Archive for February 3rd, 2014

Sen. Tom Harkin says Cuba has lower child mortality, longer life expectancy than U.S.

February 3, 2014

Cuba has “a lower child mortality rate than ours. Their life expectancy is now greater than ours.”
Sen. Tom Harkin, D-Iowa, recently spent three days in Cuba — the longtime socialist adversary of the United States — to learn more about the island nation’s health care system.

For years, some health policy specialists in the United States have been intrigued by Cuba’s health care system. Cuba produces a disproportionate number of doctors, and it has posted relatively strong health statistics in international comparisons, especially considering the country’s shortage of material goods and economic wealth.

For some liberals, Cuba’s health care system has offered an alternative to the one in the United States, where millions of Americans have struggled without insurance in recent years. Notably, Michael Moore’s 2007 health care documentary Sicko includes scenes where Americans in need of medical attention travel to Havana and are treated for free at a high-quality hospital. Critics have countered that such free, quality care is available only to the communist elite, not to ordinary Cubans.

Harkin certainly saw something promising in Cuba’s health care system. During a press conference upon his return to Washington on Jan. 29, 2014, Harkin — who chairs the Senate Health, Education, Labor, and Pensions Committee — said that Cuba is a “poor country, but they have a lower child mortality rate than ours. Their life expectancy is now greater than ours. It’s interesting — their public health system is quite remarkable.”

We wondered whether these statistics are accurate, and what they say about health care in Cuba.

Child mortality statistics

On child mortality, we found a few data sources that are generally considered credible. According to the CIA Factbook, Cuba infant mortality rate is indeed lower — an estimated 4.76 deaths per 1,000 live births in 2013, compared to 5.90 for the United States.

And more precisely given the phrase Harkin chose, Cuba also has a better child mortality rate — that is, the likelihood of death under 5 years of age. According to the World Health Organization, Cuba had 6 deaths under age 5 per 1,000 live births between 2005 and 2010, compared to 8 deaths for the United States.

So on child mortality, Harkin had his numbers right.

Life expectancy statistics

The data for life expectancy appears to be mixed. According to both the CIA Factbook, the estimated life expectancy for both sexes in 2013 was 78.62 in the United States, compared to 78.05 years in Cuba. And according to the World Health Organization, life expectancy in 2011 was 79 years in the United States and 78 in Cuba.

By these sources, Harkin would be wrong. But when we contacted Harkin’s office, they pointed us to data from Pan American Health Organization that backed up their claim. For 2012, the group found that life expectancy was 79.2 years in Cuba, compared to 78.8 years in the U.S.

So for life-expectancy numbers, the data is varied, with some supporting Harkin and some not.

How reliable is this data?

We wondered, however, whether the data from Cuba’s authoritarian government could be trusted. As we looked into it, we heard a measure of skepticism.

We did find one area of agreement: Cuba puts a lot of emphasis on its health data. Richard H Streiffer, dean of the College of Community Health Sciences at the University of Alabama, said his conclusion from two visits to Cuba is that Cuban health practitioners are “very compulsive about collecting data and reporting it regularly.”

On a recent trip, Streiffer said, he spent time with a family doctor in a neighborhood clinic. “Family doctors are mandated to collect certain data,” he said. “He had right on his wall a ‘dashboard’ of data characterizing his practice — an age/sex distribution; an age/sex distribution of the top 10 chronic diseases in his practice; a map of where his patients lived in the neighborhood. You don’t find that in the US.”

However, some experts said that this obsession with statistics can be a two-edged sword when it comes to reliability. Some say Cuba is so concerned with its infant mortality and life-expectancy statistics that the government takes heavy-handed actions to protect their international rankings.

“Cuba does have a very low infant mortality rate, but pregnant women are treated with very authoritarian tactics to maintain these favorable statistics,” said Tassie Katherine Hirschfeld, the chair of the department of anthropology at the University of Oklahoma who spent nine months living in Cuba to study the nation’s health system. “They are pressured to undergo abortions that they may not want if prenatal screening detects fetal abnormalities. If pregnant women develop complications, they are placed in ‘Casas de Maternidad’ for monitoring, even if they would prefer to be at home. Individual doctors are pressured by their superiors to reach certain statistical targets. If there is a spike in infant mortality in a certain district, doctors may be fired. There is pressure to falsify statistics.”

Hirschfeld said she’s “a little skeptical” about the longevity data too, since Cuba has so many risk factors that cause early death in other countries, from unfiltered cigarettes to contaminated water to a meat-heavy diet. In a more benign statistical quirk, Carmelo Mesa-Lago, a professor emeritus of economics at the University of Pittsburgh, suggests that the flow of refugees could skew longevity statistics, since those births are recorded but the deaths are not.

Transparency would help give the data more credibility, but the Cuban government doesn’t offer much, experts said.

“I would take all Cuban health statistics with a grain of salt,” Hirschfeld said. Organizations like the Pan-American Health Organization “rely on national self-reports for data, and Cuba does not allow independent verification of its health claims.”

Rodolfo J. Stusser — a physician and former adviser to the Cuban Ministry of Public Health’s Informatics and Tele-Health Division who left for Miami at age 64 — is another skeptic. While Stusser acknowledges that Cuba has improved some of its health numbers since the revolution, the post-revolution data has been “overestimated,” he said. “The showcasing of infant mortality and life expectancy at birth has been done for ideological reasons,” he said.

Our ruling

Harkin said that Cuba has “a lower child mortality rate than ours. Their life expectancy is now greater than ours.”

According to the official statistics, Cuba does beat out the United States for both infant and child mortality, and on life expectancy, the data is mixed, with a slight edge to the United States. However, the combination of the Cuban government’s heavy-handed enforcement of statistical targets and the lack of transparency has led some experts to suggest taking the numbers with a grain of salt. On balance, we rate Harkin’s claim Half True.,

Piero Gleijeses Sends a Letter to Obama

February 3, 2014

February 5th for the Cuban 5,
Professor and Author Piero Gleijeses Sends a Letter to Obama
Piero Gleijeses is a professor of US foreign policy at the Johns Hopkins School of Advanced International Studies. His most recent book is Visions of Freedom: Havana, Washington, Pretoria and the Struggle for Southern Africa, 1976-1991, Chapel Hill, 2013. His other books include The Cuban Drumbeat: Castro’s Worldview, Seagull Books, 2009; Conflicting Missions: Havana, Washington and Africa, 1959-1976. Chapel Hill, 2002; Shattered Hope: The Guatemalan Revolution and the United States, 1944-1954, Princeton, 1992; The Dominican Crisis: The 1965 Constitutionalist Revolt and American Intervention. Baltimore, 1978 (revised edition: La esperanza desgarrada: la rebelión dominicana de 1965 y la invasión norteamericana, Dominican Republic, 2012).


February 5, 2014

Mr. President,

I will not address the juridical flaws of the case against the Cuban Five. These flaws are well known and others have written you about them. The Five were tried in a kangaroo court and received very heavy sentences because of the crimes of Fidel Castro.

What are these crimes?

Clearly, they have nothing to do with the state of political democracy in Cuba. The United States has very good relations with the government of Saudi Arabia and, as you know, there are no political freedoms there; indeed, there isn’t even freedom of religion and the rights of women are severely curtailed.

Castro’s crime – for which the Five are paying – is obvious: he humiliated the United States. As Leycester Coltman, a British ambassador to Cuba, has written, Fidel Castro is “still a bone . . . stuck in American throats. He had defied and mocked the world’s only superpower, and would not be forgiven.”[1]

Where did the Castro brothers defy the United States? One of the most important places is southern Africa. I am sure you sensed this in your recent visit to South Africa when you witnessed how warmly the South African people responded to Raúl Castro. As the chair of the African National Congress said, when introducing Raúl Castro, “We now will get an address from a tiny island, an island of people who liberated us, who fought for our liberation.”

While the Cubans were fighting for the liberation of the people of South Africa, successive American governments did everything they could to stop them.

In October 1975, the South Africans, encouraged by the Ford administration, invaded Angola to crush the left wing Popular Movement for the Liberation of Angola (MPLA). In response, 36,000 Cuban soldiers suddenly poured into Angola. By April 1976, the Cuban troops had pushed the South Africans out.

Had the South Africans succeeded in imposing their will on Angola, the grip of white domination would have tightened over the people of southern Africa. It was a defining moment: Castro sent troops to Angola because of his commitment to what he has called “the most beautiful cause,”[2] the struggle against apartheid. Castro, Kissinger explained, “was probably the most genuine revolutionary leader then in power.”[3]

The tidal wave unleashed by the Cuban victory in Angola washed over South Africa. Mandela later recalled hearing about it while he was incarcerated on Robben Island. “I was in prison when I first heard of the massive aid that the internationalist Cuban troops were giving to the people of Angola. … We in Africa are accustomed to being the victims of countries that want to grab our territory or subvert our sovereignty. In all the history of Africa this is the only time a foreign people has risen up to defend one of our countries.”[4]

This Cuban victory over apartheid meant a defeat and a humiliation for the United States. Enraged, the Ford administration ended the talks it had been conducting with Cuba toward normalizing relations.

President Carter also said there could be no normalization of relations until Cuba withdrew its troops from Angola – even though the CIA conceded that the Cuban troops were “necessary to preserve Angolan independence” against the continuing threat posed by South Africa.[5] In June 1980, the South Africans launched another major raid, advancing more than a hundred miles into Angola, stopping only thirty miles south of the Cuban line protecting the country. The UN Security Council responded with a tough resolution condemning the invasion, and the US representative on the Council minced no words in his speech chastising South Africa. When it came to vote, however, he abstained because the resolution included language suggesting that if South Africa launched another attack on Angola the Security Council might impose sanctions.

I am sure you can appreciate the irony, Mr. President. The United States had stationed large numbers of troops in Italy, West Germany and Turkey – countries that faced no immediate military threat from the Soviet Union in 1980, but Jimmy Carter denied the Angolans the right to have Cuban troops to protect their country from the very real South African threat.

Castro refused to bow to Carter’s demands, which meant that he sacrificed the possibility of normalization with the United States (and the lifting of the embargo) in order to protect Angola from the apartheid regime.

From 1981 to 1987, the South Africans launched bruising invasions of southern Angola, encouraged by the friendly Reagan administration in Washington. It was a stalemate until November 1987, when Castro decided to push the South Africans out of Angola once and for all. His decision was triggered by the fact that the South African army had cornered the best units of the Angolan army in the southern Angolan town of Cuito Cuanavale. And his decision was made possible by the Iran Contra scandal rocking Washington. Until the Iran Contra scandal exploded in late 1986, weakening and distracting the Reagan administration, the Cubans had feared that the United States might launch an attack on their homeland. They had therefore been unwilling to deplete their stocks of weapons. But Iran Contra defanged Reagan and freed Castro to send Cuba’s best planes, pilots, and antiaircraft weapons to Angola. Castro’s strategy was to break the South African offensive against Cuito Cuanavale in the southeast and then attack in the southwest, “like a boxer who with his left hand blocks the blow and with his right – strikes.”[6]

On March 23, 1988, the South Africans launched their last major attack against Cuito Cuanavale. It was an abject failure. The US Joint Chiefs of Staff noted, “The war in Angola has taken a dramatic and — as far as the South Africans are concerned — an undesirable turn.”[7]

The Cubans’ left hand had blocked the South African blow while their right hand was preparing to strike: powerful Cuban columns were moving towards the Namibian border, pushing the South Africans back. Cuban MIG-23s began to fly over northern Namibia.

Among the Cuban soldiers advancing toward the Namibian border were two young men whose names are now well known: Fernando González Llort and Gerardo Hernández Nordelo. Ten years earlier, René González Sehwerert had also fought in Angola. These three men, together with Ramón Labañino Salazar and Antonio Guerrero Rodríguez, are the five Cubans on whose behalf I am writing.

US and South African documents prove that the Cubans gained the upper hand in Angola. The Cubans demanded that Pretoria withdraw unconditionally from Angola and allow UN-supervised elections in Namibia. The US Joint Chiefs of Staff warned that if South Africa refused, the Cubans were in a position “to launch a well-supported offensive into Namibia.” The South Africans acknowledged their dilemma: if they refused the Cuban demands, they ran “the very real risk of becoming involved in a full-scale conventional war with the Cubans, the results of which are potentially disastrous.” The South African military was grim: “We must do the utmost to avoid a confrontation.”[8]

Pretoria capitulated. It accepted the Cubans’ demands: it withdrew unconditionally from Angola and agreed to UN-supervised elections in Namibia.

The Cuban victory reverberated beyond Namibia and Angola. In the words of Nelson Mandela, the Cuban victory “destroyed the myth of the invincibility of the white oppressor … [and] inspired the fighting masses of South Africa … Cuito Cuanavale was the turning point for the liberation of our continent – and of my people – from the scourge of apartheid.”[9]

You were at Mandela’s memorial service, Mr. President, and you celebrated his legacy. You saw the reaction of the South African people to Raúl Castro and to the name of Cuba. Yes, Cuba changed the course of history in southern Africa despite Washington’s best efforts to prevent it. In so doing Cuba offended and provoked the United States – not only Ford, and Reagan but also Carter, self-styled champion of human rights. In the American mind, Cuba was the aggressor and the United States was, as always, on the side of the angels. As US historian Nancy Mitchell has pointed out, “our selective recall not only serves a purpose, it also has repercussions. It creates a chasm between us and the Cubans: we share a past, but we have no shared memories.”[10]
Perhaps, Mr. President, what you saw in South Africa may inspire you to bridge the chasm and understand that in the quarrel between Cuba and the United States the United States is not the victim, and that the Five Cubans are, simply, political prisoners.

Piero Gleijeses

[1] Leycester Coltman, The Real Fidel Castro, New Haven, 2003, p. 289.
[2] “Indicaciones concretas del Comandante en Jefe que guiarán la actuación de la delegación cubana a las conversaciones en Luanda y las negociaciones en Londres (23-4-88),” p. 5, Centro de Información de las Fuerzas Armadas Revolucionarias, Havana.

[3] Henry Kissinger, Years of Renewal, New York, 1999, p.785.

[4] Mandela, 26 July 1991, Granma (Havana), 27 July 1991, p. 3.

[5] CIA, “Angola Cuba: Some Strains but No New Developments,” 9 Apr. 1979, Central Intelligence Agency Records Search Tool, National Archives, College Park, MD.

[6] Memcon (Fidel Castro, Joe Slovo et al.), 29 Sept. 1988, p. 16, Centro de Información de las Fuerzas Armadas Revolucionarias, Havana.

[7] US Joint Chiefs of Staff, 15 Apr. 1988, National Security Archive, Washington DC.

[8] US Joint Chiefs of Staff, 28 July 1988, ibid.; Mike Malone to A. Jacquet, enclosed in Jacquet to Pik Botha, 20 July 1988, SWA/Angola, v. 2, Department of Foreign Affairs, Pretoria; General Jannie Geldenhuys, “Samevatting van notas mbt SAW-operasies in Suid-Angola,” 23 Aug. 1988, H SAW, gr. 4, box 160, Department of Defence, Documentation Centre, Pretoria.

[9] Mandela, 26 July 1991, Granma, 27 July 1991, p. 3.

[10] Nancy Mitchell, “Remember the Myth,” News and Observer (Raleigh), 1 Nov. 1998, G5.

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