The epidemiologic approach of the Cuban health system

Revista Brasileira de Epidemiologia

Martínez Calvo, Silvia¹ 

[1]Facultad Salud Pública, Ciudad Habana, Cuba

关键词: Epidemiology;    Health system;    National strategies;    Health manpower;    Health planns and programmes;    Health policy;   

DOI  :  10.1590/S1415-790X1999000100003

学科分类：过敏症与临床免疫学

来源: SciELO

【 摘 要 】

The internationalrecognition of the achievements of the Cuban health system, the stability -questionedon some occasions - of health indicators, and the enormous human resources andmaterials invested to develop the policies and national sanitary strategiescomprise an excellent field to analyze the epidemiological contribution to thosepositive results in the health area. Among those outstanding results, the longerlife expectancy, the low mortality rates, infant mortality, and mortality dueto infectious and parasitic diseases partly due to the elimination or eradicationof a group of diseases preventable by immunization. Were these results reachedby an epidemiologically oriented health system? Do the procedures carried outallow for the proposal of a Cuban School of Epidemiology? The objective of thispaper is to offer answers to these queries through a critical appraisal on thepresumable epidemiological orientation of the health system, and the incorporationof epidemiological thinking in the sanitary strategies that have been designedand developed in Cuba. An arbitrary, but notorious dichotomy, the Seminar onthe "Uses and Perspectives of Epidemiology", held in Buenos Aires in 1983, hastraced rules for the epidemiological performance in the Region as a whole andcontributed to the analysis above. The dichotomy -before and after the Seminar- created the national scenarios for practicing epidemiology at the academic,investigative and health services levels, supported on 4 basic pillars: politicalwill, an organized and conscious community, accessible health system, totalcoverage and broad financing, and highly qualified human resources. The healthsystem went through four stages whose description - including healthcare models,development strategies, epidemiological activity and training - provides themeans to recognize its presumably epidemiological orientation, and its linkto the different schools of thought prevailing during each stage. Another importantaspect on the theme is the proposal of a Cuban School of Epidemiology, and theassessment carried out, specifying the distance between the ideal thing andthe real thing, because a "school of thought" does not seem "to be built bysum of well-known actions, if not, for overwhelming contributions that may re-formulatethe discipline itself, and consequently reorient practice." In conclusion, acertain gap between the theoretic argument and the epidemiological practicein the National Health System is recognized. Consequently, its epidemiologicalorientation has been limited. The challenge the situation represents to reachthe epidemiological leadership that is promoted in the discourse is unavoidable,and for this reason, health reform appears as an excellent and timely opportunity.

【 授权许可】

CC BY