How Cubans Live as Long as Americans at a Tenth of the Cost

Compulsory health checks
"My nurse knows where they live," Dr Quevas Hill jokes. "They can run, but they can't hide!"
The data from this check-up allows the family doctor to put her patients into categories according their "risk". If they're healthy, the annual check-up is enough. But if they're showing signs of ill-health, if they drink too much, smoke or have a continuing health condition, they're seen much more regularly.
It's an integrated, whole-person approach to healthcare, perhaps too intrusive for some, but widely accepted within Cuba.
The aim is to stop people getting ill in the first place.
According to Gail Read, executive editor of the international health journal, MEDICC Review, Cuba had to focus on prevention precisely because it is a poor country.
"It's much more cost-effective to treat hypertension by exercise than to do a coronary by-pass", she says. "It makes sense to go upstream, to catch the problem before it begins or very soon afterwards."
So in this highly centralised country, data is gathered at the local level, fed up to the second tier of healthcare, the neighbourhood policlinic.
Here, health trends are spotted and decisions taken about how best to intervene.

between 1991 and 2011. The data showed that, during the period of the economic crisis, deaths from cardiovascular disease and adult-onset type 2 diabetes fell by a third and a half, respectively.

The researchers say that it has more to do with simple weight loss. Cubans, who were walking and bicycling more after their public transportation system collapsed, and eating less

It wasn't only the amount of food that Cubans ate that changed, but also what they ate. They became virtual vegans overnight, as meat and dairy products all but vanished from the marketplace. People were forced to depend on what they could grow, catch, and pick for themselves-- including lots of high-fiber fresh produce, and fruits, added to the increasingly hard-to-come-by staples of beans, corn, and rice. Moreover, with petroleum and petroleum-based agro-chemicals unavailable, Cuba "went green," becoming the first nation to successfully experiment on a large scale with low-input sustainable agriculture techniques. Farmers returned to the machetes and oxen-drawn plows of their ancestors, and hundreds of urban community gardens (the latest rage in America's cities) flourished. "If we hadn't gone organic, we'd have starved!"

During the special period, expensive habits like smoking and most likely also alcohol consumption were reduced, albeit briefly. This enforced fitness regime lasted only until the Cuban economy began to recover in the second half of the 1990s. At that point, physical activity levels began to fall off, and calorie intake surged. Eventually people in Cuba were eating even more than they had before the crash. The researchers report that "by 2011, the Cuban population has regained enough weight to almost triple the obesity rates of 1995."

Not surprisingly, the diseases of affluence made a comeback as well. Diabetes increased dramatically, and declines in cardiovascular disease slowed to their sluggish pre-1991 levels. (Heart disease did decline slightly in the 1980s due to improved detection and treatments.) By 2002, "mortality rates returned to the pre-crisis pattern," according to the authors of the study. Cancer deaths, which fell in the years after the crash, also started inching up after the recovery, rising 5.4 percent from 1996 to 2010.