- Email: [email protected]
The Cuban Public Health System Focuses Research on Community Needs
Author’s Accepted Manuscript The Cuban Public Health System Focuses Research on Community Needs Roberto Cañete Villafranca
www.elsevier.com/locate/cuthre
PII: DOI: Reference:
S0011-393X(16)30072-8 http://dx.doi.org/10.1016/j.curtheres.2016.11.003 CUTHRE497
To appear in: Current Therapeutic Research Cite this article as: Roberto Cañete Villafranca, The Cuban Public Health System Focuses Research on Community Needs, Current Therapeutic Research, http://dx.doi.org/10.1016/j.curtheres.2016.11.003 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
The Cuban Public Health System Focuses Research on Community Needs Contact: Roberto Cañete Villafranca, M.D., M.S., Ph.D. Council of Scientific Societies of Health. University of Medical Sciences and Centre of Hygiene, Epidemiology and Microbiology. Calle Milanés esquina a Buena Vista. Matanzas City, Cuba. CP: 40100. Telephone at office: +53-45-266417 Cell phone: +53-53289356 Emails: [email protected] or [email protected]
Cuba is the largest island of the Caribbean and presents –in many aspects- a challenge for visitors from all over the world. Internet access is very limited, credit cards otherwise accepted worldwide are useless, and the currency market is almost non-existent. These limitations –and others- not only reduce the economic development of the country but also represent a challenge for Cubans. This is probably the reason why Cubans are known the world over for their inventiveness. One of the most recognized goals in Cuba is public health. Our health needs are similar to those faced by high-income countries and our health care system has solved problems that most countries have not yet managed to address. Enhancing primary health care has for us been an essential public health strategy implemented in Cuba prior to the 1978 Declaration of Alma Ata.1 Healthcare in Cuba is guided by some fundamental basic principles such as the state and social character of medicine, access and universality as well as the implementation of the latest scientific and technological advances consistent with the realities of a low-income country. The Cuban National Health System is highly structured, prevention-oriented and gives special attention to continuing medical education. Useful and impressively cost-effective solutions have been implemented for decades in Cuba in response to epidemics, non-communicable diseases and other health related problems and are now offered to other countries as humanitarian support. By focusing on primary care and health promotion, the Cuban health care model strives to identify and produce solutions to health problems at the community level.
This highly structured, prevention-oriented system has produced impressive positive results. Vaccination rates in Cuba are among the highest in the world.2 The life expectancy of 77 and 81 years from birth in males and females, respectively, is virtually identical to that in the United States and the infant mortality rate in Cuba has fallen from more than 80 per 1000 live births in the 1950s to less than 5 per 1000 today.3, 4 A number of different innovations represent Cuban developments in medical science. One of the most representative, in my opinion, is Heberprot-P®.5 Because diabetes mellitus has become a significant health problem throughout the world, the Center for Genetic Engineering and Biotechnology in Havana, Cuba has designed an integrated strategy for the preclinical testing, pharmaceutical development, production, clinical trials and business negotiations for an intralesional injectable drug used for treating diabetic foot ulcers; Heberprot-P®. This product, which uses epidermal growth factor as its active ingredient, avoids amputations, is the only registered drug of its type, and has already had considerable medical, social and economic impact in Cuba and in other nations, placing national science and the Cuban health system at the forefront of the fight against this disorder. In this issue, we present some important scientific research studies carried out in Cuba. The letter to the editor and the first original research, concerning Heberprot-P®, came from the large experience of the authors using this novel product. Another paper illustrates one of the on-going studies evaluating hepatitis c vaccines and another presents novel data about the clinical profile and treatment of autoimmune liver diseases in Cuban patients. No less important, the latest advances in immunotherapy and some important approaches related with digestive disturbances are reviewed. The growing concern among those who recognize that healthcare resources are finite has promoted policies of cost reduction and an in depth analysis of what is fair and equitable in the provision of health services. For scientists in Cuba, even considering the economic limitation and their own necessities, efforts to guarantee a healthy population are considered primary.
References 1. International conference on Primary Health Care, a gathering of historical importance, convened by WHO and UNICEF; 134 countries, 67 international agencies and many NGO’s participated.
Declaration
of
Alma-Ata.
Sept
6-12,
1978.
Available
in:
http://www.who.int/publications/almaata_declaration_en.pdf 2. The
United
Nations
Children’s
Fund
(UNICEF).
Country
Statistics.
http://www.unicef.org/infobycountry/cuba_statistics.html (Accessed Aug. 30, 2016). 3. World Health Organization (WHO). Cuba. http://www.who.int/countries/cub/en/ (Accessed Aug. 30, 2016). 4. Castro Pacheco BL. Evolución de la mortalidad infantil en Cuba. Rev Cubana Pediatr. 2016; 88(1).
Available
in:
http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0034-
75312016000100001&lng=es (Accessed Aug. 30, 2016). 5. Fernández-Montequín JI, Betancourt BY, Leyva-Gonzalez G, et al. Intralesional administration of epidermal growth factor-based formulation (Heberprot-P) in chronic diabetic foot ulcer: treatment up to complete wound closure. Int Wound J. 2009; 6:67-72.
Roberto Cañete Villafranca, M.D., M.S., Ph.D. Profile Roberto Cañete Villafranca, M.D., M.S., Ph.D., is Professor of Parasitology, Biosafety and Bioethics at the University of Medical Sciences in Matanzas, Cuba, and Researcher at the Center of Hygiene, Epidemiology and Microbiology in Matanzas. He is the Director of the Matanzas Council of Scientific Societies of Health and president of the Matanzas Chapter of the Cuban Society of Microbiology and Parasitology. His areas of expertise include clinical trials, research ethics, ethics and public health, parasitology, and the development of public health professionals and students’ ethical attitudes and behaviors. Prof. Cañete Villafranca received his M.D. degree at the University of Havana in 1997, and his certification as Master in Parasitology and Specialist in Medical Microbiology at the Tropical Medicine Institute Pedro Kourí in Havana in 2001 and 2002, respectively. In 2009, he received his Ph.D. in Medical Sciences from Havana’s University of Medical Sciences with a dissertation about the evaluation of the efficacy and safety of alternative drugs in the treatment of Giardia duodenalis infection in children. Prof. Cañete Villafranca is the author of more than 70 scholarly articles and book chapters. His current research is focused on ethics and public health as well as in ethics research. He is also involved in programs for the control of intestinal parasitic infection at community level, and the designing and carrying out of clinical trials in resource-limited settings.
www.elsevier.com/locate/cuthre
PII: DOI: Reference:
S0011-393X(16)30072-8 http://dx.doi.org/10.1016/j.curtheres.2016.11.003 CUTHRE497
To appear in: Current Therapeutic Research Cite this article as: Roberto Cañete Villafranca, The Cuban Public Health System Focuses Research on Community Needs, Current Therapeutic Research, http://dx.doi.org/10.1016/j.curtheres.2016.11.003 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
The Cuban Public Health System Focuses Research on Community Needs Contact: Roberto Cañete Villafranca, M.D., M.S., Ph.D. Council of Scientific Societies of Health. University of Medical Sciences and Centre of Hygiene, Epidemiology and Microbiology. Calle Milanés esquina a Buena Vista. Matanzas City, Cuba. CP: 40100. Telephone at office: +53-45-266417 Cell phone: +53-53289356 Emails: [email protected] or [email protected]
Cuba is the largest island of the Caribbean and presents –in many aspects- a challenge for visitors from all over the world. Internet access is very limited, credit cards otherwise accepted worldwide are useless, and the currency market is almost non-existent. These limitations –and others- not only reduce the economic development of the country but also represent a challenge for Cubans. This is probably the reason why Cubans are known the world over for their inventiveness. One of the most recognized goals in Cuba is public health. Our health needs are similar to those faced by high-income countries and our health care system has solved problems that most countries have not yet managed to address. Enhancing primary health care has for us been an essential public health strategy implemented in Cuba prior to the 1978 Declaration of Alma Ata.1 Healthcare in Cuba is guided by some fundamental basic principles such as the state and social character of medicine, access and universality as well as the implementation of the latest scientific and technological advances consistent with the realities of a low-income country. The Cuban National Health System is highly structured, prevention-oriented and gives special attention to continuing medical education. Useful and impressively cost-effective solutions have been implemented for decades in Cuba in response to epidemics, non-communicable diseases and other health related problems and are now offered to other countries as humanitarian support. By focusing on primary care and health promotion, the Cuban health care model strives to identify and produce solutions to health problems at the community level.
This highly structured, prevention-oriented system has produced impressive positive results. Vaccination rates in Cuba are among the highest in the world.2 The life expectancy of 77 and 81 years from birth in males and females, respectively, is virtually identical to that in the United States and the infant mortality rate in Cuba has fallen from more than 80 per 1000 live births in the 1950s to less than 5 per 1000 today.3, 4 A number of different innovations represent Cuban developments in medical science. One of the most representative, in my opinion, is Heberprot-P®.5 Because diabetes mellitus has become a significant health problem throughout the world, the Center for Genetic Engineering and Biotechnology in Havana, Cuba has designed an integrated strategy for the preclinical testing, pharmaceutical development, production, clinical trials and business negotiations for an intralesional injectable drug used for treating diabetic foot ulcers; Heberprot-P®. This product, which uses epidermal growth factor as its active ingredient, avoids amputations, is the only registered drug of its type, and has already had considerable medical, social and economic impact in Cuba and in other nations, placing national science and the Cuban health system at the forefront of the fight against this disorder. In this issue, we present some important scientific research studies carried out in Cuba. The letter to the editor and the first original research, concerning Heberprot-P®, came from the large experience of the authors using this novel product. Another paper illustrates one of the on-going studies evaluating hepatitis c vaccines and another presents novel data about the clinical profile and treatment of autoimmune liver diseases in Cuban patients. No less important, the latest advances in immunotherapy and some important approaches related with digestive disturbances are reviewed. The growing concern among those who recognize that healthcare resources are finite has promoted policies of cost reduction and an in depth analysis of what is fair and equitable in the provision of health services. For scientists in Cuba, even considering the economic limitation and their own necessities, efforts to guarantee a healthy population are considered primary.
References 1. International conference on Primary Health Care, a gathering of historical importance, convened by WHO and UNICEF; 134 countries, 67 international agencies and many NGO’s participated.
Declaration
of
Alma-Ata.
Sept
6-12,
1978.
Available
in:
http://www.who.int/publications/almaata_declaration_en.pdf 2. The
United
Nations
Children’s
Fund
(UNICEF).
Country
Statistics.
http://www.unicef.org/infobycountry/cuba_statistics.html (Accessed Aug. 30, 2016). 3. World Health Organization (WHO). Cuba. http://www.who.int/countries/cub/en/ (Accessed Aug. 30, 2016). 4. Castro Pacheco BL. Evolución de la mortalidad infantil en Cuba. Rev Cubana Pediatr. 2016; 88(1).
Available
in:
http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0034-
75312016000100001&lng=es (Accessed Aug. 30, 2016). 5. Fernández-Montequín JI, Betancourt BY, Leyva-Gonzalez G, et al. Intralesional administration of epidermal growth factor-based formulation (Heberprot-P) in chronic diabetic foot ulcer: treatment up to complete wound closure. Int Wound J. 2009; 6:67-72.
Roberto Cañete Villafranca, M.D., M.S., Ph.D. Profile Roberto Cañete Villafranca, M.D., M.S., Ph.D., is Professor of Parasitology, Biosafety and Bioethics at the University of Medical Sciences in Matanzas, Cuba, and Researcher at the Center of Hygiene, Epidemiology and Microbiology in Matanzas. He is the Director of the Matanzas Council of Scientific Societies of Health and president of the Matanzas Chapter of the Cuban Society of Microbiology and Parasitology. His areas of expertise include clinical trials, research ethics, ethics and public health, parasitology, and the development of public health professionals and students’ ethical attitudes and behaviors. Prof. Cañete Villafranca received his M.D. degree at the University of Havana in 1997, and his certification as Master in Parasitology and Specialist in Medical Microbiology at the Tropical Medicine Institute Pedro Kourí in Havana in 2001 and 2002, respectively. In 2009, he received his Ph.D. in Medical Sciences from Havana’s University of Medical Sciences with a dissertation about the evaluation of the efficacy and safety of alternative drugs in the treatment of Giardia duodenalis infection in children. Prof. Cañete Villafranca is the author of more than 70 scholarly articles and book chapters. His current research is focused on ethics and public health as well as in ethics research. He is also involved in programs for the control of intestinal parasitic infection at community level, and the designing and carrying out of clinical trials in resource-limited settings.