Developed nations would do well to import some aspects of Cuba's exemplary health system, writes Roger Downer.
The escalating cost of healthcare presents a major problem for the governments of all developed nations and, with increasing life expectancies, the problem is likely to become even more severe.
In light of this growing global crisis, it is interesting to observe how one economically disadvantaged country has deployed limited resources to develop and sustain an outstanding healthcare system.
The country is Cuba and, on a recent visit, I learned about the Cuban healthcare system and the high priority placed by that government in upholding the basic right to health of every individual.
The system is structured so that there is approximately one physician for every 360 citizens and each person is seen by his/her physician twice annually, with one of the consultations taking place in the home.
Detailed medical histories are maintained with strong emphasis placed on disease prevention and early diagnosis of disease.
The income of the physician is determined, to some extent, by the state of wellness of the patients under his/her care.
The results are impressive. Infant mortality in 2006 was 5.2 per 1,000 live births - lower than that of any developed country and the adult life expectancy of 77.1 years is comparable to any developed country.
Advanced research institutes have developed, and are producing, vaccines against major global diseases including cholera and several forms of meningitis. All children are immunised against measles, mumps, pertussis, meningitis B and C, tetanus, hepatitis B and tuberculosis.
Moreover, Cuba is helping to alleviate the global health crisis by providing up to 28,000 health workers to lesser developed countries.
The Latin American School of Medical Sciences in Havana is training more than 10,000 students from 27 countries to help address the global shortage of physicians.
It is particularly interesting to note that recruits to the medical school include students from poor, remote and marginalised communities with an expectation that, upon graduation, they return to serve those communities.
Undoubtedly, there are a number of factors which have contributed to Cuba's remarkable healthcare achievement, but two stand out.
The first is the government's absolute commitment to providing the best possible healthcare system as a fundamental human right in which the state and all citizens are fully engaged. Second is recognising the need to deploy available resources optimally in order to deliver on this commitment.
Prof William Keck, board member, Medical Education Co-operation with Cuba (MEDICC) and editor-in-chief of MEDICC Review, explains the Cuban philosophy succinctly: "Whereas most countries are exploring how to pay for their expensive healthcare systems, Cuba asked 'How we can use our resources to best effect to keep the population healthy?'"
Given this highly pragmatic philosophy, it is not surprising that there is close integration between preventive and curative services. Clearly, it is much less expensive to detect and treat disease at an early stage than to delay until more expensive interventions are required.
The vigilance of the Cuban medical personnel in this goal is illustrated by a story told by an American journalist living in Havana. One evening she answered the door to her apartment and was confronted by a nurse from her local family clinic who said: "You caused me to climb four flights of stairs because you did not come to the clinic for your regular PAP smear; please come with me now."
The success of the Cuban healthcare system in maintaining the population's good health is undisputed and the model has been transferred and adapted effectively to improve the health of people in some of the poorest parts of the world.
In light of these reports, it is tempting to consider the Cuban system as a universal panacea for ailing global health systems. Indeed, in 2001, following a highly positive report on the Cuban health system by a visiting delegation from the British House of Commons, the BBC recommended that prime minister Tony Blair resolve the British healthcare problem by "going Cuban".
Such proposals are simplistic and it is wrong to believe the system could be imported directly into developed countries where individual freedom of choice is sacrosanct.
Nonetheless, much can be learned from what Cuba has achieved and few can question the wisdom of the Cuban emphasis on prevention and community medicine.
As Ireland continues to struggle with burgeoning costs and public discontent with our health service, there would be much merit in examining those aspects of the Cuban system that could be imported.
Roger Downer is President Emeritus at the University of Limerick. He recently spent one week exploring aspects of the Cuban health system under the auspices of the Atlantic Charitable Trust.