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Dear PM, your briefing note on the Cuban health system

We heard on the news earlier this week that a Queanbeyan doctor put the skids under the PM’s health reform sales bandwagon, by suggesting he should take a leaf out of Cuba’s book.

Cuba achieved much more bang for its health buck, she suggested.

You might be wondering, PM, what exactly is so special about the Cuban health system.

It so happens that UNICEF has just published this article highlighting the benefits of a health system focused on infant and children’s health.

A UNICEF representative, José Juan Ortiz Brú, says that Cuba has done more than most countries to realise the United Nations Convention on the Rights of the Child (CRC), which states that nations “shall ensure to the maximum extent possible the survival and development of the child.”

“Undoubtedly, the reach and quality of child- and mother-friendly hospitals in Cuba sets one of the highest standards in the world,” he says.

The article describes how one hospital promotes breastfeeding, with the result that 98 per cent of its newborns are sent home breastfeeding exclusively.

Meanwhile, a recent study of breastfeeding rates in NSW identified significant room for improvement.

Of the babies discharged in 2007, 80% went home being fully breastfed, 7% were partially breastfed, and 13% were not breastfed.

Lower rates of breastfeeding were observed in some groups:

• teenage mothers (69%)

• Aboriginal mothers (64%)

• mothers born in South-East Asia (71%), North-East Asia (72%) and Melanesia, Micronesia and Polynesia (74%)

• mothers who commenced antenatal care later than 20 weeks gestation (74%)

• mothers who smoked (67%)

• mothers who received general anaesthetic during delivery (67%)

• mothers who gave birth by caesarean section (76%)

• mothers living in the most socially disadvantaged areas (73%)

• mothers living in remote and very remote areas (73% and 76% respectively)

• mothers of preterm infants (70%).

The findings are relevant to the PM’s health reform plans in a few ways. They highlight the need for health reform to be focused around meeting the needs of disadvantaged groups (it’s where the greatest need is, after all). They also highlight the potential for adverse consequences of a specialist-driven, hospital-centric system (how many women are told that surgical delivery is associated with reduced chances of breastfeeding, I wonder).

Isn’t it time we stopped speaking about “health reform” anyway? So far as I can tell, what we’ve really been talking about in recent weeks is “health services reform” – quite a different thing altogether.

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