The Equity Initiative’s Global Learning module helps Fellows develop a global perspective on the social determinants of health, as it exposes them to equity issues and concerns in other countries and contexts. During a weeklong trip to Havana and Pinar del Río, Cuba, held May 26 to June 2, Fellows explored aspects of Cuba’s history and culture, as well as its social, economic, and political contexts, in order to better understand the ways in which the country promotes health equity.

Over the course of the week, overview presentations and panel discussions examined the socioeconomic dynamics shaping Cuban society and the implications for equity. Urban planner Miguel Coyula highlighted key points in Cuba’s history and economic development through the lens of his work in housing, infrastructure, investment, and restoration programs. Sociologist Marta Núñez addressed changing cultural patterns, as she argued that integrating women into the labor force can be a means of fighting poverty, gender inequality, and underdevelopment. Three Cuban economists, David Pajón Espina, Juan Alejandro Triana, and Javier Ortiz, focused on Cuba’s major barriers to economic growth, the ways in which the benefits of economic growth are currently distributed, and the challenges of inclusivity and equity.

Cuba’s health sector was addressed in remarks by Marcelino Feal Suarez, professor of general surgery at the University Hospital Calixto García, and in a joint presentation by Gail Reed of Medical Education Cooperation with Cuba and Tomás Reinoso Medrano, a medical doctor and professor at the National School of Public Health. Ms. Reed pointed out that health has long been a priority in Cuba’s social safety net. Cuba has adopted a community-oriented approach to primary health care, directed resources to the most vulnerable populations first, and ensured that human resources for health are highly trained. As a result, life expectancy in Cuba reached 80 years in 2017, and other health indicators, such as infant and maternal mortality and under-five survival, are strong. Dr. Medrano spoke about medical education in Cuba, including its principles, ethics, and teaching settings, and argued that the way medicine is taught is essential to the way it is practiced.

Visiting the Centro Oscar Arnulfo Romero (OAR) gave Fellows a chance to see the ways in which a Cuban NGO responds to inequities with programs that empower women and youth and provide care for the elderly. These programs reflect OAR’s core belief that popular education can be a transformative social practice and that participatory community planning gives a voice to vulnerable populations. Fellows also traveled a couple hours outside Havana to the community of Pinar del Rio, where scientist and organic farmer Fernando Funes Monzote explained the ways in which agroecological practices at his farm, Finca Marta, and others, can contribute to food security, job creation, and cultural preservation. While enjoying homestays with local families in Pinar del Rio, Fellows had a chance to ask questions about daily life and draw comparisons with living conditions in their own countries

Cuba is undergoing political, economic, and social transitions, and its development roadmap remains unclear. While these dynamics create uncertainties about the outlook for equity in Cuba, a key takeaway for Fellows is that health and sociopolitical development are inextricably woven together. The week of contrasting experiences in Cuba gave them much to reflect upon as they return to the health and equity challenges within their own societies.