Cuba and the Philippines are countries with broad similarities in historical background yet sharp divergences in political economic developments and relations to the capitalist world-system in recent times. U.S. economic and political interests dominated both countries during the first half of the 20th century. The changes generated by the Cuban revolution resulted in the end of U.S. power in Cuba in 1959. The Philippines, however, remain profoundly dependent on the United States. The approach taken in this article contrasts these countries, asking what the results of their divergent paths are in terms of health and health services. The ability of Cuba and the Philippines to support the primary health care (PHC) approach by fostering socioeconomic justice, authentic citizen participation, and a regionalized health system is examined. It is clear that the last 25 years of socialist-oriented development in Cuba reversed the negative effects of the previous market economy by providing improved social and health services. The success of the political economy and the fully regionalized health system, supportive of the PHC approach in Cuba, is reflected in the high-level health status of the people. In contrast, poverty, gross social and economic inequities, high prevalence of infectious disease, and inaccessible, inadequate, and uncoordinated health services persist in the Philippines after some 85 years of international and national capitalist development. The poor health status of the Philippine people is a direct reflection of this underdeveloped system.
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References
1.
World Health Organization. Alma-Ata 1978, Primary Health Care. WHO, Geneva, 1978.
2.
KleczkowskiB.EllingR.SmithD.Health System Support for Primary Health Care. Public Health Papers Series No. 80. World Health Organization, Geneva, 1984.
3.
EllingR.Cross-National Study of Health Systems: Political Economies and Health Care. Transaction Books, New Brunswick, N.J., 1980.
4.
NavarroV.A critique of the ideological and political position of the Brandt Report and the Alma Ata Declaration. Soc. Sci. Med.18: 467–474, 1984.
5.
RodwinV. G.The Health Planning Predicament, France, Quebec, England, and the United States, Appendix. University of California Press, Berkeley, 1984.
6.
EllingR.The Struggle for Workers' Health: A Study of Six Industrialized Countries, Chapter 2. Baywood Publishing Co., Farmingdale, N.Y., 1986.
7.
CeresetoS.WaitzkinH.Capitalism, socialism, and the physical quality of life. Int. J. Health Serv. 16: 643–658, 1986.
8.
WallersteinI.The Modern World-System I. Capitalist Agriculture and the Origins of the European World-Economy in the Sixteenth Century. Academic Press, New York, 1974.
9.
WallersteinI.The Modern World-System II. Mercantilism and the Consolidation of the European World-Economy, 1600–1750. Academic Press, New York, 1980.
10.
FrankA. G.Dependent Accumulation and Underdevelopment. Monthly Review Press, New York, 1979.
11.
GramsciA.The modern prince. In Selections from the Prison Notebooks. International Publishers, New York, 1971.
12.
EllingR.The capitalist world-system and international health. Int. J. Health Serv. 11: 21–52, 1981.
13.
DixonM.Dual power: The rise of the transnational corporation and the nation state: Conceptual explanations to meet popular demand. Contemporary MarxismNo. 5, pp. 129–146, 1982.
14.
Chase-DunnC. K. (ed.). Socialist States in the World-System. Sage Publications Inc., Beverley Hills, 1982.
15.
EllingR.Is socialism bad for your health: Cuba and the Philippines. Med. Anthropol., in press, 1987.
16.
RoemerM.Political ideology and health care: Hospital patterns in the Philippines and Cuba. Int. J. Health Serv. 3: 487–492, 1973.
17.
Diaz-BriquetsS.The Health Revolution in Cuba. University of Texas Press, Austin, 1983.
18.
DominiquezJ.Cuba: Internal and International Affairs. Sage Publications Inc., Beverley Hills, 1982.
19.
DanielsonR.Cuban Medicine. Transaction Books, New Brunswick, N.J., 1979.
20.
NavarroV.Health services in Cuba, an initial appraisal. N. Engl. J. Med.2: 954–959, 1972.
21.
RoemerM.Cuban Health Services and Resources. Pan American Health Organization, Washington, D.C., 1976.
22.
GuttmacherS.DanielsonR.Changes in Cuban health care: An argument against technological pessimism. Int. J. Health Serv. 7: 383–400, 1977.
23.
Academic American Encyclopedia, p. 379. Grolier Inc., Danbury, 1985.
24.
BridgwaterW.SherwoodE. (eds.). The Columbia Encyclopedia in One Volume, pp. 488–489. Columbia University Press, New York, 1950.
25.
Europa Year Book 1981: A World Survey, Vol. II, p. 206. Europa Publishers Limited, London, 1981.
26.
BryonW.Cuba: The Continuing Revolution, p. 81. Parents' Magazine Press, New York, 1969.
27.
FagenR. R.Revolution: For international consumption only. In Cuban Communism, edited by HorowitzI. L. pp. 68–80. Transaction Books, New Brunswick, N.J., 1972.
28.
OrrisP.The Role of the Consumer in the Cuban National Health System, pp. 20–21. Unpublished Essay for the MPH Degree. Yale University, New Haven, 1970.
29.
GreenG.Cuba at 25: The Continuing Revolution. International Publishers, New York, 1983.
30.
Mesa-LagoC.The Economy of Socialist Cuba: A Two-Decade Appraisal. University of New Mexico Press, Albuquerque, 1981.
31.
VergaraF.Cuba: Beset by worries. In World View 1982, edited by WheenF. pp. 100–101. South End Press, Boston, 1982.
32.
HubermanL.SweezyP. M.Cuba: Anatomy of a Revolution, p. 3. Monthly Review Press, New York, 1960.
33.
SivardR.World Military and Social Expenditures. Institute for World Order, New York, 1974.
34.
SivardR.World Military and Social Expenditures, World Priorities, Washington, D.C., 1986.
35.
World Bank. The Development Data Book: Social and Economic Statistics of 125 Countries. World Bank, Washington, D.C., 1984.
NavarroV.Workers' and community participation and democratic control in Cuba. Int. J. Health Sery. 10: 197–216, 1980.
38.
TeshS.Health education in Cuba: A preface. Int. J. Health Serv. 16: 87–104, 1986.
39.
SteinZ.SusserM.The Cuban health system. A trial of comprehensive service in a poor country. Int. J. Health Serv. 2: 551–566, 1972.
40.
WernerD.Health care in Cuba: A model service or a means of social control—or both? In Practicing Health for All, edited by MorleyD.RohdeJ.WilliamsG. p. 24. Oxford University Press, New York, 1984.
41.
RoemerM.Comparative National Policies on Health Care, p. 83. Marcel Dekker, New York, 1977.
42.
SivardR.World Military and Social Expenditures. World Priorities, Washington, D.C., 1983.
43.
WoodC. H.Infant mortality trends and capitalist development in Brazil: The case of Sao Paulo and Belo Horizonte. Latin American Perspectives4: 56–65, 1977.
44.
World Health Organization. Cuba. Sixth Report on the World Health Situation, 1973–1977, Part Two, p. 84. WHO, Geneva, 1980.
45.
DjukanovicV.MachE. P.Alternative Approaches to Meeting Basic Health Needs in Developing Countries. A Joint UNICEF/WHO Study. World Health Organization, Geneva, 1975.
46.
BungeF.Philippines, A Country Study. Department of the Army, Washington, D.C., 1984.
47.
PlanasC. L.Myths and Realities of Philippine Development Under the Marcos Regime. Friends of the Filipino Briefs. Friends of the Filipino People, Washington, D.C., undated (probably 1980).
48.
AquinoB.Political Violence in the Philippines, Aftermath of the Aquino Assassination. Southeast Asian Affairs, Institute of Southeast Asian Studies, Singapore, 1984.
49.
DavidR.Food as a human right: The case against banana plantations. Int. J. Health Serv. 12: 389–396, 1982.
50.
FesslerL.Science and herbal medicine in the Philippines. American Universities Field Staff ReportsNo. 48, pp. 1–5, 1978.
51.
IlanL.Quality of Life in Selected Rural Barrios in Southern Luzon, Philippines. Dissertation, Texas A. and M. University, 1980.
52.
JainS.Size Distribution of Income, A Compilation of Data, Table 57, p. 91. The World Bank, Washington, D.C., 1975.
53.
DoughertyJ. F.Who controls the Philippine economy: Some need not try as hard as others. In Cronies and Enemies: The Current Philippine Scene, edited by AquinoB. p. 28. Philippines Studies Occasional Paper No. 5. Center for Asian and Pacific Studies, Honolulu, 1982.
54.
FiloteoL.Nurses in the streets: A new dimension for a meaningful change. Philippine J. Nursing54: 113, 1984.
55.
Alliance of Health Workers for the Batasang Pambansa. The 1986 Health Budget: Everybody's concern. Philippine J. Nursing55: 76–78, 1985.
56.
BurgosG. C.U.S. Unemployment and Corporate Profits—The Philippine Connection: Cheap Labor, Underdevelopment and Marcos' Rule, p. 3. Friends of Filipino Brief. Friends of the Filipino People, Washington, D.C., undated (probably 1980).
57.
GuyotE.Strikers murdered by troops. Guardian, October, 2 1985.
58.
GrayD. D.Peaceful Filipinos display bent for violence. The Hartford Courant, October, 13 1983.
59.
Associated Press. One killed, 27 hurt in anti-Marcos riot. The Hartford Courant, October, 22 1985.
60.
OcampoP. SantosRaborI.The role of parents and auxiliary agencies in the Philippines. Southeast Asian J. Trop. Med. Public Health13: 446–450, 1982.
61.
AbuegE. A.Popular participation in housing and urban-poor: Selected cases in urban Manila. Habitat Int. 10: 197–206, 1986.
62.
StandingG.SzalR.Poverty and Basic Needs: Evidence from Guyana and the Philippines. International Labour Office, Geneva, 1979.
63.
DoughertyC.The Philippines: Medical industry thrives, health care fails. Science for the People, March/April, 1981, pp. 16–21.
64.
Health for all Filipinos by 2000. Philippine J. Nursing50: 135–136, 1980.
65.
Doctoring danger, Filipino health workers killed by military. New Internationalist, December 1984, p. 5.
66.
QuesadaM. L.Economics of nursing and the effects of economics on nursing. Philippine J. Nursing55: 98–101, 1985.
67.
NeumannA. K.Ethnomedicine and biomedicine linking. Soc. Sci. Med.16: 1817–1824, 1982.
68.
EmeryG. M.The Philippines: Rizal. Basic health care. In Developing Countries: An Epidemiological Perspective, edited by HetzelB. S. pp. 68–75. Oxford University Press, New York, 1978.
69.
KuangA. K.The Western Pacific. In Traditional Medicine and Health Care Coverage: A Reader for Health Administrators and Practitioners, edited by BannermanR. H. pp. 236–278. World Health Organization, Geneva, 1983.
70.
RussellS. D.Curing and commerce. Changes in an indigenous medical practice in a highland Philippine town. Soc. Sci. Med.18: 129–137, 1984.
71.
HageyR.Healing Entrepreneurship in the Philippines. Dissertation, Case Western University, 1980.
72.
Updated Philippine Development Plan 1984–1987. National Economic and Development Authority, Republic of the Philippines, September 1984.
73.
DayritM. M.Training village health workers in the Philippines: A nongovernmental approach. World Health Forum6: 27–29, 1985.
74.
SeitzR.Self-help in the barrios. World Health, January 1980, pp. 17–18.
75.
OrtinE. L.Motivating the community. World Health, July 1982, pp. 15–17.
76.
BrownE. R.Exporting medical education. Professionalism, modernization, and imperialism. Soc. Sci. Med.13B: 585–595, 1979.
77.
Philippine Moslems expanding attacks. New York Times, July, 31 1978.
78.
StarkR.Non-professional primary health care workers: Socio-political issues in utilization. In Third World Medicine and Social Change, edited by MorganJ. H. pp. 229–239. University Press of America, New York, 1983.
79.
Health and human rights in the Philippines. Search15: 194, 1984.
80.
ConceptionM.SmithP.The Demographic Situation in the Philippines: An Analysis in 1977. Paper of the East-West Center No. 44. East-West Center, Honolulu, 1977.
81.
WoolleyP. O.Jr.Syncrisis: The Dynamics of Health: An Analytic Series on the Interactions of Health and Socio-economic Development. IV: The Philippines, p. 46. U.S. Department of Health, Education, and Welfare, Office of International Health, Division of Planning and Evaluation, Washington, D.C., 1972.
82.
Target health 2000. World Health Forum2: 36–44, 1981.
83.
FlavierJ. M.Rural reconstruction, the Philippines. In Basic Health Care in Developing Countries, An Epidemiological Perspective, edited by HetzelB. S. pp. 75–86. Oxford University Press, New York, 1978.
84.
CarreonG. G.The role of the hospital in primary care. World Health Forum3: 152–155, 1982.
85.
SivardR.World Military and Social Expenditures. Institute for World Order, New York, 1976.
86.
KronholzJ.Despite some success, Philippines' new ruler is beset by problems. The Wall Street Journal, April, 3 1986, p. 15.
