PHA-Exch> Physicians, Population Health and the Cuban Paradox

[Claudio Schuftan]

From: Ruggiero, Mrs. Ana Lucia (WDC) <ruglucia at paho.org>
crossposted from: EQUIDAD at listserv.paho.org

  *Thomas McKeown, Meet Fidel Castro: Physicians, Population Health and the
Cuban Paradox*



Robert G. Evans, Professor of Economics, University of British Columbia,
Vancouver, BC Canada

*Healthcare Policy / Politiques de Santé, 3(4) 2008: 21-32*



Website : http://www.longwoods.com/product.php?productid=19916



PDF [12p.] at: http://www.longwoods.com/view.php?aid=19916&cat=554



'……About 40 years ago, Thomas McKeown demonstrated that the historic decline
in the great killer diseases owed little or nothing to progress in medicine.
A generation of research on population health followed, highlighting the
large social gradients in health within populations. These vary greatly
across societies, but appear largely unrelated to medical care. Medicine was
acknowledged as "powerful, but within limits"; the major determinants of
health lie elsewhere.



We may have missed something. Cuba has achieved "first world" population
health status despite a minimal economic base. Far from marginalizing
medicine, Cuba has by far the world's largest physician workforce. But
doctors' roles are significantly expanded. The system seems to work….'
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