This Volume II Number 1 is devoted to Aging in Cuba, and was put together just as the International Year of Older Persons was drawing to a close.  The designation of such a year by the United Nations served to focus attention on one of the most rapidly advancing demographic trends in the world, and one which presents particular challenges to the world's poorer countries--whose over-60 populations have rather suddenly become significant ones.  It was pointed out in the closing UN General Assembly debates on the issue in 1999 that by the year 2005, more than 70% of all persons over 60 will live in these developing countries.

Cuba presents a particular case within the developing world:  its economy, although pulled back from the brink of disaster, is still shaky; and yet, its universal comprehensive health care system has managed to shelter the most vulnerable from the social fallout of the economic depression.  (As we note in Health News from Cuba, the 1999 infant mortality rate declined once again to a record low:  6.4 deaths/1,000 live births.)

Analysts credit this phenomenon to the emphasis that the Cuban health-care design places on primary care, health promotion in the community, and a general preventive approach to disease.  The main actors in this model are the family doctor-and-nurse teams which dot the island, one for every 150 families or so, and who live in the neighborhoods they serve.  They receive backup from specialists in such fields as pediatrics, ob-gyn, psychology and internal medicine at community-level polyclinics. 

The question is:  will this model also ensure a better quality of life for the growing population over 60?

Experts in Cuba are quick to admit that the challenge is monumental:  Cuba's is already the "oldest" society in Latin America, with 13.6% of the population, or 1.5 million people, over 60.  This is due both to declines in fertility rates, and an extension of life expectancy over 75. By 2015, the proportion of older persons is expected to be one out of every five; and one out of every four Cubans by 2025.  For a comprehensive look at both population and individual aging in Cuba, we recommend the first of four articles in the Cuban Medical Research section of this issue:  Aging in Cuba by Alberta Durán and Ernesto Chávez, both from the Department of Family Studies at the Center for Psychological and Sociological Research.  The article was especially prepared for this issue of MR and contains a wealth of information and observations on the current status of older persons in Cuba, as well as a clear statement of the challenges ahead.

For a more specific look at the public health system's approach to the care of older patients and the results achieved thus far, we refer you to Cuba's National Comprehensive Program for the Elderly in the Spotlight section of this issue, The Elderly in Cuba: Main Demographic Trends, Morbidity and Mortality; Use of Primary Care Services by the Elderly, and Nursing Care of Hospitalized Geriatric Patients in the Cuban Medical Reserach section. As you will note, we have also added a column of Abstracts for additional references.

Finally, we recommend you turn to Dr. Enrique Vega's thoughtful insights in MR Interviews...  As Director of the Ministry of Public Health's National Group for Attention to Older Persons, he offers important reflections on strategy development and the particular problems of older persons and their families in Cuba.

Please let us know your reactions to the issue and the new format.  In May, we will bring you Cardiology: A Primary Care Perspective.