Nayeri K
Department of Preventive Medicine and Community Health, State University of New York, Health Science Center at Brooklyn 11203, USA.
J Community Health. 1995 Aug;20(4):321-34. doi: 10.1007/BF02283057.
This paper explores the dynamics of health and health care in Cuba during a period of severe crisis by placing it within its economic, social, and political context using a comparative historical approach. It outlines Cuban achievements in health care as a consequence of the socialist transformations since 1959, noting the full commitment by the Cuban state, the planned economy, mass participation, and a self-critical, working class perspective as crucial factors. The roles of two external factors, the U.S. economic embargo and the Council of Mutual Economic Cooperation (CMEA), are explored in shaping the Cuban society and economy, including its health care system. It is argued that the former has hindered health efforts in Cuba. The role of the latter is more complex. While the CMEA was an important source for economic growth, Cuban relations with the Soviet bloc had a damaging effect on the development of socialism in Cuba. The adoption of the Soviet model of economic development fostered bureaucracy and demoralization of Cuban workers. As such, it contributed to two internal factors that have undermined further social progress including in health care: low productivity of labor and the growth of bureaucracy. While the health care system is still consistently supported by public policy and its structure is sound, economic crisis undermines its material and moral foundations and threatens its achievements. The future of the current Cuban health care system is intertwined with the potentials for its socialist development.
本文采用比较历史研究方法，将古巴严重危机时期的卫生与医疗动态置于其经济、社会和政治背景中进行探讨。文章概述了自1959年社会主义变革以来古巴在医疗保健方面取得的成就，指出古巴国家的全力投入、计划经济、群众参与以及自我批评的工人阶级视角是关键因素。探讨了两个外部因素——美国经济封锁和经济互助委员会（经互会）在塑造古巴社会和经济（包括其医疗体系）方面所起的作用。文章认为，前者阻碍了古巴的卫生事业发展。后者的作用则更为复杂。虽然经互会是经济增长的重要来源，但古巴与苏联集团的关系对古巴社会主义发展产生了破坏作用。采用苏联经济发展模式助长了官僚主义，使古巴工人士气低落。因此，它促成了两个破坏包括医疗保健在内的进一步社会进步的内部因素：劳动生产率低下和官僚主义的增长。虽然医疗体系仍然持续得到公共政策的支持，其结构也较为健全，但经济危机削弱了其物质和道德基础，威胁到其取得的成就。当前古巴医疗体系的未来与古巴社会主义发展的潜力相互交织。
