The report continues, "A humanitarian catastrophe has been averted only because the Cuban government has maintained a high level of budgetary support for a health care system designed to deliver primary and preventive health care to all its citizens."

The American Association for World Health is the U.S. Committee for the World Health Organization and the Pan American Health Organization. It includes a number of well- known doctors and other medical professionals on its staff. Former U.S. president James Carter is honorary chairman of its board. AAWH conducted its study over a 12-month period between 1995 and 1996.

Cuban Democracy Act of 1992
Washington's embargo has been in place since October 1960. But its recent tightening since the early 1990s, after Cuba lost aid and trade in favorable terms with the former Soviet bloc countries, has exacerbated the effect. The study, titled "The Impact of the U.S. Embargo on Health and Nutrition in Cuba," points to several factors adversely affecting the availability of food and medicines in Cuba, stemming from "little-understood provisions of the U.S. Congress' 1992 Cuban Democracy Act."

The Cuban Democracy Act (CDA) banned trade with Cuba of U.S. subsidiaries in third countries. The ban applies to all foodstuffs and medicines. Prior to the cut-off, more than 90 percent of U.S. subsidiary trade with Cuba was in foods and medicines.

Under the CDA, the U.S. Treasury and Commerce Departments are allowed in principle to license individual sales of medicines and medical supplies, ostensibly for humanitarian reasons. The licensing provisions are so restrictive, however, that the number of licenses granted - or even applied for since 1992 - are minuscule.

The CDA also prohibited ships docking in Cuba from entering U.S. ports for six months, severely curtailing the ability of the Cuban government to secure shipping of medical equipment and increasing import costs. "From 1993 to 1996, Cuban companies spent an additional $8.7 million on shipping medical imports from Asia, Europe, and South America," the report states.

The misnamed Cuban Liberty and Democratic Solidarity Act of 1996, also referred to as Helms-Burton law, has added to the "chilling effect, further discouraging American suppliers in the health care industry from even contemplating trade with Cuba."

Disastrous results on health
As a result of these draconian sanctions, the study found that physicians now have regular access to only 889 of the 1,297 medicines that were available in Cuba in 1991. "U.S. dominance of the international pharmaceutical industry as a result of a wave of mergers in the early 1990s has severely exacerbated the problem," said Robert White, Professor of Neurosurgery at Case Western Reserve University in Cleveland, who was part of the AAWH delegation to Cuba.

"In 1995, for instance," the AAWH report says, "Upjohn, a major U.S. pharmaceutical company, merged with a Swedish concern, Pharmacia, which since 1970 has logged multimillion dollar sales to Cuba for protein purifying equipment, reagents for clinical laboratories and production plants, chemotherapy drugs, and growth hormones." Upjohn ended Pharmacia's sales and closed down its Havana office within three months of the merger. "Cuba suddenly lost another supplier of plates for HIV tests and other diagnosis kits to screen for hepatitis B and C, when Sybron International of Wisconsin bought out Nunc of Germany."

Today it is difficult to find any state-of-the-art machinery that does not have some U.S.-built component, said Dr. Peter Bourne, chairman of the AAWH board. "Cuba cannot get spare parts for the U.S. equipment it has. We witnessed kidney dialysis, x-ray, respirators, incubators and other life-saving equipment standing idle for want of U.S.-produced spare parts."

Surgeries have dropped from nearly 886,000 in 1990 to about 536,500 in 1995, the AAWH study found - "a glaring indicator of the decline in hospital resources."

AAWH surveyed 12 U.S. pharmaceutical and medical supply companies. Ten stated that licensing red tape kept them from fulfilling requests from Cuba to purchase goods. When the Canadian subsidiary of Cleveland-based Picker International applied for permission to sell x-ray parts for 20-year-old machines earmarked for use in maternity and pediatric hospitals in Cuba, the U.S. Department of Commerce denied a license, writing that exports would be "detrimental to U.S. foreign policy."

In one instance Cuban cardiologists diagnosed a heart attack patient with a ventricular arrhythmia. He required an implantable defibrillator to survive. Though the U.S. firm CPI, which held a virtual monopoly on the device, expressed a willingness to make the sale, the U.S. government denied a license for it. Two months later the patient died. The AAWH study found that heart disease is the number one cause of death in Cuba. Mortality rates for men and women increased from 189 deaths per 100,000 in 1989 to nearly 200 per 100,000 in 1995.

Washington has also actively tried to prevent Cuba from manufacturing its own drugs. In 1993, for example, the U.S. Treasury Department denied a license to the German subsidiary of Pfizer to sell Cuba one pound of the active ingredient methotrextate for trials of an anti-cancer drug.

Breast cancer, a primary cause of death for women worldwide, is often preventable with early detection and treatment. Until 1990 all women over 35 in Cuba received mammograms on a regular basis at no cost. Today mammograms are no longer employed as a routine preventive procedure and are used only for women considered to be at high risk. "The embargo prevents the Eastman Kodak company or any subsidiary from selling the U.S.-produced Kodak Mini-R film - a product specifically recommended by the World Health Organization because it exposes women to less radiation," the study says.

Cuba's water supply system is built with U.S. manufactured parts. Since 1992, Cuba can no longer purchase parts for the chlorination systems that treat 72 percent of Cuba's drinking water because parts are only available from the U.S. firm Wallace and Tiernan. This single embargo-related prohibition jeopardizes safe drinking water for over 4 million people. Morbidity rates from water-borne diseases have doubled since 1989, particularly affecting elderly Cubans.

The outright ban on the sale of U.S. foodstuffs has also contributed to serious nutritional deficits, particularly among pregnant women, leading to an increase in low birth- weight babies, the AAWH report notes.

Response by Cuban government
"Such a stringent embargo, if applied to most other countries in the developing world, would have had catastrophic effects on the public health system," the study says.

Such results have been averted in Cuba because of the attention and resources the revolutionary government in Havana has invested in limiting erosion of health care.

"The Cuban constitution makes health care a right of every citizen and the responsibility of the government," the report says. "The system is based on universal coverage and comprehensive care, essentially free of charge to the population. Over the years, the central government has placed a top priority on public health expenditures in the national budget... Consequently in the 1990s Cuba's health statistics more closely approximated those of the nations of Europe and North America than of developing countries, with 195 inhabitants per physician, and 95 percent of the population attended by family doctors living in the communities they serve."

Life expectancy in Cuba in 1994 was 75 years, compared to an average of 68 in Latin America, and infant mortality was 9.4 per 1,000 live births, compared to 38 in Latin America. To counter the impact of Washington's intensified economic war, the Cuban government has increased health-care spending by more than 30 percent between 1989 and 1996, the study says. The problem is that imports of medical supplies and food have to be purchased in hard currency now, which is scarce.

The report can be obtained from AAWH at 1825 K St., NW, Suite 1208, Washington, DC 20006. Tel: (202) 466-5883.  
 
 
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