GESTIÓN EN SALUD PÚBLICA: BioEdge: Questioning Bernie’s praise of Cuban health stats

domingo, 1 de marzo de 2020

BioEdge: Questioning Bernie’s praise of Cuban health stats

BioEdge: Questioning Bernie’s praise of Cuban health stats

Bioedge

Questioning Bernie’s praise of Cuban health stats

by Michael Cook | 29 Feb 2020 |

Senator Bernie Sanders again got into hot water this week with careless remarks about Cuba. "It's unfair to simply say everything is bad" about the way Castro governed, he said on CBS 60 Minutes.

Over the years Sanders has praised Cuba’s achievements in advancing literacy and health care – while also condemning its authoritarianism.

In fact, extolling Cuba’s health statistics is hardly confined to Mr Sanders. It's a common factoid in the media. In 2002, a World Bank study asserted that Cuba had achieved “near universal literacy, the eradication of certain diseases, widespread access to potable water and basic sanitation, and among the lowest infant mortality rates and longest life expectancies in the region.”

As President, Barack Obama told a meeting during a visit to Argentina that “Medical care -- the life expectancy of Cubans is equivalent to the United States, despite it being a very poor country, because they have access to health care. That's a huge achievement. They should be congratulated.”

Hmmmm. Here’s where the medical ethics comes in: are these stats “fake news”? How do we know that Cuba hasn't been fiddling with the figures?

In the wake of Sanders’s remarks this week, opposition research helpfully reminded the Bernie-philic Twitterverse of a paper in Health Policy and Planning by academics from Texas Tech which argues that “data manipulation” is responsible for Cuba’s strong health statistics.

They found that Cuba’s figures on infant mortaliy were out of sync with other Latin American countries. They suspect that “physicians likely reclassified early neonatal deaths as late fetal deaths, thus deflating the infant mortality statistics and propping up life expectancy”.

Authoritarian policies also help. “Physicians often perform abortions without clear consent of the mother, raising serious issues of medical ethics, when ultrasound reveals fetal abnormalities because ‘otherwise it might raise the infant mortality rate’.”

“If we combine the misreporting of late fetal deaths and pressured abortions, life expectancy would drop by between 1.46 and 1.79 years for men,” they write.

Michael Cook is editor of BioEdge

“Progressive! Individuals have a right to ‘self-determined’ suicide, including the freedom to take one's own life and to enlist support provided by third parties. German court rules assisted suicide ban violates citizens' rights to determine their own death.”

This was tweeted by Philip Nitschke, Australia’s indefatigable campaigner for an unfettered right to die. It was a good summary of a decision by the German Federal Constitutional Court on Wednesday, which declared that banning assisted suicide was against Germany’s ‘Basic Law’.

From now on people will be free to seek commercial assistance to help them die. (At least doctors won’t be co-opted, for the moment.) This opens up all sorts of business opportunities. Will there be death doulas in every funeral home? Watch this space.