Subpopulations were identified with higher proportions of the disease burden and with particular risk profiles. These subpopulations exhibit certain features consistent with trends in the social structure of Cuban families that have been evolving over the past two decades.

Over the past 50 years, the Cuban health system has been developing a roster of programs to ensure its social mission: to achieve a health status of the population consistent with the priority established by the highest authorities of the country. In response to the call of the Commander in Chief, Fidel Castro Ruz, to create a different doctor and a new specialist that would take into account the needs of the Cuban population; the family doctor model was implemented. Thus, in the decade of the eighties, the “Family Doctor and Nurse Working Program” was established, together with the corresponding polyclinic and hospital. At the same time, comprehensive general medicine as a medical specialty was created to serve the primary health care services. Both actions constituted a vital component in the development of Cuban public health services in recent decades. This article presents an account of the unique characteristics of these processes, while highlighting their impact on health indicators, as well as the participation of this specialty in the training of human resources for the health system

CONCLUSIONSWe confi rmed interactions between individual and contextual (neighborhood and household) factors, whose effects on individual health are not entirely mediated by individual factors. Research needs to pay more attention to context beyond its direct effect on individual risk factors.