Cuba is a Third World country that aspires to First World medicine and health. Its health-care system is not only a national public good but also a vital export commodity. Under the Castro brothers' rule, Cubans' average life expectancy has increased from 58 years (in 1950) to 77 years (in 2009), giving Cuba the world's 55th-highest life expectancy ranking, only six places behind the United States. According to the World Health Organization (WHO), Cuba has the second-lowest child mortality rate in the Americas (the United States places third) and the lowest per capita HIV/AIDS prevalence. Fifty years ago, the major causes of disease and death in Cuba were tropical and mosquito-borne microbes. Today, Cuba's major health challenges mirror those of the United States: cancer, cardiovascular disease, obesity, diabetes, and other chronic ailments related to aging, tobacco use, and excessive fat consumption.
By any measure, these achievements are laudable. But they have come at tremendous financial and
social cost. The Cuban government's 2008 budget of $46.2 billion allotted $7.2 billion (about 16 percent) to direct health-care spending. Only Cuba's expenditures for education exceeded those for health, and Cuba's health costs are soaring as its aging population requires increasingly expensive chronic care.
Cuba's economic situation has been dire since 1989, when the country lost its Soviet benefactors and its economy experienced a 35 percent contraction. Today, Cuba's major industries -- tourism, nickel mining, tobacco and rum production, and health care -- are fragile. Cubans blame the long-standing U.S. trade embargo for some of these strains and are wildly optimistic about the transformations that will come once the embargo is lifted.
Overlooked in these dreamy discussions of lifestyle improvements, however, is that Cuba's health-care industry will likely be radically affected by any serious easing in trade and travel restrictions between the United States and Cuba. If policymakers on both sides of the Florida Straits do not take great care, the tiny Caribbean nation could swiftly be robbed of its greatest triumph. First, its public health network could be devastated by an exodus