Health Promotion and Nursing in Cuba

Saturday, 28 October 2017: 2:35 PM

Debra Whisenant, PhD, MSN, MSPH
Alice L. March, PhD
Capstone College of Nursing, University of Alabama, Tuscaloosa, AL, USA

United States nursing faculty from one public university traveled to Havana, Cuba. Our primary objective was to initiate the development of relationships between our nursing faculty and the nursing faculty in Havana. Other objectives were to observe and assess how nursing education, nursing roles within the community, and Cuban primary and secondary prevention efforts guide the nurse to focus on health promotion and disease prevention. We were also interested in how these preventive practices could be introduced and implemented to improve health promotion and disease prevention in the United States.

The purpose of this presentation is to provide up-to-date information for nurses regarding the organization and functioning of the Cuban health care system. First, we will examine how nurses are educated, as well as how they practice in that country. Next we will discuss our preconceived ideas about health care in Cuba and how those were altered by an actual visit to the country. In our visits we have discovered a very different environment than expected and have learned methods that could be applied in the United States.

Cuba has experienced multiple dramatic political and social changes. While Cuba dealt with trade and travel embargos, as well as economic crises, they also designed and developed an impressive and extremely effective health care system which focuses on health promotion and disease prevention from crib to death. Cuba has been successful at developing a culture of health and managing the populations’ wellness as evidenced by a life expectancy in Cuba for males and females of 77 years and 80 years of age, respectively; versus 76 years and 81 years of age in the United States (US) (World Health Organization [WHO], 2016). The infant mortality rate of 4.5 deaths per 1,000 live births compares favorably to the 5.80 per 1,000 live births in the US (Central Intelligence Agency Factbook, 2017), and child mortality rates are better than the US. For children under the age of six, Cuba reports only 6 deaths per 1,000 live births, while the US reports 8 deaths per 1,000 live births (WHO, 2016). In addition, the WHO recently validated the elimination of mother-to-child transmission of HIV and syphilis in Cuba (WHO, 2015). These statistics are even more impressive when one considers that per capita health care expenditures from 2011 to 2015 in Cuba were significantly lower than in the US; $ 603 versus $ 9,146 respectively (World Bank Group, 2015).

It was difficult to establish communication in the very beginning; however, through multiple trips to Cuba we have built a relationship of trust and have placed an emphasis on collaborative learning opportunities. Cuban nurses are open and willing to share their knowledge and experiences with US nurses. They are also interested in education of nurses and the responsibilities of nurses in the US. The hospital based learning approach in the US is different than the community based learning approach used in Cuba. Cuban nursing students spend most of their time in the community and in homes versus the hospital. They are eager to share the prevention efforts that work well in a resource-limited environment, as well as what prevention methods are less than effective.

The common perception of Cuba, the Cuban population, and the Cuban health care system is often one of confusion and low expectations for positive outcomes; however, Cuba has a strong history of successful primary and secondary prevention (Erwin & Bialek, 2015; Pan American Health Organization, 2011). Misperceptions of Cuban health care include lack of access to care, poorly trained providers, facilities in disrepair, and lack of resources for treatment. Each of these misperceptions were easily proven incorrect. Each Cuban citizen has direct access to free, quality care, the providers are highly trained and skillful, facilities are appropriate for providing care, and resources for health promotion and primary prevention are readily available. There is much to be learned from the Cuban health care system and how primary prevention and professional nursing have played a significant role in this impressive health care success story.

Health care access and equity in Cuba is a high priority for the Cuban government and is a guiding principle in nursing and medical education. Visits to universities and health care facilities were instrumental in demonstrating how the emphasis on primary prevention during the education of nurses and physicians is key in providing holistic care. Students are taught to provide targeted health promotion education and supportive social services within the entire population.

Cuban nurses are experts in primary prevention. Nurses are the first line provider for immunizations, scheduling health screenings, and providing home visits for new mothers, the sick, and the elderly. Nurses, independently and jointly with the physician, make regular home visits to provide health education, patient examinations, and treatment. It is also common for Cuban nurses to work internationally. These nurses carry their health promotion practices and beliefs to both developed and developing countries.

Cuba and U.S. political relations are rapidly changing. This transformation provides unique opportunities for the exchange of important philosophies, including ideas related to how health care in general, and nursing care in particular are delivered. Considering Cuba is a developing country, the ability to have reached health care goals that even developed countries have yet to meet is remarkable. There is much to learn from our Cuban nursing colleagues, and the development of a reciprocal learning relationship has been beneficial already.

We are committed to continuing these efforts to bring both U.S. and Cuban health care providers together for the exchange of ideas and evidence that support improved patient outcomes, improved health equity, and better public health strategies. In our world of high-tech care this experience helped us to better understand how a public health-based, high-touch, low technology approach leads to clear expectations of health care providers’ roles, patient roles, and supportive interprofessional relationships. Collaborating with our Cuban colleagues is a unique way to reestablish relationships and build bridges to fill health care gaps in both countries.