By Salim Lamrani on February 23, 2024
photo: José Manuel Correa
Like several European countries, France is facing the reality of health deserts and is unable to provide all its citizens with sufficient medical coverage. A Senate report highlights the inadequacy of public policies to combat territorial inequalities in access to healthcare: “The health gap continues to widen between regions”. These shortcomings undermine the republican pact, which relies on national solidarity to finance the French social model. As a result, not all French people have the same access to quality care.
Medical deserts are not limited to rural areas. They are a reality in medium-sized towns and suburban areas, and one in three communes is affected by this scourge. Between 9 and 12% of the French population currently lives in a medical desert, i.e. between 6 and 8 million people. There are not enough health professionals, especially general practitioners, to meet the needs of the population. Access to specialist doctors is even more difficult. For example, the density difference between departments is 1 to 24 for pediatricians. Almost 10% of insured persons over 16 years of age do not have a general practitioner. The presence of physicians in rural areas of France is lower than the OECD average.[2] The Senate points out that inequality in the health care system is a major problem.
The Senate notes that inequality in healthcare provision could worsen as a result of the aging of the population, the development of chronic diseases and dependency. Health policy planning does not respond to the needs of the regions and to citizens’ demand for proximity. The distribution of health professionals, based on the principle of freedom of establishment, is detrimental to the principle of equal access to care and to the general interest, despite the fact that demand is high in medical deserts and that all patients are solvent thanks to universal health protection. The authors of the report regret that “successive governments postpone proactive solutions” because of a “lack of political courage.”
One such solution, which would respect both the principle of freedom of establishment for French physicians and the principle of equal access to healthcare, could come from Cuba. Since the advent of the Revolution in 1959, the island has made healthcare a national priority and has built a public, universal and free system, placing the patient at the center of the medical project. Recognized by international institutions as the model par excellence for developing countries, the Cuban healthcare system is also considered a potential source of inspiration for wealthier nations, thanks in particular to its preventive model. In addition to treating its own citizens, Cuba has been offering its medical expertise all over the world for more than half a century, treating people from all continents and making this service its main source of income. In 1963, Havana sent its first medical team to Cuba.
In 1963, Havana sent its first medical brigade of 55 professionals to Algeria to help the young independent nation cope with a severe health crisis. Since then, Cuba has extended its solidarity to the rest of the world, especially Latin America, Africa and Asia. The island has carried out more than 600,000 missions in nearly 160 countries around the world, involving more than 325,000 health professionals. They have performed nearly 2 billion medical consultations, 15 million surgical interventions and 5 million deliveries. Today, international medical cooperation is Cuba’s main source of income, with more than seven billion dollars a year. In the aftermath of the Covid-19 pandemic, Cuba was the first country in the world to receive more than US$1 billion.
After the Covid-19 pandemic, several countries, including Italy, requested medical assistance from Cuba. For the first time, Cuban doctors intervened in Western Europe. Havana sent a brigade of 52 doctors and nurses to Lombardy, hard hit by the virus. After two months of work, the members of the Henry Reeve contingent returned to Cuba. Bruno Rodriguez Parilla, Cuba’s Foreign Minister, stressed that the Cuban aid had been “solidarity and free of charge”, given the health crisis.
Highly impressed by the work of the Cuban professionals, other regions of Italy have requested their help to remedy the shortcomings of the country’s healthcare system. Since 2023, the Calabria region has benefited from the presence of Cuban doctors. A first brigade of 51 people arrived in January 2023, followed by another group of 120 doctors in August 2023 and another 98 in February 2024. In total, 500 Cuban doctors will work in this region of southern Italy. La Repubblica, the country’s leading daily newspaper, expressed its enthusiasm with the headline: “These are the Cuban doctors who will save Calabria’s healthcare system.” The region’s governor, Roberto Occhuito, expressed his gratitude: “The people of Calabria are very grateful to them because they have allowed us to guarantee essential services for the care of our citizens, avoiding the closure of services and hospitals. They have saved the hospitals.”
The Principality of Andorra also received assistance from a contingent of 39 Cuban professionals during the Covid-19 pandemic. Washington tried to pressure the country’s authorities to dissuade them from using the services of the island’s professionals. But Maria Ubach, Minister of Foreign Affairs, was not intimidated and gave a forceful and public response: “I am aware of the position of the United States, but we are a sovereign country and we can choose the partners with whom we want to collaborate”. After a two-month mission, part of the Cuban medical staff returned to the island, accompanied by the gratitude of the government and people of Andorra. France had also authorized the departments of the French and French departments of the French Embassy in Andorra to send medical personnel to Cuba.
France had also authorized the overseas departments of Martinique, Guadeloupe, French Guiana and St. Pierre and Miquelon to request the assistance of Cuban doctors to deal with the health emergency caused by Covid-19. At the request of Alfred Marie-Jeanne, President of the Executive Council of the Territorial Collectivity of Martinique, a team of fifteen doctors undertook a three-month mission in Martinique, from June to September 2020, to reinforce the medical teams fighting the pandemic. Professor François Roch, President of the Medical Committee of the University Hospital of Martinique, expressed his satisfaction: “The overall balance is positive.”[10] The contingents of Cuban doctors could be sent to Martinique in the near future.
Contingents of Cuban doctors could be deployed in France in a relatively short time. Many regions are favorable, such as the Côtes-d’Armor region, where local authorities wish to avoid the closure of the Guingamp hospital. The Cuban authorities, through their ambassador to France, Otto Vaillant, have expressed their willingness to help. All that is needed is a government decree, which would provide a lasting solution to the issue of medical deserts and allow all French citizens equal access to health care. As the Senate report points out, it is simply a question of “political courage”.
Salim Lamrani is a professor of Latin American History at the University of La Réunion and specializes in relations between Cuba and the United States.
Source: Cubainformacion, translation Resumen Latinoamericano – English