"Isolation doesn't work," proclaimed President Obama on his historic trip to Cuba in March. Several weeks later, APA followed with its fourth trip to Cuba as part of our Learning Partnership program, which is open to all members. I went on the trip two years ago and again this year in May during a time of great social change in Cuba. On the trip, we participated in a conference sponsored by the Cuban Society of Psychology, toured health-care facilities, and further developed relationships with our Cuban colleagues and conference participants from close to 50 other Latin American countries.
We discovered a lot about the strength of the Cuban people. In the time since the "Triumph of the Revolution," Cubans have endured years of struggle, especially because of the U.S. embargo that started in 1960 and then the sudden lack of economic support with the collapse of the Soviet Union in 1991. But Cuba is changing. While there continues to be such serious human rights concerns as restrictions on freedom of expression, association and movement, the government now allows small private businesses, such as stores and restaurants. Travel restrictions on most Cubans have lifted, if they have the resources.
With regard to their health-care system, there is much for us to learn. Cuba has been organized for decades around a population health, prevention approach much like what the United States is aiming for now. In terms of cost, the World Bank in 2012 rated the United States' health care as the most expensive — spending $8,895 on health care per capita per year — whereas Cuba ranks 118th — spending $558 per capita per year. Even with this huge cost difference, citizens of both countries have life expectancies of 79 years, and Cuba's infant mortality rate is lower than that of the United States.
How can a low-resource country spend so much less and get equivalent or better outcomes? Because health promotion, well-being and prevention are more than posters on their walls. All Cubans have annual physical and mental health screenings; if patients don't come in, nurses visit them at home. Health professionals live in the neighborhood and know who is pregnant and in need of prenatal care. There are no access problems; people go to see their primary-care clinician without appointments. Integrated care is the norm; psychologists are embedded in all health-care services. When patients need a higher level of care, they are sent — often the same day — to the secondary level of care, the polyclinic, where they see a psychologist or other health professional for more intensive treatment. Only those with the most serious conditions, mental or physical, go to day treatment or the hospital, considered tertiary care.
Overall, the main difference is that Cuba is focused on collective values, while the United States is more individually focused. "Social variables are the ruling ones," one psychologist told us. Family support and education, couple and family therapy, and community interventions are all more common in Cuba than here.
What's next in our relationship with Cuba? As highly respected Cuban psychologist Dr. Manuel Calvino Valdes-Fauly said at the conference: "Our doors, windows, hearts and arms are being opened." What is the meaning of "open?" He defined it as "a fresh start — a time when we must change the way we perceive, think about and do things…. We need to be open to criticism to be able to criticize," he said and argued for "responsible consumption."
Many conference participants expressed the desire for Cuba to have a collaborative relationship with the United States. To do so, we will have to move from a position of unintended entitlement and perceived arrogance to one of receptivity and listening, a willingness to engage. One speaker ended by encouraging engagement, saying, "Let us be participants in the construction of our Cuba." We might adapt this sentiment for our own needs: Let us be participants in the construction of our association, our discipline of psychology, our culture, our health-care system, and our relationships with colleagues in other countries.
