Cuba has "a lower child mortality rate than ours. Their life expectancy is now greater than ours."

Cuba has "a lower child mortality rate than ours. Their life expectancy
is now greater than ours."
Tom Harkin on Wednesday, January 29th, 2014 in a press conference

Sen. Tom Harkin says Cuba has lower child mortality, longer life
expectancy than U.S.

Sen. Tom Harkin, D-Iowa, recently spent three days in Cuba -- the
longtime socialist adversary of the United States -- to learn more about
the island nation's health care system.

For years, some health policy specialists in the United States have been
intrigued by Cuba's health care system. Cuba produces a disproportionate
number of doctors, and it has posted relatively strong health statistics
in international comparisons, especially considering the country's
shortage of material goods and economic wealth.

For some liberals, Cuba's health care system has offered an alternative
to the one in the United States, where millions of Americans have
struggled without insurance in recent years. Notably, Michael Moore's
2007 health care documentary Sicko includes scenes where Americans in
need of medical attention travel to Havana and are treated for free at a
high-quality hospital. Critics have countered that such free, quality
care is available only to the communist elite, not to ordinary Cubans.

Harkin certainly saw something promising in Cuba's health care system.
During a press conference upon his return to Washington on Jan. 29,
2014, Harkin -- who chairs the Senate Health, Education, Labor, and
Pensions Committee -- said that Cuba is a "poor country, but they have a
lower child mortality rate than ours. Their life expectancy is now
greater than ours. It's interesting — their public health system is
quite remarkable."

We wondered whether these statistics are accurate, and what they say
about health care in Cuba.

Child mortality statistics

On child mortality, we found a few data sources that are generally
considered credible. According to the CIA Factbook, Cuba infant
mortality rate is indeed lower -- an estimated 4.76 deaths per 1,000
live births in 2013, compared to 5.90 for the United States.

And more precisely given the phrase Harkin chose, Cuba also has a better
child mortality rate -- that is, the likelihood of death under 5 years
of age. According to the World Health Organization, Cuba had 6 deaths
under age 5 per 1,000 live births between 2005 and 2010, compared to 8
deaths for the United States.

So on child mortality, Harkin had his numbers right.

Life expectancy statistics

The data for life expectancy appears to be mixed. According to both the
CIA Factbook, the estimated life expectancy for both sexes in 2013 was
78.62 in the United States, compared to 78.05 years in Cuba. And
according to the World Health Organization, life expectancy in 2011 was
79 years in the United States and 78 in Cuba.

By these sources, Harkin would be wrong. But when we contacted Harkin's
office, they pointed us to data from Pan American Health Organization
that backed up their claim. For 2012, the group found that life
expectancy was 79.2 years in Cuba, compared to 78.8 years in the U.S.

So for life-expectancy numbers, the data is varied, with some supporting
Harkin and some not.

How reliable is this data?

We wondered, however, whether the data from Cuba's authoritarian
government could be trusted. As we looked into it, we heard a measure of
skepticism.

We did find one area of agreement: Cuba puts a lot of emphasis on its
health data. Richard H Streiffer, dean of the College of Community
Health Sciences at the University of Alabama, said his conclusion from
two visits to Cuba is that Cuban health practitioners are "very
compulsive about collecting data and reporting it regularly."

On a recent trip, Streiffer said, he spent time with a family doctor in
a neighborhood clinic. "Family doctors are mandated to collect certain
data," he said. "He had right on his wall a 'dashboard' of data
characterizing his practice -- an age/sex distribution; an age/sex
distribution of the top 10 chronic diseases in his practice; a map of
where his patients lived in the neighborhood. You don't find that in the
US."

However, some experts said that this obsession with statistics can be a
two-edged sword when it comes to reliability. Some say Cuba is so
concerned with its infant mortality and life-expectancy statistics that
the government takes heavy-handed actions to protect their international
rankings.

"Cuba does have a very low infant mortality rate, but pregnant women are
treated with very authoritarian tactics to maintain these favorable
statistics," said Tassie Katherine Hirschfeld, the chair of the
department of anthropology at the University of Oklahoma who spent nine
months living in Cuba to study the nation's health system. "They are
pressured to undergo abortions that they may not want if prenatal
screening detects fetal abnormalities. If pregnant women develop
complications, they are placed in 'Casas de Maternidad' for monitoring,
even if they would prefer to be at home. Individual doctors are
pressured by their superiors to reach certain statistical targets. If
there is a spike in infant mortality in a certain district, doctors may
be fired. There is pressure to falsify statistics."

Hirschfeld said she's "a little skeptical" about the longevity data too,
since Cuba has so many risk factors that cause early death in other
countries, from unfiltered cigarettes to contaminated water to a
meat-heavy diet. In a more benign statistical quirk, Carmelo Mesa-Lago,
a professor emeritus of economics at the University of Pittsburgh,
suggests that the flow of refugees could skew longevity statistics,
since those births are recorded but the deaths are not.

Transparency would help give the data more credibility, but the Cuban
government doesn't offer much, experts said.

"I would take all Cuban health statistics with a grain of salt,"
Hirschfeld said. Organizations like the Pan-American Health Organization
"rely on national self-reports for data, and Cuba does not allow
independent verification of its health claims."

Rodolfo J. Stusser -- a physician and former adviser to the Cuban
Ministry of Public Health's Informatics and Tele-Health Division who
left for Miami at age 64 -- is another skeptic. While Stusser
acknowledges that Cuba has improved some of its health numbers since the
revolution, the post-revolution data has been "overestimated," he said.
"The showcasing of infant mortality and life expectancy at birth has
been done for ideological reasons," he said.

Our ruling

Harkin said that Cuba has "a lower child mortality rate than ours. Their
life expectancy is now greater than ours."

According to the official statistics, Cuba does beat out the United
States for both infant and child mortality, and on life expectancy, the
data is mixed, with a slight edge to the United States. However, the
combination of the Cuban government's heavy-handed enforcement of
statistical targets and the lack of transparency has led some experts to
suggest taking the numbers with a grain of salt. On balance, we rate
Harkin's claim Half True.

Source: Sen. Tom Harkin says Cuba has lower child mortality, longer life
expectancy than U.S. | PolitiFact -
http://www.politifact.com/truth-o-meter/statements/2014/jan/31/tom-harkin/sen-tom-harkin-says-cuba-has-lower-child-mortality/