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PAHO Basic Health Indicator Data Base This is a multidimensional query tool that offers a collection of 108 indicators from 1995 to 2005. The system presents data and indicators on:
- demography
- socioeconomic
- mortality by cause indicators
- morbidity and risk factors
- access, resources and health services coverage.
Selected indicators are disaggregated into age groups, sex and/or urban/rural region. Generated tables can be exported and printed.
The data presented is updated annually with the latest country information.
GENERAL SITUATION AND TRENDS The Republic of Cuba is an archipelago with a surface
of 110,860 km2 at the entry to the Gulf of Mexico in the Caribbean
Sea . As of June 2000, the population estimate was 11,187,673 with a density
of 101.2 pop./km2. Cuba is divided into 14 provinces and one special
municipality. Policy has focused on achieving social equity by ensuring universal
availability of free social services, including health. A basic level of food
intake and provision of essential goods are assured, with differential treatment
for vulnerable groups.
Demography:
The sustained decline in fertility and mortality rates over the last two decades
has led to a shift in the age structure of the population. In 2000, those aged
60 years and older were 12,9% of the population, while persons under 15 years
of age constituted 22%. The population growth rate was 0.3% in 2000; 75 % resided
in urban areas. Life expectancy at birth was 74.8 years; 72.9 for men and 76.9
for women, 1994-1995.
Economy: The economy recovered since 1995;
GDP grew steadily at an annual average rate of 4.8%, 1994-2000. Tourism revenues
have become a mainstay of the national economy. The unemployment rate in 1990
was 7.5%, when more than 155,000 workers lost their job; however, in 1998 only
3,044 workers were jobless. The agriculture sector comprised a cooperative subsector,
a private subsector, and a state subsector. To stimulate production of crops
for family supply, the state delivered 100.000 hectares of state-owned land
to farmers in the last 6 years. The means for constructing and repairing dwellings
is limited.
Mortality:
The Crude death rate was 6.8 per 1,000 in 2000, slightly higher for men, 55%.
The leading causes of death in 2000 were chronic non communicable diseases.
Diseases of the heart, malignant neoplasms and cerebrovascular diseases accounted
for 60% of all deaths. Mortality from heart diseases decreased 10 % from 1996
to 2000, while malignant neoplasms increased 6.6%. Mortality in urban areas
was 755 per 100,000, 1.4 times greater than in rural areas in 2000.
SPECIFIC HEALTH PROBLEMS Analysis by population group Children (0-4 years). Infant
mortality reached 7.2 per 1,000 live births in 2000. 63% of deaths occurred
in the neonatal period. Perinatal disorders, birth defects, sepsis, influenza,
pneumonia and accidents accounted for more than 80% of all deaths in this age
group. Deaths among children under 5 years of age (1.7% of all deaths) represented
9.1 per 1,000 live births in 2000. The leading causes of death were: accidents,
birth defects, malignant neoplasms, influenza, pneumonia and meningitis. The
percentage of low birth weight fell to 6.1% in 2000.
Schoolchildren (5-9 years):Of
total deaths 0.3% occurred among children 5-9 years in 2000, with a mortality
rate of 0.3 per 1,000. The five leading causes of death (73% of total) included
accidents, malignant neoplasms, birth defects, homicide, influenza and pneumonia.
Adolescents (10-19 years):In
2000, adolescents constituted 14% of the population. The fertility rate among
adolescents decreased to 52.3 per 1,000 women in 2000. The mortality for all
causes among adolescents decreased to 0.48 per 1,000 in the same year and deaths
represented less than 1% of all deaths, 1996-2000.
Adults (25-59 years): Adults
represented 50% of the population and accounted for approximately 20% of deaths
in this age range. The crude death rate was 2.8 per 1,000 population in 2000.
The leading causes of death were malignant neoplasms, heart disease, and accidents,
accounting for 57% of all deaths. Excess male mortality was observed for all
causes except malignant neoplasms. Almost all mothers gave birth in a health
institution and the average number of prenatal visits exceeded 10 per birth,
and 95% of first visits occurred before the 14th week of pregnancy. The maternal
mortality rate was 34.1 per 100,000 live births in 2000, mainly due to other
complications of pregnancy, of childbirth and of the puerperium.
Elderly (60 years and older): Community
services are provided through a comprehensive program for the elderly, oriented
towards health promotion through "grandparents'circles", which currently has
468,584 participants. There are also grandparents homes, which served more than
60,100 elderly. Those 60 years of age and older accounted for 75% of all deaths
in 2000. The leading causes were heart diseases, malignant neoplasms and cerebrovascular
diseases, responsible for 63% of total deaths. Mortality from heart diseases
was reduced 16% in 2000 in comparison to 1996. In 2000, the most frequent communicable
diseases were acute diarrheal diseases and acute respiratory infections, which
accounted for 57 and 296 per 1,000 medical visits, respectively.
Workers: In
2000, there were 4,722 workplaces with health care services. Since 1998, reporting
of occupational diseases has been mandatory, with 436 cases in 2000. Male laborers
aged 40-50 years old who had more than 15 years of exposure comprised 70% of
cases. The main diseases were dermatosis caused by exposure to petroleum products,
chronic nodular laryngitis and chronic chemical poisoning. The annual average
number of occupational accidents is 13,000.
Special groups: A
special government program aims to provide sustainable development to population
residing in mountainous areas (Turquino-Manatí plan), where 726,605 inhabitants
have access to an extensive network of health services. These include1,387 primary
health care teams in 1,137 health care facilities. In 2000, infant mortality
in these areas was reported as 7.6 per 1000 live births.
Analysis by type of health problem Natural disasters: Between
1997-1999 there were droughts and two hurricanes, Georges and Irene, which caused
considerable property damage.
Vector-borne diseases: A
program aimed at eradicating the Aedes aegypti mosquito, with an entomological
and epidemiological surveillance program is in place. In 1997, an outbreak of
dengue, serotype 2 virus, occurred in Santiago de Cuba , with 3,012 confirmed
cases, 205 cases of hemorrhagic dengue and 12 deaths. In 2000, 138 cases of
dengue fever, virus types 3 and 4, were reported in Havana province.
Vaccine-preventable diseases. The
National Immunization Program protects against 13 diseases. Vaccination coverage
among children under 2, schoolchildren, and adults is higher than 95%. In 1999,
vaccination against Haemophilus influenzae type b was introduced for all children
under 1 year, resulting in only 35 cases of illness in 2000. A similar situation
occurred with vaccination against meningococcus B and C with 56 cases in 2000,
or a decline of 13%.
Intestinal infectious diseases:The
incidence of intestinal infectious disease in 2000 was 77.1 per 1,000 population.
Foodborne diseases: In
1996, 716 outbreaks produced by food, water, and ciguatera fish were reported,
while in 2000 only 306 were reported.
Tuberculosis: The
incidence of tuberculosis showed a downward trend, with an annual reduction
of 5% to 10.1 per 100,000 population in 2000, while mortality remained below
1 per 100,000. The cure rate is 92% and BCG vaccination coverage of newborns
is 99%. The association of HIV infection and tuberculosis occurred in 7% of
cases during 1986-1999.
Acute respiratory infections:Mortality
from influenza and pneumonia remain among the five leading causes of death in
children under 5 and in the general population. Morbidity shows an annual average
of 4 million health care visits and account for 25-30% outpatient visits and
around 30 % of hospitalizations. The influenza A/Sidney (H3N2) virus was the
predominant causal agent. Since 1997, the flu vaccine has been administered
to all older persons as well as to patients undergoing dialysis.
Zoonoses:Four
cases of human rabies due to bat transmission have been reported during 1995-2000.
AIDS and sexually transmitted infections:
Between 1986 and 2000, 3,231 HIV-positive individuals had been detected; of
them, 1,194 have developed AIDS and 840 have died. Between 1995-2000, 839 cases
of AIDS were reported. 50% of them in Havana , 76% affected are males. The most
frequent route of transmission is sexual (98%). While the epidemic remains in
certain groups, all HIV-infected persons and AIDS patients received treatment
free of charge. The annual incidence of AIDS ranged between 8.9 in 1996 to 15.1
per 100,000 of pop. in 2000. Cases of syphilis and gonorrhea decreased, 1996-2000.
In 1992, universal vaccination of newborns against Hepatitis B was implemented,
coupled with vaccination of the population cohort aged under 20 years (completed
in 2000) and the principal risk groups. In 2000, morbidity had declined 80%
compared with 1992. The prevalence of Hepatitis B among blood donors was 0.8%
in 2000.
Nutritional disorders: In
2000, a national survey showed the prevalence of moderate malnutrition at 4%
of all children and 0.4% from severe malnutrition, according to weight-for-age.
With regard to height by age, 5% showed moderate malnutrition and 1% severe
malnutrition. Based on weight-for-height, 2% of children suffered moderate malnutrition
and 0.4% severe malnutrition. Iron deficiency anemia is the most frequent nutritional
problem in Cuba , affecting 23% of pregnant women in their third trimester of
pregnancy and 46% of children from 6 months to 2 years of age in 2000. The national
plan for prevention and control of iron deficiency and anemia includes food
fortification, food supplementation, food diversification, and surveillance.
A nationwide study, conducted in 1999 that measured vitamin A levels in children
aged 6 months to 2 years, showed that only 4% had values under 20 mg/dl.
Diseases of the circulatory system: Heart
disease is the leading cause of death, with 180.3 deaths per 100,000 population
in 2000. The majority of deaths occur between the age of 65 years and over or
77% of all deaths. Between 1997-2000, ischemic heart disease was the leading
cause of death in this age group. In 2000, the incidence was 1.8 x 1000 population
among persons over 15 years of age, with a case-fatality rate of 65%. Mortality
from cerebrovascular diseases rose in 2000 to 72.9 per 100,000 population and
an average of 7,900 people died from this cause in the last five years. However,
the age-ajusted rate era 53.8 per 100,000 population in 2000. These diseases
are responsible for the highest in hospital mortality and are the leading cause
of hospital admission for neurological disease in the acute phase. Arterial
hypertension constitutes the principal risk factor.
Malignant tumors: Mortality
from malignant neoplasms increased from 108 to 112 per 100,000 population, 1990-2000,
affecting more men than women. Among the most frequent cancer sites were trachea,
bronchia, and lung (22%) as well as colon and rectum (9%). Among men, sites
included the prostate (19%), and among woman breast (15%) and uterus (6%). Only
1% of cancer cases and deaths occurred in children. In children under 15 years
of age the principal neoplasms were leukemia, lymphomas, and kidney tumors.
The risk of dying from arterial hypertension was 11.5 per 100,000 population
in 2000. The National Risk Factors Survey found 30% prevalence of high blood
pressure in persons aged 15 years and older in urban areas.
Metabolic diseases: The
mortality rate due to diabetes mellitus declined 44% from 23.5 per 100,000 pop.
in 1996 to 13.1 in 2000, while the prevalence increased to 23.6 per 1,000 population.
The National Diabetes Mellitus Program carried out a variety of activities,
including training, and activities to increase the detection of the disease
and improve the availability of effective medication.
Bronchial asthma:Mortality
declined from 5.2 per 100,000 in 1996 to 1.9 in the 2000.
Accidents and violence:Mortality
from external causes (accidents, suicide and homicide) decreased from 79.3 per
100,000 in 1996 to 68.9 in 2000, although the risk of dying increased after
the age of 40 years. Death rate from accidents declined from 51.6 per 100,000
population to 44.5. Accidental falls and transport accidents accounted for 70%
of all deaths from external causes. Male mortality is higher for all types of
accidents, except accidental falls and burns from exposure to fire. Suicide
deaths were 16.4 per 100,000 population.
RESPONSE OF THE HEALTH SYSTEM Health sector policies and plans:
Cuba's health system is an ongoing reform process. The Ministry of Public Health
(MINSAP) drafted a policy to enhance the efficiency and quality of health services,
ensuring the sustainability of the system, and eliminating health inequalities
between regions and population groups. The policy prioritizes health promotion
and disease prevention activities, decentralization, intersectoral action, and
community participation. In 1995, MINSAP launched a process of health sector
reform, which included a sectoral analysis that identified the existing problems
and served as a basis for the development of a normative document known as the
"methodological toolkit". In addition to methodological guidelines, this document
established five strategies: reorientation of the health system towards primary
care, improvement of hospital care, promotion of high-technological programs
and research institutes; development of the program and natural and traditional
medicine and drugs, and prioritization of dental, eye, and emergency care. Maternal
and child health, noncommunicable diseases, communicable diseases, and health
of older personas are high-priority programs of the sector.
Institutional organization: The
health system is structured in three levels that correspond to the political
and administrative subdivisions of the country: national, provincial, and municipal.
The national level was overseen by MINSAP that plays a steering role and carries
out methodological, regulatory, coordination, and control functions. The municipal
level consisted of municipal departments of public health, that were subject
to the authority of municipal people's councils, polyclinics, and health areas.
Health legislation: Law
41 lays out the basic principles for the regulation of social relationships
in the field of public health. New legislation has reorganized the medical ethics
commissions at all levels, established regulations for MINSAP managerial staff,
addressed the issue of organ and tissue transplant, and regulated the dismissal
and transfer of upper- and mid-level technicians in the health sector. New legislation
included laws on drugs, regulations for medical equipment and issue and control
of medical certificates, a resolution on encephalitis deaths, and legislation
on the human genome.
Regulatory actions: The
MINSAP was responsible for enforcing state and government policies on the protection
of human health. It established and ensured compliance with regulatory policies
on research, introduction of health technologies, and regulation and quality
control of pharmaceutical products, cosmetics, foods, chemical products, and
medical equipment and devices. Health inspection functions were overseen by
the MINSAP and executed at all levels of the national health system, under the
supervision of the public health and epidemiology centers and units. Pharmaceutical
products were subject to a state system of quality control based on good manufacturing
practices. Quality control functions were carried out by the Center for Drug
Development, responsible for evaluation and certifying drugs and diagnostic
material for registration, setting standards, and regulations.
Public health care services:The
health promotion strategy was strengthened through decentralization of the national
health system. The National Network of Health Municipalities, which includes
46.7% of the country's 169 municipalities encouraged activities in educational
institutions, workplaces, cooperative centers, markets, and penitentiaries.
Health Analysis and surveillance: Surveillance
is carried out at all levels of the national health system by trend analysis
units created in 1993. The country has a network of microbiology laboratories,
which comprises one national reference unit (at the Pedro Kourí Institute of
Tropical Medicine), 145 local units, and 14 regional units.
Potable water and sewerage services:Underground sources comprise 72% of potable water.
In 2000, the volume increased 57.1 hm3 from 1999. Of the water supplied,
94% received treatment. In 1999, 95% of the population was supplied with drinking
water, and 74% had house connections (85% in urban area and 40% in rural areas).
It is estimated that 38% of the population has access to sewerage systems and
55% to septic tanks and latrines. The country had addressed the problem of final
disposal of urban solid waste through the construction of 166 manual sanitary
landfills, which worked well in cities of up to 20,000 inhabitants.
Food safety: Cuba
developed a new food safety program that included: surveillance, inspection,
education and training, standardization, food laboratory network, risk reporting,
and investigation of outbreaks. There was a network of 52 laboratories, including
provincial and municipal public health as well as epidemiology centers. In accordance
with the Program of Food Imports and Exports, all imported foods and cosmetics
must be registered.
Organization of individual health care services:
The strategy for strengthening primary health
care (PHC) aimed to improve the response capacity of family medicine clinics
and polyclinics with respect to organization, implementation, and evaluation
of health care. The PHC system comprised 31.000 physicians and nurses, organized
in a network that encompassed 442 polyclinics, 64 rural hospitals and some 22.000
family medicine clinics. In 2000, 99% of the Cubans were covered by the health
care system, which addresses needs of individuals and families throughout the
lifecycle. Hospital services form a network of 270 hospitals that provided preventive,
curative, and rehabilitation services. Hospitals were comprised of 60% general,
clinical- country surgical, pediatric, and gynecological and obstetric hospitals.
To serve the rural population, 62 hospitals offered care in basic specialties.
Between 1996 and 2000, some 10,000 low-use hospital beds were eliminated as
a result of an increase in outpatient care and home health care.
Blood banks:Blood
banks were established in 24 institutions. There were 575,000 annual blood donations
and 100% were screened for syphilis, HIV-1, HIV-2, hepatitis B and C.
Health supplies:
More than 1,000 generic drugs were produced in Cuba, and classified based on
the WHO criteria as to whether they were of chemical-industrial origin, naturopathic,
homeopathic, or herbal, as well as phytopharmaceuticals or apitherapy products
and cover 86% of the drugs consumed in the country. Medical products included
biotechnical, laboratory equipment, computerized equipment for studies of electrical
activity of the heart, bone scans, rapid microbiological test kits, and ozone,
as well as laser treatment instruments and magnetic resonance models.
Human resources: Numbers
of workers in the national health system increased 6% in 1999; 72% were women.
The country had 58.2 physicians per 10,000 population in 1999. Employment for
100% of graduating health professionals was guaranteed and met the demand for
health services. There was a centralized human resources planning process, through
which five-year plans were developed, considering geographic areas and the country
as a whole.
Health sector expenditure and financing: The
total amount spent on public health increased 59%, between 1994 and 2000 - an
annual average increase of 9.6% (170.8 million US $ in 2000). Wages accounted
for the larges proportion of this spending. Spending on drugs averaged around
180.000 pesos a year. The share of the central government in the distribution
of expenditure on public health showed a downward trend, which is reflective
of the process of decentralization and the strengthening of primary health care.
