U.S. Sen. Tom Harkin, D-Iowa, recently spent three days in Cuba — the longtime socialist adversary of the United States — to learn more about the island nation’s health care system.
For years, some health policy specialists in the United States have been intrigued by Cuba’s system. The country produces a disproportionate number of doctors, and it has posted relatively strong health statistics in international comparisons, especially considering its shortage of economic wealth.
Harkin certainly saw something promising in Cuba’s system. During a press conference upon his return to Washington on Jan. 29, Harkin — the chairman of the Senate Health, Education, Labor, and Pensions Committee — said that Cuba is a “poor country, but they have a lower child mortality rate than ours. Their life expectancy is now greater than ours. It’s interesting — their public health system is quite remarkable.”
We wondered whether these statistics are accurate and what they say about health care in Cuba.
Child mortality statistics
On child mortality, we found a few data sources that are generally considered credible. According to the CIA Factbook, Cuba’s infant mortality rate is indeed lower — an estimated 4.76 deaths per 1,000 live births in 2013, compared with 5.90 for the United States.
And more precisely given the phrase Harkin chose, Cuba also has a better child mortality rate — that is, the likelihood of death under 5 years of age. According to the World Health Organization, Cuba had six deaths under age 5 per 1,000 live births between 2005 and 2010, compared with eight deaths for the United States.
So on child mortality, Harkin had his numbers right.
Life expectancy statistics
The data for life expectancy appear to be mixed. According to the CIA Factbook, the estimated life expectancy in 2013 was 78.62 in the United States, compared with 78.05 in Cuba. And according to the World Health Organization, life expectancy in 2011 was 79 in the United States and 78 in Cuba.
By these sources, Harkin would be wrong. But when we contacted his office, it pointed us to data from the Pan American Health Organization that backed up its claim. For 2012, the group found that life expectancy was 79.2 years in Cuba, compared with 78.8 years in the U.S.
How reliable is this data?
We wondered, however, whether the data from Cuba’s authoritarian government could be trusted. As we looked into it, we heard a measure of skepticism.
We did find one area of agreement: Cuba puts a lot of emphasis on its health data. Richard H Streiffer, the dean of the College of Community Health Sciences at the University of Alabama, said his conclusion from two visits to Cuba is that Cuban health practitioners are “very compulsive about collecting data and reporting it regularly.”
On his most recent trip, Streiffer spent time with a family doctor in a neighborhood clinic. “Family doctors are mandated to collect certain data,” he said. “He had right on his wall, a ‘dashboard’ of data characterizing his practice — an age/sex distribution; an age/sex distribution of the top 10 chronic diseases in his practice; a map of where his patients lived in the neighborhood. You don’t find that in the U.S.”
Some experts, however, say Cuba is so concerned with its infant mortality and life-expectancy statistics that it takes heavy-handed actions to protect its international rankings.
”Pregnant women are treated with very authoritarian tactics to maintain these favorable statistics,” said Tassie Katherine Hirschfeld, the chairwoman of the department of anthropology at the University of Oklahoma, who spent nine months living in Cuba to study the nation’s health system. “They are pressured to undergo abortions that they may not want if prenatal screening detects fetal abnormalities. If pregnant women develop complications, they are placed in ‘Casas de Maternidad’ for monitoring, even if they would prefer to be at home. Individual doctors are pressured by their superiors to reach certain statistical targets. If there is a spike in infant mortality in a certain district, doctors may be fired. There is pressure to falsify statistics.”
Hirschfeld said she’s “a little skeptical” about the longevity data, too, because Cuba has so many risk factors that cause early death in other countries, such as unfiltered cigarettes, contaminated water and a meat-heavy diet.
Transparency would help give the data more credibility, but the Cuban government doesn’t offer much, experts said.
Hirschfeld said that organizations such as the Pan-American Health Organization “rely on national self-reports for data, and Cuba does not allow independent verification of its health claims.”
Rodolfo J. Stusser — a physician and former adviser to the Cuban Ministry of Public Health’s Informatics and Tele-Health Division who left for Miami at age 64 — is another skeptic. While Stusser acknowledges that Cuba has improved some of its health numbers since the revolution, the post-revolution data have been “overestimated,” he said. “The showcasing of infant mortality and life expectancy at birth has been done for ideological reasons,” he said.
Harkin said Cuba has “a lower child mortality rate than ours. Their life expectancy is now greater than ours.”
According to the official statistics, Cuba does beat out the United States for both infant and child mortality, and on life expectancy, the data are mixed, with a slight edge to the United States. But the combination of the Cuban government’s heavy-handed enforcement of statistical targets and the lack of transparency has led some experts to look skeptically at the numbers. On balance, we rate Harkin’s claim Half True.
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This article was edited for length. To see a complete version and its sources, go to www.politifact.com/truth-o-meter/statements/2014/jan/31/tom-harkin/sen-tom-harkin-says-cuba-has-lower-child-mortality/.