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MR FEATURES The Right to Health Care and the Law Although not unique in its inclusion of the right to health care as part of the law of the land, the Cuban Constitution is distinct in both breadth and detail. The Constitution, adopted in 1976[1], obligates the State to assure that there shall be “no sick person who does not receive medical attention.”[2] It also articulates specific obligations of the State to provide a full range of universally accessible health services free of charge, as well as to guarantee the promotion and protection of the health of individuals.[3] Thus, as early as 1976, Cuban law established a constitutional framework for the development of a comprehensive and universal program of health services.
Article 50 stipulates that all Cubans are entitled to receive free medical care and to have their health protected. It also enumerates the obligations of the State to provide medical and hospital care free of charge, including dental care, prophylactic services and access to specialized centers. In addition, the Constitution embodies Cuban public health policy grounded in preventive care, specifying that the State shall develop plans for health education, programs for periodic medical examinations, immunization and other preventive measures. Other provisions of the Constitution relate to health rights and guarantees for specific populations. For example, Article 43 establishes that all citizens have the same right to receive medical attention without regard to “color of skin, gender, religious belief, national origin and any distinction harmful to the dignity of man.” Other provisions provide for protection of the health and safety of workers (Article 49) and assistance to the elderly (Article 48). In order to ensure maternal and infant health, the Constitution provides that pregnant working women shall be guaranteed paid leave before and after birth. Cuba’s Public Health Law The express premise of the Public Health Law, adopted in 1983,[4] is that the protection and improvement of the health of the population is a fundamental and permanent obligation of the State. The law entrusts the Ministry of Public Health (MINSAP) and other institutions to organize and provide health services, and to assure that services are made available free of charge in all parts of the country, including rural areas. The services and preventive programs include not only those required to preserve life and general physical health, but mental and dental health as well. Article 4 sets out guiding principles for the organization of the Cuban health system, including:
With respect to preventive activities, the law requires the institutions that form part of the National Health System to develop health education programs and to pay particular attention to health issues arising in the work place. Thus, the law mandates that workers receive pre-employment medical exams where appropriate, as well as periodic examinations when they are subjected to particular job-related health risks. In addition, work places are required to adopt measures necessary to prevent work-related injuries and illnesses. Pursuant to the Labor Code, employees are entitled to stop working whenever protective gear or equipment is inadequate or lacking. The statement in the Public Health Law that medical practice has a social character reflects a 1964 law passed at the request of the assembly of medical students at the universities of Havana and Oriente obliging future graduates to serve only in the public sector, rather than private practice. The law also set up an obligatory two-year social service requirement following graduation.[5] Consistent with this, since 1965, when the first post-revolutionary medical graduates received their diplomas, medical students have taken an oath renouncing private practice (for the oath from this year’s graduating class, see Cuban Disaster Doctors in Guatemala, Pakistan). In the 1965 oath, graduates also committed to serving two years in the Rural Medical Service, the first national program to extend health care to people in the most remote areas of the country. Rehabilitation of persons suffering from physical or mental disabilities is also set forth in the Public Health Law, mandating that rehabilitation services be designed to restore patients to an active and productive life. In addition, MINSAP is required to work with the Ministry of Labor and Social Security, the Ministry of Education, the unions and various civil organizations to develop rehabilitation programs. Current labor regulations call for special affirmative efforts to provide employment to the disabled.[6] In 1995, these were embodied in a national Program for the Employment of the Disabled (PROEMDIS), intended to both identify and create employment opportunities for persons with mental and physical disabilities. Social Security In addition to the Public Health Law, Cuba enacted legislation in February 1959 - about one month after the revolutionary government came to power - to provide social assistance to those in need.[7] Current law provides special assistance (services, nutritional supplements, and financial aid), for those in particular need. Among the vulnerable groups specifically mentioned are the elderly, persons unable to work and single mothers who require special assistance. Maternal and Infant Health Cuban law provides a generous foundation for national health policies directed at insuring the health of newborns and their mothers, and in this context, also addresses gender equality by providing support and guarantees to working mothers. Cuba’s maternity leave legislation grants women 18 weeks fully paid leave, during which their employers are required to hold their jobs. Women are required by law to stop working at 34 weeks into their pregnancy, and take a fully paid leave until delivery. Expectant mothers are also entitled to paid time off from work for antenatal care, and once the child is born, for regular pediatric care during the infant’s first year of life.[8] In addition, labor laws protect women from engaging in harmful on-the-job activities and require they be assigned other duties during pregnancy. For details on maternity leave and the National Program for Maternal-Child Health (PAMI), see MEDICC Review “Pediatrics: The First Year of Life in Cuba” (Vol. VII, No. 6, 2005). The Broader Framework Under the Cuban Constitution, citizens have the right to equal treatment under the law, without regard to gender, race, national origin, religion or other characteristics.[9] The document also establishes a number of substantive rights in addition to health care, including the right to a job, access to sports and culture, and education.[10] These provisions commit the State to take affirmative steps to fulfill the rights described. The Constitution obligates the State to offer free education from grade school through university and post-graduate studies, thus eliminating the most important economic barrier to formal learning opportunities. This lays the basis for a universally educated citizenry, considered by international health authorities to be a key requisite for a healthy population. Notes & References
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