Politifact Debunks Senator Harkin: On Cuban Health Care

Friday, January 31, 2014
Unsurprisingly, retiring U.S. Senator Tom Harkin (D-IA) has recently returned from Cuba praising Castro's health care propaganda.

(Senator Harkin was one of Congress' most infamous supporters of the Sandinista dictatorship in the 1980s.)

This week, Harkin stated 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."

Politifact gave this statement a Half-True rating.

This is too kind, as it gives half-credence to Castro's manipulated statistics.

But to its credit, Politifact did a good analysis raising doubts:

How reliable is [Cuba's health care] data?

We wondered [...] 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, 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 a recent trip, Streiffer said, he 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 US."

However, some experts said that this obsession with statistics can be a two-edged sword when it comes to reliability. Some say Cuba is so concerned with its infant mortality and life-expectancy statistics that the government takes heavy-handed actions to protect their international rankings.

"Cuba does have a very low infant mortality rate, but pregnant women are treated with very authoritarian tactics to maintain these favorable statistics," said Tassie Katherine Hirschfeld, the chair 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, since Cuba has so many risk factors that cause early death in other countries, from unfiltered cigarettes to contaminated water to a meat-heavy diet. In a more benign statistical quirk, Carmelo Mesa-Lago, a professor emeritus of economics at the University of Pittsburgh, suggests that the flow of refugees could skew longevity statistics, since those births are recorded but the deaths are not.

Transparency would help give the data more credibility, but the Cuban government doesn’t offer much, experts said.

"I would take all Cuban health statistics with a grain of salt," Hirschfeld said. Organizations like 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 has been "overestimated," he said. "The showcasing of infant mortality and life expectancy at birth has been done for ideological reasons," he said.