The Ischemic Heart Disease in Cuba

Cuba is a republic that is situated in the Caribbean. It is a communist state with the population over 11 million, which ranks as one of the most populous in the region. Cuba consists of about 1600 islands and islets that together cover approximately 109, 886 km² (Pan American Health Organization, 2012). It is considered as a unitary democratic republic that includes 15 provinces together with Isla de la Juventud that is regarded as a special municipality. Cuba provides free health services and guarantees universal access to healthcare for every citizen (Pan American Health Organization, 2012). The National Health System is responsible for providing these services, and the country depends on a primary care model that emphasizes family medicine and nursing care. The health system is organized to encompass the municipal, provincial, and national levels. According to Pan American Health Organization (2012), the life expectancy of the citizens of this country stands at about 77.97 years. However, Cuba experiences a disproportionately high mortality rates with one of the main causes being ischemic heart disease.

Cardiovascular diseases account for the significantly high annual mortality rates in Cuba. They cause 40.5 percent of the annual mortality, which translates to about 39, 084 deaths (“Cuba Statistics on Diseases,” n. d.). Of all cardiovascular disorders, the ischemic heart disease is linked with the most mortalities. Statistics indicate that ischemic heart disease has a mortality rate of about 200.5 cases per every 100,000 people (“Cuba Statistics on Diseases,” n. d.). Thus, Cuba ranks top among the countries that have the highest mortality rates globally. The mortality rate is also the highest in the Caribbean considering that the mortality rate of Trinidad and Tabogo is 161.8 individuals per every 100,000 people and ranks as the second highest in the Caribbean (Health Grove, 2017a). The current mortality rate reflects a 2.2 percent increment in this rate since 1990. Other than mortality, ischemic heart disease also causes disability and leads to significant losses in productivity and healthy life, especially those who get diagnosed in their early adulthood. Statistics indicate that ischemic heart disease leads to significant losses in healthy life, which is approximately 2917 annual years in every 100,000 people (“Cuba Statistics on Diseases,” n. d.).

Ischemic heart disease affects specific populations more than others depending on exposure to the predisposing factors.  The disease is less prevalent in young children and adolescents, and prevalence starts to rise as age increases. Although some people develop this disease in their younger years, the prevalence is relatively low compared to those in middle and late adulthood. The disease achieves a peak mortality when people reach 80 years and above. For instance, in 2013, 3314.3 and 3303. 3 deaths occurred per every 100,000 people for women and men aged 80 years and above respectively (“Cuba Statistics on Diseases,” n. d.). The mortality rate is generally higher in men than their female counterparts. However, these statistics indicated that more women deaths occurred in those aged 80 years and above. The target population is multiethnic though Afro-Cubans and White Cubans constitute the majority. A majority of those who constitute the target population follows the Christian religion of which Roman Catholic predominates.

Various social factors play a role in the high prevalence and mortality rates of the ischemic heart disease. The culture of Cubans impacts greatly the prevalence of the disease. Unhealthy lifestyle is often implicated as a common cause of cardiovascular diseases and more importantly, the ischemic heart disease. Diet is ranked top among the behavioral risks that account for the disproportionately high prevalence of the ischemic heart disease. For example, the mortality rate associated with dietary risks is 112.4 cases per every 100, 000 people (“Cuba Statistics on Diseases,” n. d.). The changes noted in Cuba with regard to physical activity and nutrition have contributed to the current ischemic heart disease menace. According to Pena, Patel, Leyva, Khan, and Sperling (2012), the collapse of the Soviet Union led to an economic crisis that transformed nutritional preferences and patterns regarding participation in physical activity. During this period, the communist state suffered food scarcity, which caused many cases of mineral and vitamin-related disorders. At the same time, a notable reduction in caloric intake occurred, which led to fewer cases of cardiovascular disease and diabetes mellitus (Pena et al., 2012). However, as economic recovery began, fast food outlets and vendors proliferated in Cuba. During the same period, Cubans experienced limited access to fruits and vegetables.

Consequently, these tendencies changed the quality of diet. Cubans have a diet with consistently low quantities of fruits, vegetables, milk, whole grains, fiber, dairy, and polyunsaturated fatty acids (“Ischemic Heart Disease,” n. d.). Cubans also have preferences for a diet that includes high quantities of processed foods, red meat, sodium, sugar-sweetened beverages, and trans fatty acids. Pena et al. (2012) notes that although cost is a significant contributor to the dietary choices of Cubans, food preferences still pose a challenge to the adoption of healthy eating behaviors in this country. The poor dietary choices coupled with insufficient physical activity lead to obesity among the population of the country (Pena et al., 2012). Obesity is a predisposing factor for ischemic heart disease. It is a prevalent problem in rural and urban settings in the country. However, statistics indicate the occurrence of obesity is lower in the rural Cuba and suggest its higher prevalence in the urban areas. These obesity rates also coincide with the relatively high cases of heart diseases among urban residents. As Pena et al. (2012) notes, “the rate of cardiovascular disease is 40% higher in urban areas when compared to rural areas” (p. 4). The rate explains the relatively high cardiovascular-related mortalities in more urbanized areas of Havana when judged against those in Isla de la Juventud.

Tobacco smoking is another aspect that is responsible for high prevalence of the ischemic heart disease among Cubans. Pena et al. (2012) acknowledge that “40% of all men smoke tobacco every day, with a higher rate of 60% in middle age men” (p. 3). Women also smoke, but the rate is relatively lower than among their male counterparts. Pena et al. (2012) further notes that the smoking rate among the elderly Cubans is relatively high when compared to their counterparts in the Caribbean and Latin America. The high smoking rates predispose Cubans to ischemic heart disease. Dietary preferences of Cubans coupled with physical inactivity also lead to type 2 diabetes and a cause of ischemic heart disease (Pena et al., 2012). The preferences also precipitate the development of metabolic syndrome that encompasses hypertension and dyslipidemia, which serve as risk factors for ischemic heart disease. As noted, the prevalence of the diseases that constitute the metabolic syndrome stands at about 44 percent among adults aged above 40 years (Pena et al., 2012).

The Cuban government initiated partnerships with other agencies to help in dealing with the ischemic heart disease menace. The Cuban Comprehensive Health allows the Cuban government to foster global health cooperation and improve health provision. The Cuban government is currently in a partnership with Cardiocity following the procurement of a five-year license for the use of RythmPad (Crockford, 2016). The tool enables the discovery of abnormal heart rhythms. The national health system works together with community polyclinics, hospitals, cardiac rehabilitation centers, and medical institutes to improve prevention, health promotion, and disease management efforts. The Family Doctor and Nurse Program has also made significant contributions to the prevention and management of ischemic heart disease.

The Ministry of Public Health works in collaboration with the National Group of Cardiology to operate cardiac rehabilitation programs throughout all provinces of Cuba (Rivas-Estany, 2016). These programs focus primarily on those with heart diseases, more specifically, individuals with ischemic heart disease and myocardial infarction. The programs involve hospitalization for comprehensive care, convalescence in a rehabilitation center, and maintenance. The Continuous Assessment and Risk Evaluation (CARE) process also helps in addressing the ischemic heart disease problem because it informs intervention plans that seek to modify risk factors and improve health outcomes (Kick & Reed, 2012). The family physician and nurse offices and their respective teams serve as other stakeholders in the fight against the problem. Other stakeholders in the Cuban health system include local health departments, community agencies, and neighborhood organizations. Neighborhood organizations and Popular Councils help in addressing the problem considering the role they play in availing resources and arranging for health education and assessing progress respectively (Kick & Reed, 2012). The ASE Foundation is a global partner that facilitates training of local clinicians and provision of cardiac care to the underserved populations.

The National Health System itself emphasizes disease prevention in addition to health promotion. It establishes health teams whose one of the responsibilities is disease prevention (Kick & Reed, 2012). The existing prevention programs focus on establishing strategies that modify risk factors, for instance, dietary choices and tobacco smoking. The intervention programs include exercise or physical activity programs aimed at individual patient factors and needs. The government also runs cardiac rehabilitation programs at the primary care level (Rivas-Estany, 2016). The physical training programs also help in addressing ischemic heart disease problem. The intervention and prevention programs involve physiotherapists, family doctors, nurses, instruction specialists, physical activity specialists, and psychiatrists.

The ethical issues that may arise in the course of developing and implementing prevention or intervention programs include the maintenance of confidential or sensitive information of the patients. The programs may require evaluation, which may involve the collection of certain information regarding the participants. As such, failure to safeguard this information might raise privacy issues. With this in mind, guaranteeing confidentiality may involve maintaining the anonymity of the reported program data.

Addressing the problem of the high prevalence and mortality rate associated with the ischemic heart disease requires taking care of various barriers. One of the barriers is food preferences that prevent Cubans from embracing healthy eating habits (Pena et al. 2012). Another barrier is the cost of healthy dietary choices that include the consumption of food with adequate quantities of fiber, vegetables, and fruits. There is notable success in addressing risk factors of this disease. For example, the Cuban legislation has helped in regulating cigarette sales, especially to juveniles (Pan American Health Organization, 2012). The legislation also discourages smoking in public establishments. Social health policies have also enabled access to healthy food choices, especially among the socially disadvantaged groups. These policies have also encouraged the access to resources that enable participation in physical activity.

In conclusion, Cuba comprises of groups of islands that together form a communist state. The state provides universal health access and relies on a primary care model for the provision of key health services. However, ischemic heart disease poses a challenge, especially considering the disproportionately high prevalence and mortality rates compared to other diseases and countries in the region. The culture of Cubans as expressed in their food preferences is a major contributing social factor to the high prevalence and mortality attributed to ischemic heart disease, as poor dietary choices lead to illnesses that predispose Cubans to the disease. However, the government has established partnerships that have helped in dealing with the problem. The existing intervention and prevention programs have also assisted in alleviating the issue although cost and food preferences still pose a challenge to prevention and disease management efforts.

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