[xyahoo]

On the other hand:

- average life expectancy in Cuba is almost the same as the USA (and higher than Mexico, Belize, Bahamas, Brazil, etc.).

- literacy rate in Cuba is higher than that in the USA

- Physicians per 10,000 people: Cuba has 67, USA has 24

In the Ebola crisis, Cuba has been leading from the front.

[WildUtah]

Physicians per capita figures are misleading.

The US figure reflects very long careers; late retirements; investment in large teams of trauma specialists due to high war, car crash, and gunshot wound rates; a high percentage of women physicians working part time; and a high concentration of expensive specialists with no documentation that they improve outcomes and paid for by large federal government subsidies.

The actual amount of primary physician and general surgery time available to Americans is very low compared to other countries with similar numbers of doctors. Most countries also allow as many as half the cases administered by fully licensed doctors with 12-20 years of post-secondary schooling in the USA to be handled by nurses and pharmacists. Prescriptions for sniffles or heartburn, basic non-controlled medications, simple physical assessments, and vaccinations are handled by professionals the USA would consider nurses or pharmacists or unlicensed assistants in most first world countries. In the USA those jobs take the time of physicians.

And that is the top reason, among many other unrelated ones, that health care is so much more expensive in the USA. US doctors are fewer and have more responsibilities and thus must be paid extraordinarily to work very long hours and not retire at the usual ages or else some must go without care. It's not an accident; medical societies have blocked medical school expansion for decades until recently as the population grew.

Cuba, on the other hand, appears to be counting nurse practitioners as physicians. That's fine to do because they're highly qualified, but it makes the numbers not comparable across countries.

[chimeracoder]

> It's not an accident; medical societies have blocked medical school expansion for decades until recently as the population grew.

Sort of. There are a lot of very common misconceptions around this.

The AAMC (not AMA!) limited the number of medical school students until about ten years ago, at which point they announced an explicit goal of expanding the number of graduates from medical school.

However, this doesn't mean anything in practice[0], because the bottleneck isn't the medical school graduates - it's the residency programs. As a medical school graduate, you have an MD, but you are not actually qualified to practice medicine. That requires usually four years of training (minimum), plus several more for various specialties.

These programs are costly to run, and so hospitals that offer residency programs are funded by the federal government to do so (through Medicare). The only way to expand the number of practicing physicians in the US is to skimp on quality during training (which nobody wants to do), or to increase funding through Medicare (which nobody wants to do.

> US doctors are fewer and have more responsibilities and thus must be paid extraordinarily to work very long hours and not retire at the usual ages

They also have to be paid a hefty amount to pay off massive debt. If you see an attending physician in his 30s (or even 40s), even if he's making a respectable amount of money, there's a good chance he still has a negative net worth. The level of debt of course varies by location, specialty, and quality of education, but it's rather misleading to look at an e.g. $200K/year income for a physician and compare that to the equivalent amount in the tech industry.

[0] pun not intended, but very a propos!

[WalterBright]

The last vaccinations I received were from the pharmacist at the drugstore.

[mistermumble]

yes, good points. It seems that Cuba has become something of a health resource for other countries in Latin America, where there is much less access to doctors (and NPs) than in Cuba. Middle-class people in those countries travel to Cuba for health care. At least that is picture I get when I've spoken to a bunch of people in the region over the past few years. I hear about a number of people travel to Cuba, others got to Chile, and almost no one can afford to go to US to get treated.

[baddox]

Not only that, but more physicians per capita isn't inherently a good thing.

[qwerta]

Perhaps good idea for startup, medical turism..

[scardine]

I highly recommend reading "Guide to the Perfect Latin American Idiot" which explain how dictatorships can pick a handful of indicators and elevate them to first-world levels while still making everybody's life miserable.

[1] http://www.amazon.com/Guide-Perfect-Latin-American-Idiot/pro...

[discardorama]

You're talking as if the dictators sit around, wondering about some sort of "SEO" to game their ranking on these lists.

The "life expectancy" figure can't be gamed, unless you out and out lie.

Here's a recent article for thought: http://www.wired.com/2010/04/cuban-health-lessons/

[mistermumble]

I highly recommend travel to those countries so that you can observe it for your self. The picture is different than the book.

[wdr1]

Michael Moore needs to read this book.

[rgbrenner]

> - Physicians per 10,000 people: Cuba has 67

2nd highest in the world, behind Monaco (70): http://kff.org/global-indicator/physicians/

For comparison: Sweden (38), UK (27), Japan (21), Canada (20)

Makes you wonder if that number has any significance at all. Japan has 1/3rd the number of doctors, but the highest life expectancy in the world.

[mod]

Maybe there's a cause-effect going on in Japan.

They just aren't unhealthy enough to demand more doctors?

[Retric]

Japan has a lot of welfare fraud which inflates their life expectancy numbers. It also has a fairly low level of income inequality relative to their per capita GDP which helps things. (AKA few poor people.) And to top it off universal healthcare which significantly increases a population’s life expectancy.

Edit: Arguably the high food prices reduce obesity which is really important.

[pdeuchler]

Comparing statistics from small, homogeneous populations to statistics from larger, heterogeneous populations is fraught with peril. Doubly so for metrics on education and health. (I like to call this the Scandinavian Fallacy)

As engineers we would never compare uptime statistics from a small, niche startup serving a couple thousand people to uptime statistics from, say, Google. Why do we immediately ignore these principles outside of engineering?

Edit: wording

[tomp]

I'd expect the uptime of Google to be better than the uptime of a niche startup.

[Hello71]

small, niche startups usually have poor uptime on their services. we commend them if they have a year up (hell, if they still exist after a year), but criticize Google for being down once every few years.

therefore, if you want to bring in the analogy of startups and Google, it should be even more impressive that small countries (viz. people in small countries, viz. Cuba) live longer than Google (viz. people in large countries, viz. United States).

[avar]

What does the heterogeneous populations of the US have to do with it? Maybe when it comes to life expectancy you're right, because genetics is a large factor in that. But when it comes to literacy rate and the proportion of physicians that's entirely down to government policy.

Do you really think the US couldn't beat Cuba on those metrics if they decided spending money on those topics was more important than spending money on the military?

[finid]

> Comparing statistics from small, homogeneous populations

Cuba is small. Does it have an homogeneous population?

No, amigo!

[sdm]

Since when has Cuba had a homogeneous population?

[aaron-lebo]

I really like that term. Is that your own?

[wazoox]

Furthermore, as Cuba lacks any agrochemicals, almost of their food production is organic, proving that agrochemicals are completely unnecessary.

[organsnyder]

Huh? I'm a big proponent of eliminating agrochemicals, but you've set up a huge straw man here: No one is arguing that agrochemicals are "necessary" in the sense that agriculture is impossible without it (indeed, millennia of experience prove otherwise). Rather, the rationale is that they allow us to increase productivity for the same input of acreage and man-hours.

I'm not saying that agrochemical proponents are right (I've heard that crop rotation is as good or better than synthetic fertilizers, though it's hard to argue against the labor efficiencies of huge tractors and lots of pest/herbicides), but the simple fact that agriculture is possible without agrochemicals doesn't disprove the argument that it might be better with them.