Introduction
Cuba is a multicultural country in the Caribbean, best known for its marvellous landscapes, historical locations, rich culture and gastronomy and, of course, the renowned Cuban cigars.
Composed of the island of Cuba, Isla de la Juventud and other minor archipelagos, there is much to discover across Cuba. Starting in Havana: the country’s capital and its main urban hub. Here, there is a wide range of museums, castles and other historical landmarks for tourists looking to learn more about the history and culture of Cuba, as well as scenic beaches for those looking to wind down and relax.
Other cities, like Santiago or Trinidad, showcase Cuba’s legacy as a former Spanish colony, mainly through architecture and gastronomy.
Finally, for the most adventurous visitors, Cuba offers the option to hike across its hills and mountains, like the Sierra Maestra, or to explore the various caverns in the main island’s interior.
The population of Cuba
The Republic of Cuba is comprised of approximately 1,600 islands, islets and cays located at the intersection of the Caribbean Sea, the Gulf of Mexico and the Atlantic Ocean. Some of the larger islands of Cuba are part of the Antilles chain of islands that envelops the Caribbean Sea, including the main island of Cuba, which is the largest of the islands of the Greater Antilles.
Amongst the country’s closest neighbours are Haiti to the east, Jamaica to the south, Mexico to the east and the Bahamas and the United States to the north.
Until the 15th century, Cuba was occupied by a wide variety of people, with dominion over different regions of the country shifting throughout history. In 1492, with the arrival of the conquistadores, indigenous people were displaced to make way for Spanish settlements. However, as Spanish settlers and their slaves established themselves in Cuba, a divide between Spanish-born and American-born citizens was established, with the indigenous people being treated even below enslaved people.
After several tumultuous centuries, Cuba eventually grew into one of the most important Spanish colonies, both commercially and strategically. In the 18th century, the country gained the title of the “Pearl of the Antilles”.
With the abolishment of slavery in Cuba in 1886, however, the political and economic differences between Cuba and Spain grew, feeding into the independence movement, which culminated in the Spanish-American War and subsequent Cuban independence in 1898.
The following century was marked by corruption, fiscal irresponsibility, difficult international relationships and social insensitivity in Cuba, but also by economic growth. By the 1950s, Cuba was one of the leading economies in Latin America, but it was also deeply affected by economic disparities, which led to a revolution led by Fidel Castro to overthrow the government.
This led to the establishment of communism, which was marked by economic isolation and a strong alliance with the Soviet Union. As the Soviet Union collapsed in 1989 and the US tightened its blockade on Cuba, the country was once again affected by a deep economic crisis and political instability.
To this day, life in Cuba is hard, but throughout this century, many strides have been made to help improve international relationships, the economy, social policies and the population’s health.
Geographic and demographic information
Summary statistics
- Land area: 103,800 sq. km
- Gross domestic product (GDP):
- Total: $107.35 billion (2020 estimate)
- Per capita: 9,499.6 (2020 estimate)
Population statistics
- Population size: 11,256,372 (2021 estimate)
- Birth rate: 9 per 1,000 people (2021 estimate)
- Death rate: 15 per 1,000 people (2021 estimate)
- Infant mortality rate: 4 per 1,000 live births (2021 estimate)
- Average Life expectancy: 74 years (2021 estimate)
- Male estimate: 71 years (2021 estimate)
- Female estimate: 76 years (2021 estimate)
- Ethnicities: 64.1% White, 26.6% mestizo and 9.3% black
Healthcare system
At the start of the 21st century, after years of extreme economic and political struggle, the Cuban government created a strategy across multiple areas to improve the conditions in the country. One of the main priorities was to improve the healthcare system, which significantly deteriorated in the 1990s.
The goal was to modernise the healthcare system and make it more efficient and tailored to the Cuban population, particularly as population ageing had started to drive a shift in the primary health concerns of the country. The government focused on reorganising the system and combining services, investing in physical resources and training of healthcare professionals, increasing health coverage across all regions and incentivising collaboration between the various levels of healthcare services.Today, Cuba has one of the best healthcare programs in the developing world and, on some levels, is even on par with developed nations, having even become a destination for health tourism.
The Cuban National Health System is publicly funded and operated by the Ministry of Public Health. The system has made healthcare available to all citizens and for the most part, for free. In fact, private health care is outlawed in Cuba, and out-of-pocket expenditures represent only 10% of the total expenditure, which is the lowest value in Latin America.
Overall, the Cuban healthcare system is divided into primary, secondary and tertiary care. Primary care is provided in clinics (referred to as consultorios), secondary care in speciality clinics called policlinics and tertiary care in hospitals and medical institutes.
The primary level of care is one of the main focal points of the system. Over the last two decades, the scope of its services has significantly expanded, particularly with regard to preventative medicine, health promotion, diagnostics, emergency care, elderly, maternal and child health and management of chronic conditions and cancer. This has led to an increase of over 19% in the delivery of first-line medical care, 56% in dental care services and a decrease of 16% in consultations in the emergency services.
These efforts have led to a significant improvement in the provision of healthcare services in Cuba, which in turn has triggered a clear impact on the health of the population with, for instance, a decrease in the rates of infant, maternal and overall mortality to a level that matches those seen in developed nations.
Overall, Cuba is now seen as an example of how to improve public health services, even with low investment power. However, significant progress still needs to be made, particularly with regard to access to certain medicines and treatments that are not publicly funded, the provision of essential resources and the improvement of facilities. Corruption in the healthcare industry is also an issue.
Health priorities
As improvements were made to the healthcare system in Cuba, several health parameters saw a positive shift. Between 1970 and 2017, for example, the mortality rate per 100,000 inhabitants decreased on average by 1.3% each year, and infant mortality declined from 29 to 4 per 1000 live births, which is even lower than in the US.
These changes are largely related to the improvements made regarding perinatal health and infectious diseases. Regarding the latter, 14 infectious diseases have now been eliminated in Cuba, and 9 others are no longer considered public health issues given the low incidence rates. Cuba the first country to eliminate mother-to-child transmission of HIV and syphilis, as certified by the WHO in 2015.
Due to these changes and population ageing, non-communicable diseases (NCDs) have since become Cuba’s most significant health concern. With the increase in life expectancy and the decline in birth rates, the percentage of older people in Cuba rose from 12.9% in 2000 to 20.1% in 2017. As such, neurological and cardiovascular diseases, cancer, chronic respiratory diseases, obesity, diabetes and pathologies related to poor nutrition, smoking, alcoholism and poor living conditions all started to rise.
According to data collected by the Pan American Health Organization (PAHO), the ten leading causes of death and disability in Cuba in 2019 included ischaemic heart disease, stroke, hypertension, lower respiratory infections, COPD, trachea, bronchus and lung cancers, prostate cancer, colon and rectum cancers and Alzheimer’s disease and other types of dementia.
As per a report published by PAHO in 2016, 83.7% of deaths in Cuba were caused by NCDs, compared to 80.7% in the entire region of the Americas. Amongst the NCDs explored in the report, the rate of death associated with both cardiovascular diseases and cancer were higher in Cuba than the average across American countries, as was the rate of suicide and the prevalence of tobacco smoking and raised blood pressure. While lower than the average, aspects such as high alcohol intake, obesity and physical inactivity are also areas of concern in Cuba.
Nevertheless, the Cuban health system has started to implement a multidisciplinary approach to tackle NCDs. Amongst the main strategies that are being put into place are a higher focus on primary and secondary prevention and clinical follow-up with patients with NCDs, as well as the development of a program that incentivises the production of pharmacological and biotechnological solutions and anepidemiological surveillance system.
Genomic medicine capabilities
During the modernisation process of Cuba’s healthcare system, clinical genetics was included as part of its design under the purview of the National Program for Diagnosis, Management and Prevention of Genetic Diseases and Birth Defects.
Among the most important factors in implementing genetics into clinical practice were the inclusion of genetics in all clinical disciplines in medical school. Additionally, a community genetics network was created, comprising of a comprehensive programme focused on health interventions, diagnosis and management of genetic conditions, and prevention. This network is currently managed by the National Centre of Medical Genetics, which is also responsible for the research conducted in this field and the provision of genetics services in the country.
Genetics services are available throughout 168 municipal services, 15 provincial services and the National Centre of Medical Genetics in Havana.
Genetic testing is included at the primary care level, where services conducted include confirmation of clinical diagnoses by geneticists, prenatal diagnostic sonograms and collection of diagnostic samples as part of screening programs like neonatal and prenatal screening. As of 2009, each municipality has at least two genetic counsellors who work in multiple sites. Municipalities also maintain registries of people with disabilities to allow for follow-up and records of genetic diseases and congenital malformations in each area.
At the secondary level, provincial centres act as reference centres for the diagnosis of genetic disorders. Services provided include foetal sonograms and echocardiograms to confirm congenital malformations, pre-and postnatal diagnosis of chromosome abnormalities, laboratory testing and supervision of neonatal metabolic disease screenings.
Finally, at the tertiary level is the National Centre of Medical Genetics, where most laboratory research in this field is conducted and which provides consulting to other medical research institutes.
All of the clinical genetics services provided in Cuba are free for all patients; however, most of the services offered are limited to the diagnosis of congenital defects and neonatal screening, as the economic situation in the country diminishes the availability of other types of genetic services.
At the prenatal level, patients can access genetic services for the diagnosis of sickle cell anaemia, congenital defects and chromosomal anomalies. At the neonatal level, the newborn screening program currently covers screening of phenylketonuria, galactosemia, biotinidase deficiency, congenital hypothyroidism, congenital adrenal hyperplasia and cystic fibrosis. This program is estimated to reach 99.4% of patients as of 2020.
In cases wherein there is a positive result, patients are referred to the National Medical Genetics Centre, wherein their diagnosis is confirmed and they can receive follow-up care.
At the postnatal level, patients can access clinical diagnoses for over 150 diseases, such as haemophilia A and B and Huntington’s chorea, and genetic counselling.
Notable projects
- National Maternal–Child Health Program (PAMI) – Created in 1983, PAMI is a centralised platform used to plan, organise and manage all actions carried out across the country related to maternal, reproductive and child health. The program is under the purview of the Ministry of Public Health and, since its establishment, has been a key tool for providing equitable and appropriate healthcare services to pregnant people and children. Currently, the program’s main priorities are to help manage high-risk pregnancies and implement genetic screening.
- Cuban Registry of Congenital Malformations (RECUMAC) –Established in 1985, RECUMAC is a research program focused on congenital malformations that works synergistically with clinical practice. Information collected in Cuban hospitals regarding babies born with congenital defects feeds into the program, which in turn helps inform medical practice and establish a surveillance system.
- National Medical Genetics Program –Established in the 1980s, this program facilitates the diagnosis, management and prevention of genetic diseases, including congenital defects. Coordinated by the National Medical Genetics Centre, this has become an essential part of the Cuban health service; its purview, however, goes beyond its direct application in medical practice, as a major component of the National Medical Genetics Program relates to the training of genetic counsellors.
Notable organisations and companies
- BioCubaFarma – Created in 2012, BioCubaFarma is a biotechnology and pharmaceutical organisation with governmental backing that is responsible for managing the manufacture of medicines, diagnostic tools and medical equipment, as well as the provision of various life sciences services. BioCubaFarma acts as an umbrella agency for Cuban companies and organisations in the fields of biotechnology and pharmaceuticals, facilitating international collaboration, as well as research and development efforts in these fields in Cuba.
- National Centre of Medical Genetics – Founded in 2003, the National Centre of Medical Genetics is responsible for coordinating the Cuban medical genetics network, its resources and the training of professionals in the field of genetics, as well as the research conducted and the genetics services provided in the country. More than just acting as the reference centre in the field of genetics in Cuba, the National Centre of Medical Genetics also participates in international research projects with organisations across Denmark, the UK and China.
- Genetic Engineering and Biotechnology Centre (CIGB) – Created in 1986, the Genetic Engineering and Biotechnology Centre works to produce new products to target health problems faced by the population of Cuba. Amongst its many contributions over the years are the hepatitis B vaccine, recombinant interferons and several key components of Heberprot-P, a medicine for treating advanced diabetic foot ulcers.
Notable individuals
- Dr Verena Muzio – Currently acting as director of clinical research at CIGB, Dr Muzio is a pioneer in the biotechnology sector in Cuba. As an immunologist, Dr Muzio was part of the team responsible for the research into the genetically engineered hepatitis B surface antigen that was used to later create the recombinant hepatitis B vaccine in 1989. More recently, the same technological platform was used to develop CIGB’s Abdala vaccine against SARS-CoV-2.
- Niurka Carlos – Niurka Carlos is an engineer, but her interest in health led her to join Cuba’s Immunoassay Centre in 1982, where she became department chief and, eventually, deputy director. Since 2014, she has been the head of the centre, wherein research, production and marketing of diagnostic tools, used both in Cuba’s National Health System and internationally, are conducted.
- Dr Beatriz Marcheco – A specialist in clinical genetics, Dr Marcheco has been involved in various research projects that have later been used to inform clinical practice, such as a door-to-door study on disabilities, the creation of a national twin registry and research into the genetic ancestry of Cubans. Today, Dr Marcheco is the director of Cuba’s National Medical Genetics Centre in Havana, a chair of the National Expert Group in Clinical Genetics and a member of the editorial board of the Revista Cubana de Genética Comunitaria (the Cuban Magazine of Community Genetics).
The future genomics landscape
Cuba has shown a clear commitment to improving health care for all over the past five decades, which has significantly improved the health of the Cuban population. However, there is still much progress to be made and several key issues to be solved. Given the positive trajectory of the healthcare system observed so far, healthcare will likely continue to be a primary focal point of the Cuban government, and further improvements should continue to be made.
As there is already an established clinical genetics system in Cuba integrating research and knowledge in this area in clinical practice, there should also be continued improvement of this field of medicine.
Genetics training of medical professionals has already become the standard in Cuba, with thousands of professionals even seeking re-training to become specialists in this area. Further, genetics research is directed at the progressive integration of knowledge and innovations into clinical practice to achieve the best possible outcomes for the Cuban population.
Although Cuba is still struggling in several areas, mainly due to its economic status, it should be expected that clinical genetics services will continue to expand, especially with regard to the diagnosis, management and prevention of conditions such as cancer, which can have a genetic component.
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