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Context of '1990: UNICEF Says Cuba Comparable to Developed Countries in Terms of Infant Mortality'

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Cuba’s Ministry of Public Health establishes rules and standards on health care for women, infants, and young children. The rules make infant health and the reproductive health of women the country’s top health priorities. The ministry’s rules specify the minimum number of prenatal examinations and consultations for pregnant women and require that all pregnant women receive education on hygiene, health during pregnancy, childbirth, and child care. They are also to receive psychological counseling and instruction in birth exercises. When women miss appointments or educational lectures, doctors are instructed to go to their homes. Additionally, the ministry’s rules state that all childbirth must take place in hospitals, where women and their new babies will typically stay for four or five days. By the mid-1980s, prenatal care provided to Cuban women will far exceed the medical norms of most industrialized countries. [Feinsilver, 1993, pp. 48-49] The ministry also issues specifications for the care of infants and children, requiring that doctors conduct a certain number of check-ups every year. By 1989, the average number of well-baby visits per year will be 11. [Feinsilver, 1993, pp. 53] Author Julie Feinsilver notes that Cuba’s commitment to prenatal and infant care is cost-effective in the long-term. “These children experience less illness, require less curative medical care, and possess greater potential for development and educational achievement, which lead to greater work capacity and higher productivity.” [Feinsilver, 1993, pp. 51]

Entity Tags: Cuba

Timeline Tags: Other Health Care Systems

UNICEF publishes a report on the “State of the World’s Children,” which concludes that “Cuba is the only [Latin American] country on a par with developed nations” with regard to infant mortality rates. [South End Press, 1993]

Timeline Tags: US-Cuba (1959-2005)

Save the Children releases a report ranking the status of mothers and children in 125 countries. The report—based on 10 indicators pertaining to health and education—concludes that Sweden is the best country in the world for mothers and children to live. The US and United Kingdom are tied for tenth place. The US places much lower, however, in infant mortality, ranking second-to-last among 33 industrialized nations. It shares the spot with Hungary, Malta, Poland, and Slovakia with a death rate of nearly 5 per 1,000 babies. Save the Children’s data shows a remarkable difference in mortality rates between white and black infants. According to the report, black babies are twice as likely as white babies to be premature, have a low birth weight, or die at birth. The infant mortality rate among US blacks—9 per 1,000—is closer to the rates of developing nations. For example, in war-torn Colombia the mortality rate is 12 per 1,000. [Save the Children, 5/2006 pdf file; Save the Children, 5/9/2006; Associated Press, 5/10/2006]

Entity Tags: Save the Children

Timeline Tags: US Health Care

In an op-ed, the New York Times calls the idea that the US has “the best health care system in the world,” as recently stated by President Bush, or provides “the best medical care in the world,” as recently stated by former New York City Mayor Rudolph Giulani, a “delusion.” “That may be true at many top medical centers,” the Times writes. “But the disturbing truth is that this country lags well behind other advanced nations in delivering timely and effective care.” The Times notes that in 2000, the World Health Organization (WHO) ranked the health care systems of 191 nations. France and Italy were first and second; the US came in 37th. The Times notes a more recent study by “the highly regarded Commonwealth Fund,” which “has pioneered in comparing the United States with other advanced nations through surveys of patients and doctors and analysis of other data”; the latest Commonwealth Fund study put the US last among six highly developed nations (see May 15, 2007). “Other comparative studies also put the United States in a relatively bad light,” the Times notes.
Lack of Universal Coverage - Unlike every other major industrialized nation, the US does not provide universal health coverage. In the US, some 45 million people have no health insurance whatsoever, and millions more suffer with poor coverage. The Times writes, “Although the president has blithely said that these people can always get treatment in an emergency room, many studies have shown that people without insurance postpone treatment until a minor illness becomes worse, harming their own health and imposing greater costs.”
Lack of Access - While citizens of foreign nations often face longer waits before they can see specialists or undergo elective surgery than do Americans in comparable situations, “[t]he real barriers here are the costs facing low-income people without insurance or with skimpy coverage.” However, “even Americans with above-average incomes find it more difficult than their counterparts abroad to get care on nights or weekends without going to an emergency room, and many report having to wait six days or more for an appointment with their own doctors.”
Unfair Disparities - The dichotomy between the care provided to economically well-off Americans and their more economically challenged fellows is worse than in any other industrialized nation. “Americans with below-average incomes are much less likely than their counterparts in other industrialized nations to see a doctor when sick, to fill prescriptions, or to get needed tests and follow-up care.”
Unhealthy Living - The US ranks last among 23 nations in its infant mortality rate—more American children die in infancy than in 22 other countries. “But the problem is much broader,” the Times continues. “We rank near the bottom in healthy life expectancy at age 60, and 15th among 19 countries in deaths from a wide range of illnesses that would not have been fatal if treated with timely and effective care. The good news is that we have done a better job than other industrialized nations in reducing smoking. The bad news is that our obesity epidemic is the worst in the world.”
Varying Quality - The Commonwealth Fund study notes that the US ranks first in providing the correct care for a given condition, and does very well in providing preventative care to its citizens. But it does much worse in coordinating the care of chronically ill patients, in protecting the safety of patients, and in meeting the needs and preferences of patients. Overall, the quality of health care in the US is the lowest among the six nations profiled by the study.
Varying Survival Rates - US citizens live longer than their foreign counterparts with breast cancer, and second-longest with cervical cancer and childhood leukemia. But US citizens rank last or next-to-last in life expectancy for patients with kidney transplants, liver transplants, colorectal cancer, circulatory diseases, respiratory diseases, diabetes, bronchitis, asthma, and emphysema.
Poor Patient Satisfaction - Only 40 percent of Americans are satisfied with the nation’s health care system. Of 17 countries surveyed, the US comes in 14th. The US ranks first in negative public perceptions, with a third of Americans calling for a system-wide revamp of American health care.
Poor Use of Information Technology - American health care providers are years behind their foreign counterparts in their use of information technology, electronic medical records, electronic prescriptions, and more. “This makes it harder to coordinate care, spot errors, and adhere to standard clinical guidelines,” the Times writes.
Conclusion - “With health care emerging as a major issue in the presidential campaign and in Congress, it will be important to get beyond empty boasts that this country has ‘the best health care system in the world’ and turn instead to fixing its very real defects,” the Times concludes. “The main goal should be to reduce the huge number of uninsured, who are a major reason for our poor standing globally.… The world’s most powerful economy should be able to provide a health care system that really is the best.” [New York Times, 8/12/2007]

Entity Tags: Commonwealth Fund, Rudolph (“Rudy”) Giuliani, World Health Organization, George W. Bush, New York Times

Timeline Tags: US Health Care

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