Let’s say you are pregnant, and at risk for complications.
Are you and your baby better off if you live in Mississippi — or Cuba?
Going by the statistics, you’re better off in Havana than in Biloxi or many other places in the United States if you’re poor.
That’s true even though the United States spends more than $9,000 per person per year on healthcare and Cuba spends less than $3,000.
One big reason: Providers are paid much more in the United States.
In addition, Cuban leaders have made a commitment to healthcare for all.
In the United States, unless you’re a veteran or Native American who lives near a tribal health center — and get free government care — you must seek out services and usually contribute to your costs.
There’s no guarantee.
And on basic measures of public health — infant mortality, life expectancy, pregnancy-related deaths, and obesity — the U.S. scorecard is weak.
In Cuba, between 4 and 5 infants die for every 1,000 live births, according to 2016 estimates from the U.S. Central Intelligence Agency .
The province of Cienfuegos in Cuba reports getting the number down even lower, to 3 per 1,000.
In the United States, nearly 6 infants die for every 1,000 live births.
Although a small island, Cuba is matching the infant mortality rate in Canada and the United Kingdom — two other, much richer, countries with a plan to assure care for all.
Now look at populations within the national U.S. number.
In much of the South, the infant mortality rate is above seven.
In Mississippi, it was 9.3 in 2015 — more than twice Cuba’s.
Among African-American residents in Mississippi, who tend to be poorer than whites, the figure is 13.
If your baby girl was born in 2015 in Cuba, she could expect to live until 82.
In the United States, her lifespan would be a year less, on average.
A newborn girl in Mississippi can expect to live until 78, four fewer years than in Cuba.
That’s also the life expectancy for all African-American girls.
Boys do better in Cuba, too.
We think of death in childbirth as a problem for the prairie pioneers long long ago.
But more than 17 U.S. women die for reasons related to pregnancy for every 1,000 live births, a number that shocks observers of U.S. healthcare.
In Mississippi, the rate is close to 40, and if you’re African-American, it jumps to almost 55.
In Cuba, the number is also 40.
It’s “not as low as it should be, and they are focused on that now, embarrassed by it,” notes Dr. C. William Keck, professor emeritus at Northeast Ohio Medical University and past president of the American Public Health Association.
Pregnancy-related deaths have been falling rapidly around the world. The big exception is the United States, where for three decades they’ve been going up.
Cuba has made maternal and infant health a priority, setting an example for developing nations around the world.
“Pregnant women see a doctor or nurse 17 times on average, before delivery,” reports Gail Reed, executive editor of MEDICC Review: International Journal of Cuban Health & Medicine, a peer-reviewed journal.
“Doctors make a big effort to identify high-risk women, particularly those who are diabetic, very young, or having a first child at a later age,” Reed told Healthline.
In Cuba, if your pregnancy is considered high risk, you might be asked to live in a home for pregnant women, with a doctor in residence — all paid for by the government.
If you choose to stay at home, you get visits from a doctor or nurse to monitor you.
Almost all babies are born in a hospital, a big achievement for Cuba.
Focusing on public health
In Cuba, healthcare is considered a right under the constitution.
To make good on that promise, Cuba brings the professionals to you.
A family nurse or doctor lives in a local “consultorio” near your home, where your visits are free.
Doctors also make house calls.
Each team is responsible for the health of families in its area — not just for treating disease or injuries.
The team keeps careful records required by the government to identify problems early. You’ll be evaluated every year and about every three months if you have a chronic illness.
Forget your Pap smear? The nurse might show up at your house.
You might find a doctor at a large factory or school, aboard ships, in child care centers, and in homes for senior citizens.
Cuban doctors, who are educated for free, must spend two years as a family doctor.
The physician may then leave, but nurses tend to stay for years in one neighborhood and follow individuals over time.
Your local family doctor can refer you to a polyclinic, which offers a range of services. From there, you might go to a hospital or specialist.
At all levels, Cuba stresses preventive care.
It has eliminated the major diseases for which we have vaccinations. In the United States, cases of measles and mumps recently cropped up because of parents resisting vaccines.
Cuba was the first country to eliminate HIV and syphilis transmission between mother and child, an achievement confirmed by the World Health Organization in 2015.
Cuba prides itself on combining the best of high-tech and low-tech care.
For example, you might be offered acupuncture for back pain, Reed reports, and there’s no talk of an opioid crisis.
The U.S. Swiss cheese system
There are many sources of healthcare in the United States and ways to get help paying for it.
However, that has created a complex Swiss cheese healthcare marketplace that lets people fall through holes.
People skip tests and doctor’s visits because of deductibles and co-pays and uncertain — and often large — costs.
Uninsured people go to the emergency room, pushing costs up for the system as a whole.
Low income people have special options. If you’re also pregnant, you qualify for Medicaid.
In fact, in half of the states, Medicaid finances half or more of all births. But hospitals say that Medicaid isn’t covering their costs. What will happen next?
You might qualify for a subsidy to buy insurance on the Affordable Care Act (ACA) exchanges.
Either way, you have to apply and follow up, and some people fail.
Before the ACA reforms mandating benefits and consistent price tags, less than half of women with private plans had maternity benefits. Women were routinely charged more than men for insurance, the nonprofit Commonwealth Fund reports.
Let’s say you’re obese and want to have weight loss surgery. Cubans who qualify can get it for free.
In nearly all U.S states, Medicaid covers this kind of surgery — but not currently in Mississippi.
Another U.S. problem is inconsistent care.
If you go to a community health center, you’ll see rotating doctors.
If you switch between private insurers, you’ll also generally need to switch doctors. You could get poor care because your current doctor doesn’t know your complete history.
In short, some people get the world’s best care and some people fall through a hole.
The fight against obesity
When people in poor countries no longer face starvation, they tend to gain too much weight.
Cubans have seen the connection between weight and disease firsthand.
In the 1990s, when gas prices soared and Cuba lost Soviet food supplies, President Fidel Castro responded by rationing food, promoting small-scale gardens, and distributing more than 1 million bicycles.
Adults lost about 10 pounds, on average, as they ate less and rode their bikes. Obesity, diabetes, and deaths from heart disease all dropped dramatically.
When the rationing eased, obesity rates climbed and the diabetes and heart disease statistics got worse, too.
Then, when Cuba allowed people to be self-employed, fast-food stands popped up on every corner.
Today, more Cubans are becoming obese, as people are around the world.
Both countries face the challenge of getting those numbers down.
Keep on the lookout to see who wins.