Poor Countries Are Unhealthy Countries

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Cholera epidemics are a bellwether of poverty and the breakdown of basic infrastructure, and Cuba's recent outbreak is no exception. On July 3rd, the Cuban Government admitted that 53 people in the south-eastern province of Granma were infected - the first cases in 130 years - and three had died. Independent reports later indicated that there were at least 15 deaths and the disease had reached Havana, on the opposite side of the island. Cuba's cholera outbreak is indicative of the country's deepening economic problems and its decaying public health system, which has long been the pride of its communist regime.

Cholera killed with impunity for millennia until a London physician, John Snow, unearthed its cause nearly 150 years ago. Dr Snow spent weeks tracking the disease's source to the Broad Street pump, a Thames-side water source thousands of people relied on. The pump's water supply had been contaminated by a cholera victim's fecal matter, allowing the disease to spread rapidly. Following Snow's discovery, cholera has been controlled extremely effectively in most places by maintaining simple sanitary standards.

Such standards have collapsed in Cuba. Deteriorating infrastructure, broken water systems, and inadequate sewage collection plague the country and undoubtedly contributed to the spread of the cholera outbreak. Meanwhile, hospital patients have been forced to provide their own linens, food, and often drugs even as shortages of these items grow.

Cuba's state-run healthcare system, idolized by many who oppose the U.S.' private healthcare system, has appropriately responded to the epidemic by providing rehydration salts for the victims and chlorine to disinfect water supplies. But only those with the rosiest of tints in their spectacles would call Cuba's broader healthcare system modern and effectual.

Meanwhile, at around 1.5% for 2009 and 2010, GDP growth has been fledgling at best. With little real private economic activity and widespread poverty, it is no surprise that basic public health provisions are falling by the wayside.

While the landscapes are vastly different, the cholera outbreak in Cuba reminded me of cholera's scourge in Zimbabwe four years ago. Zimbabweans are considerably poorer than Cubans, and at the time, Robert Mugabe's despotism was unmatched even by Fidel Castro's dictatorial rule in Cuba. In Zimbabwe, 100,000 people contracted the disease and an estimated 4,000 died. I recall that doctors at Mpilo hospital in Bulawayo were unable to treat the numbers of patients, and the morgue was literally overflowing with bodies.

Since the Zimbabwean crisis, cholera has only emerged in a few poor, and poorly governed, places: parts of Central Africa, the Democratic Republic of Congo, Pakistan, and Haiti. The inept government of Haiti - along with legions of aid workers - allowed the easily treatable disease to claim more than 2,500 lives before it was successfully contained. In all of these cases, a government's failure to provide even the most basic sanitation services allowed a disease which has been effectively combated for 150 years to kill.

Hopefully Cuba's cholera problem will spur Raul Castro to privatize more of the country's assets, a trend he began last year. While it is unlikely that Cuba's companies will be sold to Western companies espousing the value of freedom and which would likely advertise their new Cuban assets, a relaxing of the state's strangehold of businesses is nonetheless a positive development. And it probably matters less who buys the assets (the Chinese and Vietnamese are favorites, since Castro visited them last month), than that they are sold to more productive entities, where price and other market signals actually mean something so that resources are directed to their most valuable uses.

No doubt the Chavistas of South America will continue to provide moral and emotional support to Cuba, and perhaps even financial support too. But it is ironic that if the recent past is any guide that it will be Cuba that exports its medical expertise to them, rather than the other way around. Cuban doctors may yet be called upon to deal with a domestic cholera epidemic, but right now Cuba needs entrepreneurs to create the wealth to develop the infrastructure that is so badly required.

American leftists might laud the nationalized healthcare provision in Cuba, but cholera outbreaks should remind even these folks that without wealth generation, a healthy nation is rarely attained and never sustained.


Roger Bate is a resident scholar at the American Enterprise Institute, and the author of "Phake: The Deadly World of Falsified and Substandard Medicines." He is writing a book on the costs and benefits of free trade zones. 

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