Science and Challenges for Cuban Public Health in the 21st Century.

Cuba's public health outcomes are rooted in political and social phenomena that have favored achievement of health indicators well above expectations for an economy of its size. A less studied causal component of Cuba's development in health is the creation, from early in the 1960s, of scientific research capacity throughout the health system, including use of science to launch a domestic industry for manufacturing high-tech products. This component should play an even greater role in meeting Cuba's 21st century health challenges, especially the demographic and epidemiologi-cal transitions, increasing prevalence of chronic diseases, rapid emergence of a complex-product biotechnology pharmacopoeia, greater molecular stratification of diseases, rising health costs, and the need to maintain communicable diseases under control in a global context of climate change and more population mobility.Tackling these challenges will demand greater scientific influence in the health system, application of a scientific approach in all ac-tivities and at all levels, and integration with scientific endeavors of other sectors such as agriculture, industry and education. KEYWORDS Public health, science, health care costs, health workforce, chronic disease, biotechnology, immunology, aging, Cuba.