Justin Trudeau’s claim that Castro made ‘significant improvements’ to Cuban health care and education

Justin Trudeau’s claim that Castro made ‘significant improvements’ to Cuban health care and education

“A legendary revolutionary and orator, Mr. Castro made significant improvements to the education and healthcare of his island nation.”
— Canadian Prime Minister Justin Trudeau, statement on the death of Fidel Castro, Nov. 26, 2016

In his surprisingly warm statement on the death of the Cuban dictator, the Canadian prime minister referenced what he called “significant improvements” in education and health care in Cuba under Castro. This is a commonly cited sentiment about Castro’s Cuba — that despite his iron rule, he improved the lives of the Cuban people, especially the poor.

A reader asked whether Trudeau’s assessment was really valid, so we decided to explore the issue.

The Facts

Obviously, it is impossible to go in a time machine and explore what would have happened if Castro had not overthrown the military dictatorship of Fulgencio Batista in 1959. But any measurement of Cuba now must take into account where Cuba stood at the time of the revolution — and whether it has maintained its place among Latin American nations during Castro’s rule.

We also have to acknowledge that any data from the Cuba government is naturally suspect. Experts say that official statistics must be treated gingerly and skeptically, as police states generally are not known to provide accurate numbers. In particular, Cuba’s relatively high ranking — 67 out of 188 countries — in the United Nations’ Human Development Index appears to be affected by questionable data.

A rigorous effort to establish an accurate picture of pre-revolutionary living standards in Cuba, published in the Journal of Economic History in 2012, found that Cuba significantly lagged its counterparts in the region during Castro’s rule. “Since current living standards appear to be below the levels of the late republic, it is hard to visualize any scenario where the republic would not have outperformed the revolutionary economy by a considerable margin in terms of living standards,” wrote Marianne Ward-Peradoza and John Devereux.

Prior to the revolution, Cuba was closely tied to the United States (which had once occupied it), and so roads, railroads and hotels had been built with U.S. investments. Ward and Devereux calculated that Cuba’s income per capita in 1955 was 50 to 60 percent of the top Western European levels — and about the same as Italy’s income per capita at the time. Cuba’s consumption was relatively high as a share of gross domestic product.

But after the revolution, ties with the United States were cut and Washington imposed an embargo (though Cuba still traded with much of the rest of the world). Significant aid to bolster the economy came from the Soviet Union and then, in recent years, from Venezuela.

Using comparisons with data for Costa Rica and Argentina, the pair calculated that Cuban consumption levels in 2000 were 52 percent of 1955 levels. At the time, Cuba was still suffering the aftereffects of the collapse of the Soviet Union. In 2007, they estimated, Cuba’s per capita consumption was 72 percent of the 1955 level.

Other studies confirm that Cubans generally suffered a loss of living standards. Data from the mid-1950s indicate that per capita consumption of calories in Cuba was 2,730 in the mid-1950s — and 2,357 in 1996. Meanwhile, other countries in the region saw an improvement, such as Mexico going from 2,420 to 3,137. In other words, Cuba declined about 13 percent while Mexico gained almost 30 percent.

In regards to health care and education, Cuba was already near the top of the heap before the revolution. Cuba’s low infant mortality rate is often lauded, but it already led the region on this key measure in 1953-1958, according to data collected by Carmelo Mesa-Lago, a Cuba specialist and professor emeritus at the University of Pittsburgh. In terms of life expectancy, Cuba was in fourth place in the mid-1950s — and advanced to third in 2005-2007. Literacy was also high — fourth place in 1950s — and Cuba advanced to second place in 2005-2007.

“We suspect that overall healthcare outcomes would not have been much different given the remarkably low levels of infant mortality in Republican Cuba,” Ward-Peradoza and Devereux said. But they said the revolution probably improved education.

In particular, gaps between the rich and poor were narrowed after the revolution. Free national public education was expanded, as was the free public-health system. The number of rural hospitals increased from one to 62, for instance. The Cuba health-care system in particular places a strong emphasis on preventive medicine, making it easy for Cubans to get checkups.

But in terms of GDP, capital formation, industrial production and key measures such as cars per person, Cuba plummeted from the top ranks to as low as 20th place. That came at a cost, even though Cubans are well educated.

“Cuba probably has the best educated population in the region, but the considerable investment in human resources is partly lost due to the low wages paid and lack of incentives that force professionals to emigrate or stay but abandon their state work and shift to private non-professional activities that allow them to survive,” Mesa-Lago said.

Andrew Wolfe, who traveled to Cuba three times in the mid-2000s when he was senior manager of the Western Hemisphere department at the International Monetary Fund, said that primary health care has probably improved under Castro but doctors and teachers in Cuba earn less than hotel workers. He said it was noteworthy that when Castro became ill in 2006, a specialist arrived from Spain to treat him, suggesting Cuban doctors lag in treating more complex cases.

Mesa-Lago says that many gains were lost after the Soviet Union collapsed and ended its support for the regime. He said that Trudeau’s remarks thus were out of date. “This was true by the end of the 1980s, as I have proved in my books and articles, but not after the huge economic crisis of the 1990s when the economy sank by 35 percent in three years; after that, health and education indicators badly deteriorated and, despite some recovery in 2000-2003, still several of them are below 1989 levels,” he said.

Data collected by Mesa-Lago show that from 1989 to 2014, the number of hospital beds declined 29 percent, hospitals fell 37 percent and family doctors plummeted 61 percent.

Reporters have also documented that Cuban hospitals are ill-equipped. A 2004 series on Cuba’s health-care system in Canada’s National Post said pharmacies stock very little and antibiotics are available only on the black market. “One of the myths Canadians harbor about Cuba is that its people may be poor and living under a repressive government, but they have access to quality health and education facilities,” the Post said. “It’s a portrait encouraged by the government, but the reality is sharply different.”