HCA 4303, Comparative Health Systems 1

Course Learning Outcomes for Unit VI Upon completion of this unit, students should be able to:

1. Identify the major diseases and disparities in the context of a country’s unique cultures.

Reading Assignment Chapter 8: The Healthcare System in France Chapter 11: The Healthcare System in Cuba

Unit Lesson You have likely seen a number of illusions in your life. Magicians can perform them, or they can be visual illusions created by a variety of computer-aided graphic software or by using the traditional pen and paper methodology. The point is that we cannot always believe what we see as our eyes can send incorrect messages to our brain. That is also the case when we attempt scholarly endeavors, such as reviewing a country’s healthcare delivery system. We have certain biases and expect to see certain data based on our preconceived notions. In other words, we are prejudice since we pre-judge a situation based on what we think we know. The same phenomena can occur when studying other countries. The focus of this unit’s assignment is to remain open-minded and to approach research with a naïve and skeptical approach. We will look beyond the obvious cultural similarities between France and Cuba (they are both predominantly Roman Catholic), both countries provide health care free of charge under a national healthcare system, and both countries continue to battle high levels of obesity. We will look at the little known facts that dispute what we believe we know about both countries and how their cultures might affect their overall health status. We have known for years that culture affects a person’s health in both positive and negative ways, but it was validated by a large retrospective study accomplished by the Institute of Medicine (Hernandez & Blazer, 2006). The research demonstrates explicitly that several interlocking factors; genetic inheritance, personal behaviors, access to quality health care, and the external environment determine a person’s health. These environmental factors need to be explored within the context of global health care. When we compare countries, we need to ensure we are comparing “apples to apples” and even “McIntosh to McIntosh” if possible. We must examine their social and cultural practices, religion, politics, socioeconomic status, pollution, and the condition of their roadways, water purification, and delivery systems. In other words, we must examine the available evidence both critically and extensively before making any determination on the overall level of a country’s health as well as the quality of their healthcare delivery system. Not only must we examine the country as a complete and complex entity, but we also must be sure that we only see what truly exists. This unit, we look at the impact culture has on a person’s health and the diseases they face by examining two distinctly different cultures: French and Cuban. We will explore the perceived disparities found between the two countries. Cuba is considered a developing country and often viewed by the Western world as a backward, untrustworthy population, yet its healthcare system is one of the best in the world. As we studied in Unit IV, Cuba is one of the countries that affluent Americans and Europeans flock to as “medical tourists” for high quality health care at a reasonable rate. Let’s take a look at some research that presents reason to question those well publicized facts. The U.S. Department of State (2017) states that Cuba’s “authoritarian regime” assumed power by force in 1959 and has severely restricted fundamental freedoms and violated human rights. The United States imposed an embargo in 1960 and broke diplomatic relations in 1961 following the Cuban government’s


France Compared to Cuba in Major Health Issues and Disparities




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adoption of a one-party communist system. Levins (2005) argues that it is time to move beyond this type of Cuba-bashing behavior and to take notice of their great advancements in the last five decades. He writes the following:

Cold-War anti-communism assumptions: that all Reds are the same and that any accusation against any of them is probably an understatement, that they support good causes only to serve their own noxious ends, that revolutionaries once in power are all cynical manipulators and monopolizers of privilege, and that their public statements are merely propaganda. The burdens of internalized Cold War anti-communism and conventional political science allow for careless judgments and casual denunciations. Cuba is not a dictatorial regime. There is a whole complex of elected assemblies at all levels, mass organizations of labor, women, and farmers, and all sorts of NGOs that make Cuban socialism what it is. It is facile and disingenuous to brand this profoundly participatory political system as “dictatorial.” (Levins, 2005, p.49)

The largest healthcare challenge for Cuba has actually been in education. It is nearly impossible to teach healthy living skills at a national level to people that cannot read and write. Thus, wiping out illiteracy has been vitally important to Cuban medical accomplishments (Fitz, 2012). The World Health Organization (WHO) recognizes the phenomenal health statistics accomplished by Cuba’s national health system. They have also built a strong foundation that prioritizes prevention and vast amounts of scientific research scrutinizing population health needs. However, Cuba receives very little publicity for their humanitarian work throughout Latin America and Africa. Levins (2005) states that feeding the hungry, healing the sick, and educating the illiterate are not very exciting to the well-fed, healthy, and college educated. France has a long and illustrious healthcare system and is a leader among European countries (Lovett-Scott & Prather, 2014). Its healthcare system is rated as one of the best in the world. Heath (2008) states that it is misleading and simplistic that “the World Health Organization anointed the French healthcare system as the best in the world” (p. 118) due to the fact that they actually score the highest in only one large category: system performance. This index was calculated by relating a country’s overall health achievement to its expenditure on its health system. This highlights France’s ability to refer patients out for specialty care. Simply put, France ranks first in efficiency. However, upon further research, the study notes that France was scored as number six in its ability to meet the needs of the patient. The same study revealed that although France has operated under a National Health System since1945 that covers most basic healthcare procedures and prescriptions, nearly 80% of the total health expenditure was purchased with public funds (insurances as well as private pay). One could argue that efficiency is not as important as effectiveness when it comes to delivering high quality health care. By now, you should be proficient at taking a large amount of data about two countries and creating a memory matrix to help make sense of the data and to write up your results. As you do that in this unit, we will be looking at what diseases France and Cuba face uniquely and which ones they have in common. You will need to provide some interpretation of that material based on literature and NOT on your preconceived notions. For example, you might note that Cuba’s cardiovascular diseases and incidence of high cholesterol might have a social and cultural link in that men are seen as better providers if their wife and children are “pleasingly plump.” This value drives a diet high in fat. The memory matrix below will assist you with this unit’s assessment. It has been developed from the literature listed in the reference section. See if there are any facts that surprise you—such as the rating for corruption, the literacy rate, their unemployment rate, or the percentage of women in their parliament. Assuming this data is accurate, it may or may not fit the stereotypes you have accumulated about Cuba and France. Either way, it is interesting to review the data when assessing how a culture impacts a person’s health.




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