after their public transportation system collapsed, and eating less (energy intake plunged from about 3,000 calories per day to anywhere between 1,400 and 2,400, and protein consumption dropped by 40 percent). They lost an average of 12 pounds.

It wasn’t only the amount of food that Cubans ate that changed, but also what they ate. They became virtual vegans overnight, as meat and dairy products all but vanished from the marketplace. People were forced to depend on what they could grow, catch, and pick for themselves– including lots of high-fiber fresh produce, and fruits, added to the increasingly hard-to-come-by staples of beans, corn, and rice. Moreover, with petroleum and petroleum-based agro-chemicals unavailable, Cuba “went green,” becoming the first nation to successfully experiment on a large scale with low-input sustainable agriculture techniques. Farmers returned to the machetes and oxen-drawn plows of their ancestors, and hundreds of urban community gardens (the latest rage in America’s cities) flourished.

And this:

During the special period, expensive habits like smoking and most likely also alcohol consumption were reduced, albeit briefly. This enforced fitness regime lasted only until the Cuban economy began to recover in the second half of the 1990s. At that point, physical activity levels began to fall off, and calorie intake surged. Eventually people in Cuba were eating even more than they had before the crash. The researchers report that “by 2011, the Cuban population has regained enough weight to almost triple the obesity rates of 1995.”

That is by Richard Schiffman, the full article is here, and for the pointer I thank Jim Oliver.


It's too bad this study only looked at residents of Cienfuegos; I would be interested if these effects held true across Cuba. I studied in Cuba a few years ago and traveled throughout the island, including to Cienfuegos. It was my sense that the reforms that were instituted during the Special Period (like the urban farming) worked better in the smaller, less-dense cities like Cienfuegos (which has a population of about 160,000) than they did in Havana, with its two million residents. The residents of Cienfuegos might have thus experienced more of the health benefits of the weight gain without experiencing the detrimental effects of true food scarcity, which most Habaneros remembered vividly.

Cuban life expectancy exceeds that of the United States, so I'd assume the findings can be extrapolated and applied to the general public.

Well, as noted above, extreme caution is warranted when talking about Cuba, but at least when it comes to health care, one of the favorite American talking points dismissing statistical comparisons of America to other countries is the demographics of the U.S.

Which seem strikingly like the demographics in Cuba, actually - 'According to a 2002 national census which surveyed 11.2 million Cubans, 1.1 million Cubans described themselves as Black, while 2.8 million considered themselves to be "mulatto" or "mestize".[9] Thus a significant proportion of those living on the island affirm some African ancestry. The matter is further complicated by the fact that a fair number of people still locate their origins in specific African ethnic groups or regions, particularly Yoruba (or Lucumi), Igbo and Congo, but also Arará, Carabalí, Mandingo, Fula, Makua, and others.

Although Afro-Cubans can be found throughout Cuba, Eastern Cuba has a higher concentration of blacks than other parts of the island, and Havana has the largest population of blacks of any city in Cuba.[10] Recently, many African immigrants have been coming to Cuba, especially from Angola. Also, immigrants from Jamaica and Haiti have been settling in Cuba, most of whom settle in the eastern part of the island, due to its proximity to their home country, further contributing to the already high percentage of blacks on that side of the island.' http://en.wikipedia.org/wiki/Afro-Cuban#Demographics

Differences in life expectancy have little to do with the health care system and more to do with the immense amount of bad food Americans eat and the fact that they have more young people killed in car accidents and by other people.

Well, how about infant mortality then? Cuba is at place 33, the U.S. at place 34 - 'The infant mortality rate (IMR) is the number of deaths of infants under one year old per 1,000 live births. This rate is often used as an indicator of the level of health in a country. The infant mortality rate of the world is 49.4 according to the United Nations and 42.09 according to the CIA World Factbook.' http://en.wikipedia.org/wiki/List_of_countries_by_infant_mortality_rate

Of course, one nation has a surprisingly dysfunctional health system, though possibly the extreme weather it is subject too on a regular basis might form the basis for some sort of esoteric excuse. The other one is an avowed communist paradise.

Infant mortality comparison between countries is meaningless; it's a self-reported statistic using different definitions of live birth (yes, even in cases where a country claims to adhere to the WHO definition). It's also the largest factor in determining life expectancy, which makes that comparison equally meaningless. It's not possible to confirm or refute your assertion about infant mortality or Patriot's about life expectancy, because the data necessary to do either doesn't exist.

My guess is that it's because the Cuban state has continuously poured its resources into health care. A detriment to living in Cuba is that the state allocates labor. A benefit to living in Cuba is that the state dedicates a large amount of its labor to working in healthcare. Cuban doctors aren't incompetent -- they can free ride on what's published in medical journals. The Cuban state has no need to innovate, but it has all the incentive to pursue the status quo.

My vote is for bad data; this isn't the first time Franco tried to tell this story. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2474886/

I agree with you. If someone was suspected of cooking the books at a financial fraud for years suddenly had much worse financial results after years of great results, enough of a swing that all the previous profit was completely erased and then some, I doubt anyone would be too trusting of the original data.

With "Cubans were unhealthy, then super healthy, but now we have recent data that shows Cubans aren't anywhere near that healthy", you have to wonder if the original data was just crooked, instead of thinking that everyone was suddenly much less healthy because of an economic cycle. Which seems more likely?

Isn't this the same effect that was noticed in Britain during WW2 (falling calorie intake, increased health, as long as you dodged the bombs)?

My thoughts exactly.
Lots of manual work, walking long distances, not sitting in front of the computer all day. Healthy food and not too much of it.

Yes - also look at the German occupation of the Scandinavian countries in the latter part of WWII. Same type of restriction to meat + dairy with subsequent fall in cardiovascular disease.

Why would anyone discuss the Cuban diet without mentioning sugar intake?

Not to mention cigars.

Cigars are actually very healthy: no calories, no sugar, no fat.

Paint, too?

(I was going to say gasoline, first... major facepalm)

This is not really new news, as it was reported over at Reason.com in 2008, there referencing a similar finding in the American Journal of Epidemiology.

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As a Cuban I am always fascinated how well intentioned and usually well informed people turn into talking donkeys the moment Cuba is the theme. The health care system in Cuba is at par with that of Guatemala or El Salvador, no medications, horrible hygiene and doctors who are overworked and over stretched. If as an American you truly feel the health system for Cubans is that good I encourage you whole-heartily to go use it, not the one for foreigners but the one for Cubans. You will soon find out that you can have as many doctors as you want, but if you have no Tylenol or any other medication you may as well have no doctor. The numbers on infant mortality rate are cooked, many of the deaths are counted as abortions or still births so they wont show on the numbers. Lastly, the suffering we as Cubans lived through during the 90's, the shortages, the many other diseases people developed because of their poor diet, should not be any more celebrated that the starvation other people have suffered because of rogue governments like the North Korea, and most of Africa. That the authors refer to this as an 'experiment' that could have any policy teachings just shows their true disconnect from humanity and their lack of compassion. I ask of the readers and commentators of this blog to show more humanity that the one showed by the 'authors' of the 'study'.

Could Wealth Decrease Longevity!
I am very skeptical of any statistic out of Cuba but this has very interesting implications. We all know that for some people increased wealth can lead to earlier death but if this article is correct it would mean that an increase in wealth above some low level has a negative effect on enough people's longevity that a fall in wealth brought up the overall life expectancy in Cuba.

Of course a longer but less enjoyable life may not be better than a shorter more enjoyable life but there are those in the health movement (Michael Bloomberg for example) for whom the implications should be thought through as to what they imply for our welfare programs like food stamps and social security.

Josef Zweimuller: I mean actually what we find in our study is that among blue-collar workers, we see that workers who retire earlier have higher mortality rates. And these effects are pretty large.

No brainer. Less booze and sweets.

No less driving, less booze, less cigarettes, less drugs and more sugar. They were surviving on sugar water, this is Cuba their biggest ag product is sugar.

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"Cardiovascular disease and adult-onset type 2 diabetes"... Aren't these lag-variable diseases, with possible long latency periods? These diseases' affects aren't seen 20 or 30 years down the road correct?

One does not eat a sugar cube and then develop diabetes, nor can someone stop exercising for 5 years and automatically develop a cardiovascular disease. Typically these risk factors are spread over a lifetime, and the diseases manifested later in life. To me it would make more sense that in the 10-20 years after the Cuban recession, that these diseases would spike.

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This study could be replicated with Romanian data. There the misery hit in the 80's. Locals dug up the lawns around apartment buildings to grow vegetables, started raising chickens and rabbits everywhere a coop or hutch could fit, and similarly to Cuba, meat and dairy products vanished from stores. Bread, cooking oil, sugar, flour, cornmeal, rice and eggs came on ration cards. All of that ended after communism fell in 1989. If the findings check, then austerity is good for the health, just as Elena Ceausescu promised it would be. Oops.

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