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The Public Health Implications of Normalized U.S.-Cuba Relations

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Image courtesy of:

Image courtesy of:

Many thanks to Sarah Roache, O’Neill Institute Law Fellow, for her invaluable insights into legal interventions to prevent NCDs.
In January 1959, after half a decade of armed revolution, Fidel Castro’s 26th of July Movement took control of Cuba from Fulgencio Batista, a president with increasingly dictatorial tendencies. Relations between the United States and Castro’s government, which was closely tied to the international Communist movement, quickly soured. More than 50 years later, the anachronistic sanctions against Cuba remain in place—causing profound harm to Cuba’s people. In October, 2014 the United Nations voted for the 23rd year in a row to condemn the sanctions. The resolution passed nearly unanimously (only the U.S. and Israel voted against).
All of this may soon change. On December 17, U.S. President Barack Obama announced a deal between the U.S. and Cuba to normalize relations between the two countries, including the establishment of a U.S. embassy in Havana and loosened sanctions. In the short time since it was announced, the deal has already encountered steep resistance from Republicans in the U.S. Congress.

The details remain sketchy, and many hurdles remain. This post is designed to spark a conversation about the possible public health ramifications of lifting Cuban sanctions, focusing on three main areas: (1) the direct benefits to public health that might result from lifting sanctions, (2) the mutual benefit that U.S. and Cuban doctors and public health officials could gain from greater collaboration, and (3) some challenges that lifting sanctions might pose to public health in Cuba (and how they might be mitigated).
Benefits to Population Health
Given its level of income, Cuba is a remarkable public health success story. Although its government spends less than 10% as much as the United States on healthcare per person, Cuba has better control of vaccine-preventable disease, a greater proportion HIV-positive people taking appropriate antiretroviral treatment for HIV, and a far lower rate of maternal mortality.
Opening trade to Cuba could have several positive impacts. For instance, it would raise incomes and increase educational opportunities, both factors linked to better health outcomes. It may also allow for more cost-effective medical care in Cuba, as illustrated in the video below:

Increased Opportunities for Public Health Collaboration
Cuban doctors are among the most effective, and respected, in the world. Cuba regularly sends doctors around the world to respond to public health crises—most recently to respond to the West African Ebola epidemic.
The U.S. and Cuba do have some limited collaboration on public health issues, but travel bans and trade sanctions have severely hampered such endeavors. Lifting the ban could allow U.S. and Cuban doctors and public health officials to learn from each others’ expertise. A health partnership between Cuba and the United States could even help to improve public health throughout Latin America, if the two countries worked together to send doctors and other experts to the region.
The Risks of Normalization
The only McDonalds in Cuba, located in Guantanamo Bay (a small section of Cuba under U.S. control)

The only McDonalds in Cuba, located in Guantanamo Bay (a small section of Cuba under U.S. control)

Increased trade between the two countries may also pose risks, however. Although some U.S. food sales have been permitted in Cuba, easing the sanctions is likely to increase Cuban’s access to cheap, unhealthy products such as fast food restaurants, packaged junk food, tobacco products and alcohol. Tobacco use, harmful use of alcohol and unhealthy diet are among the key risk factors for non-communicable diseases (NCDs), such as heart disease, diabetes and cancer. Increased availability of cheap, unhealthy U.S. products could thus undermine Cuba’s public health gains.
Cuba should quickly begin considering laws and policies to prevent a surge of NCDs. These could include interventions that have proven effective in other countries, such as: menu and nutrition labeling; banning or restricting advertising on calorie-dense foods, including sugar-sweetened beverages; zoning laws that keep junk food away from schools; taxation of unhealthy goods or ingredients, such as alcohol and sugar; or banning certain particularly harmful ingredients (such as trans fats) outright. Moreover, U.S. companies have an ethical responsibility to act in a responsible manner in moving into Cuba, and the U.S. government should pressure them to do so.
Despite the risks, on balance I believe that lifting Cuban sanctions is likely to be a boon to public health, both in the U.S. and Cuba. I would love to hear your thoughts in the comments: What do you think are other challenges and opportunities that might come from lifted sanctions and the travel ban? Overall, do you think it will be a benefit or liability to Cubans’ (and Americans’) health?

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The views reflected in this expert column are those of the individual authors and do not necessarily represent those of the O’Neill Institute for National and Global Health Law or Georgetown University. This blog is solely informational in nature, and not intended as a substitute for competent legal advice from a licensed and retained attorney in your state or country.

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