Health education in Cuba: a preface

Cuba's response to the HIV epidemic

BACKGROUND

Cuba's response to the human immunodeficiency virus (HIV) epidemic has been to conduct mass testing of the population to ascertain seroprevalence, to enforce mandatory relative quarantine of persons testing positive, and to implement educational interventions using media and school-based programs.

METHODS

Interview with the Vice-Minister of Health and review of available data.

RESULTS

Reports to date show a very low seroprevalence rate without evidence of a widespread epidemic. Sexual contact with foreign-born persons is the primary risk factor. Possible advantages of Cuba's policy include rapid reduction in the risk of HIV transmission by infected blood products, an opportunity for focused education and secondary prevention, and limitation of new infections. Possible disadvantages include the restriction of individual freedom in those who are not guilty of any illegal act, quarantine of persons with false positive HIV tests, and ongoing transmission because of the incomplete nature of the quarantine. The policy is expensive and may displace other public health priorities. The content of the media-based educational interventions has emphasized rational medical information in unimaginative formats with a limited focus on prevention.

CONCLUSIONS

The issue of personal responsibility for behavioral change versus government imposed regulations is at the core of Cuba's HIV policy. The quarantine policy may paradoxically permit most Cubans to feel that they are personally invulnerable to the HIV epidemic.

Transnational tobacco companies and health in underdeveloped countries: recommendations for avoiding a smoking epidemic

This paper examines the impact of transnational tobacco companies on health in underdeveloped countries and makes recommendations for avoiding a coming smoking epidemic. Although tobacco is generally seen as primarily a health problem, tobacco's future in the Third World depends upon a number of nonhealth related considerations, especially political and economic factors. Unfortunately, there is very little relationship between what the World Health Organization and others have recommended, and what most Third World countries are doing today. Although the controversy concerning cigarette smoking and health has only become a 'burning issue' in recent decades, tobacco products have been used around the world for hundreds of years. The public outcry against cigarette smoking has become increasingly widespread since the 1964 U.S. Surgeon General's report on smoking and health. The ill effects of cigarette smoking are now widely considered collectively as the number one preventable health problem in the world, responsible for an estimated 2.5 million deaths per year. In response to declining sales in developed countries, the tobacco transnational corporations have begun focusing their attention on Third World markets, where tobacco consumption has increased dramatically in recent years. Cigarettes not only take precious limited resources away from desperately needed basic human needs, but they also inflict future health problems on vast numbers of Third World people who have only a vague understanding of the risks involved in cigarette smoking. Until Third World governments address the long-term consequences of their short-term lust for cash, the probabilities of a smoking epidemic in the Third World grow increasingly likely.(ABSTRACT TRUNCATED AT 250 WORDS)

Issues of control and responsibility in workers' health

The issues of responsibility for health and control of factors influencing health are discussed with regard to workplace health programs. The role of each of the parties involved - workers, unions, management, and the government - can best be understood in relation to the interests they hold in workers' health. A matrix is presented which divides influences on workers' health according to the degree to which they are controlled by employers and workers. This matrix is used to suggest that workplace health promotion and employee assistance programs may represent employer involvement in areas over which they lack legitimate control. These programs are also criticized for their emphasis on behavior and their neglect of work-related causes of ill health and unhealthy behavior. They should be considered supplemental to a work environment which is conducive to both physical and psychosocial health; they will be most effective and appropriate with a high degree of worker involvement and control. Evidence regarding the effects of occupation and class on health and health-related behavior is presented to support the need for a comprehensive, ecological approach to workers' health. Such an approach should take into account the full range of influences and recognize the limits of legitimate control.

Cuba and the Philippines: contrasting cases in world-system analysis

Cuba and the Philippines are countries with broad similarities in historical background yet sharp divergences in political economic developments and relations to the capitalist world-system in recent times. U.S. economic and political interests dominated both countries during the first half of the 20th century. The changes generated by the Cuban revolution resulted in the end of U.S. power in Cuba in 1959. The Philippines, however, remain profoundly dependent on the United States. The approach taken in this article contrasts these countries, asking what the results of their divergent paths are in terms of health and health services. The ability of Cuba and the Philippines to support the primary health care (PHC) approach by fostering socioeconomic justice, authentic citizen participation, and a regionalized health system is examined. It is clear that the last 25 years of socialist-oriented development in Cuba reversed the negative effects of the previous market economy by providing improved social and health services. The success of the political economy and the fully regionalized health system, supportive of the PHC approach in Cuba, is reflected in the high-level health status of the people. In contrast, poverty, gross social and economic inequities, high prevalence of infectious disease, and inaccessible, inadequate, and uncoordinated health services persist in the Philippines after some 85 years of international and national capitalist development. The poor health status of the Philippine people is a direct reflection of this underdeveloped system.

Tobacco or health in the Third World: a political economy perspective with emphasis on Mexico

In response to declining cigarette sales in the United States and Europe, transnational tobacco conglomerates have turned to the underdeveloped world to promote their unhealthy products for consumers who are at best only vaguely aware of the health risks associated with cigarette smoking. While cigarette sales in the Third World are growing "healthily," the consumers of these cigarettes generally are not. Along with the already difficult problems of malnutrition and communicable diseases, underdeveloped countries are facing the probability of a smoking epidemic, which is directly related to the penetration of capitalist tobacco interests into new markets. While the tobacco companies are quick to suggest that these people who can least afford cigarettes (both financially and in terms of health risks) are exercising their "free choice" as consumers in an "open marketplace," the author suggests that political and economic factors are central. Aided by two months of fieldwork in Mexico in 1986, the author examines smoking behavior and perceptions of associated health consequences. In addition, the influence of the tobacco companies and the Mexican government on tobacco production and consumption is analyzed.

The prevention of health risks in Cuba

Cuba still has a double burden of health risks. It must contend with some risks to health that persist in underdeveloped rural areas, and it must also deal with the risk factors associated with modern, urban living conditions. The economic and social changes fostered in the postrevolutionary period have reduced the relative importance of the first set of factors, but the changes have also introduced or intensified a myriad of factors derived from their own successes. In this article, the risk factors of greatest concern in contemporary Cuba are described, and the strategies adopted to combat these risk factors, together with the ways in which such strategies are shaped by Cuba's social and economic development are discussed.