Psychiatric social epidemiology in Cuba I: Contextual and developmental considerations

Abstract

This review is reported in two parts. This first article lays the groundwork for the analysis of psychiatric social epidemiology by (a) drawing in broad strokes the developmental phases followed by the Cuban Revolution, as the contextual base on which to build this analysis; (b) exploring the development of the field of psychiatric epidemiology in the Island; (c) delineating the development of human and material resources in health and mental health; (d) reviewing issues of access to care by traditionally underserved populations; (e) exploring gradual changes in the character of mental health care as reflected by service utilization patterns; and (f) discussing changes in the attitude of the population towards mental health and illness, as reflected by pathways to care. Overall, this section provides evidence of a rapid development and deployment of resources in this domain and of their egalitarian distribution and general accessibility to the population.

The Puerto Rican and Cuban public health systems: A Comparison

“…One-third of the women also work, and for 1982 constituted 33% of the total working population (Federaci6n de Mujeres Cubanas, 1982). There are no indications of a significant unemployment problem (Camayd-Freixas, 1985b).…”

“…In contrast, Cuban socioeconomic policies are directed toward the reduction of class differences, the valuing of all productive work, and the egalitarian redistribution of social and economic resources (Camayd-Freixas, 1985a, 1985b. Equal access to education, recreation, health services, adequate housing, and employment are goals of the Cuban government which are contrary to the social conditions that generate economic dependence and give meaning to the word "poverty.…”

“…In Puerto Rico, this rate has remained relatively constant since 1970 (Department of Health, 1980. The reader is referred to Camayd-Freixas (1985b) for a detailed discussion of the possible significance of these suicide statistics. It should be stressed, however, that the unreliability of Puerto Rico's suicide statistics must definitely be taken into consideration, as the general level of personal violence in this country (Assistant Secretariat for Mental Health, 1981Department of Health, 1980"El Crimen," 1984) suggests that real suicide incidence should be much higher.…”

“…The impact of psychosocial stressors. While mental health problems have acquired a relative priority, they apparently are not an urgent concern in Cuba (Camayd-Ereixas &z Uriarte, 1980;Camayd-Freixas, 1985b;Garcia-Averasturi, 1985;PCrez-Stable, 1985). Contrastingly, they are listed as the main priority of Puerto Rico's Department of Health Revised State Healrh Plan for 1980-1985.…”

“…In contrast, the Ministerio de Salud Pdblica (1977, quoted in Camayd-Freixas, 1985b, discussing the causes of absenteeism and occupational disability, lists psychiatric disorder rates of 5.2% and 16.2% for men and women, respectively. Camayd-Freixas (1985a, 1985b has developed an index of socioenvironmental stressors that includes leading causes of death with mental health implications (e.g., cirrhosis of the liver, homicide). Figure 1 illustrates a comparison of aggregate socioenvironmental stressors for Puerto Rico and Cuba.…”