Este artículo detalla el proceso de desarrollo de una innovadora alianza académico-gubernamental entre el Centro Oncológico de la Universidad de Illinois (UICCC) y el Ministerio de Salud Pública de Cuba (MINSAP). Esta colaboración, la primera de su tipo, tuvo
como objetivo abordar las desigualdades en materia de salud materna e infantil (SMI) en Englewood, un barrio predominantemente negro y estructuralmente desatendido de Chicago. El sistema de salud de Cuba, reconocido mundialmente por su modelo de atención primaria innovador y basado en la comunidad, cuenta con una tasa de mortalidad infantil (TMI) de 4,3 muertes por cada 1000 nacidos vivos, en comparación con las 5,6 de los Estados Unidos. Este logro notable, a pesar de los recursos limitados, destaca el éxito de Cuba en el aprovechamiento de la atención preventiva y el acceso universal para mejorar los resultados de salud pública. El manuscrito sirve como un trabajo en desarrollo que documenta la formación de esta alianza única y sus esfuerzos por adaptar el marco de Análisis de la Situación de Salud (ASS) de Cuba al contexto de los Estados Unidos. En el artículo se describen los pasos necesarios para obtener las aprobaciones regulatorias, fomentar el intercambio intercultural y comprometer a la comunidad local de Englewood para abordar las disparidades en materia de salud. Aprovechando la experiencia cubana en atención primaria y abordando los determinantes sociales de la salud, la asociación buscó crear soluciones viables para reducir la mortalidad infantil y mejorar la equidad en materia de salud
en general.
El artículo proporciona información valiosa sobre los desafíos y los éxitos de las colaboraciones transnacionales, ofreciendo un modelo reproducible para abordar las desigualdades sistémicas en materia de salud en comunidades desatendidas. Al detallar el desarrollo de la asociación, este trabajo enfatiza la importancia de los enfoques centrados en la comunidad y culturalmente competentes para transformar los resultados de salud en entornos con recursos limitados. Las lecciones de esta iniciativa subrayan el potencial de las asociaciones globales para impulsar la innovación y la equidad en la salud pública.
Fecha de recepción: noviembre 2024
Fecha de aceptación: noviembre 2024
Referencias bibliográficas
Alexandra, F. W. M. (2019). US foreign policy in restoring diplomatic relations with Cuba in 2015-2016. SociaePolites, 20(2), 81-102. https://doi.org/10.33541/sp.v20i2.1459
Alhusen, J. L., Bower, K. M., Epstein, E. & Sharps, P. (2016). Racial discrimination and adverse birth outcomes: An integrative review. Journal of midwifery & women’s health, 61(6), 707-720. https://doi.org/10.1111/jmwh.12490
Attanasio, L. M. S. & Kozhimannil, K. B. (2015). Patient-reported communication quality and perceived discrimination in maternity care. Medical Care, 53(10), 863-871. https://doi.org/10.1097/MLR.0000000000000411
Beech, B. M., Ford, C., Thorpe, R. J., Jr, Bruce, M. A. & Norris, K. C. (2021). Poverty, racism, and the public health crisis in America. Frontiers in public health, 9, 699049. https://doi.org/10.3389/fpubh.2021.699049
Bishop-Royse, J., Lange-Maia, B., Murray, L., Shah, R. C. & DeMaio, F. (2021). Structural racism, socio-economic marginalization, and infant mortality. Public health, 190, 55-61. https://doi.org/10.1016/j.puhe.2020.10.027
Braveman, P. (2006). Health disparities and health equity: Concepts and measurement. Annual Review of Public Health, 27(1), 167-194. https://doi.org/10.1146/annurev.publhealth.27.021405.102103
Chicago Metropolitan Agency for Planning (2024). Englewood Community Data Snapshot. https://www.cmap.illinois.gov/wp-content/uploads/dlm_uploads/Englewood.pdf
Ciano, A. (2024). From revolution to resilience: The impact of the US embargo on the post-revolutionary Cuban public health system (Doctoral dissertation, University of North Carolina at Chapel Hill). https://cdr.lib.unc.edu/concern/honors_theses/rb68xp-25t?locale=en
Cooper, R. S., Kennelly, J. F. & Ordúñez-García, P. O. (2006). Health in Cuba. International Journal of Epidemiology, 35(4), 817-824. https://doi.org/10.1093/ije/dyl175
Collins, J. W., Jr, David, R. J., Handler, A., Wall, S. & Andes, S. (2004). Very low birthweight in African American infants: the role of maternal exposure to interpersonal racial discrimination. American Journal of Public Health, 94(12), 2132-2138. https://doi.org/10.2105/ajph.94.12.2132
Crombet Ramos, T., Rodríguez, P. C., Neninger Vinageras, E., Garcia Verdecia, B. & Lage Dávila, A. (2015). CIMAvax EGF (EGF-P64K) vaccine for the treatment of non-small-cell lung cancer. Expert review of vaccines 14(10), 1303-1311. https://doi.org/10.1586/14760584.2015.1079488.
Cuban Ministry of Public Health (n. d.). Convención Internacional de Salud International HealthConvention. https://cubasalud.sld.cu/en/convencion
Dagher, R. K. & Linares, D. E. (2022). A critical review on the complex interplay between social determinants of health and maternal and infant mortality. Children (Basel, Switzerland), 9(3), 394. https://doi.org/10.3390/children9030394
DeWeerdt, S. (2001). Embargoing science: U.S. policy toward Cuba and scientific collaboration. BioScience, 51(8), 612. https://doi.org/10.1641/0006-3568 (2001)051[0612:ESUPTC]2.0.CO;2
Dresang, L. T., Brebrick, L., Murray, D., Shallue, A. & Sullivan-Vedder, L. (2005). Family medicine in Cuba: Community-oriented primary care and complementary and alternative medicine. The Journal of the American Board of Family Medicine, 18(4), 297-303. https://doi.org/10.3122/jabfm.18.4.297
Espinosa, M. C. S., Lauzurique, M. E., Alcázar, V. R. H. et al. (2018). Maternal and child health care in Cuba: Achievements and challenges. Revista Panamericana de Salud Pública, 42, e27. https://doi.org/10.26633/rpsp.2018.27
Fink, G. R., Leshner A. I. & Turekian, V. C. (2014). Science diplomacy with Cuba. Science, 344(6181), 1065.https://doi.org/10.1126/science.1256312
Gorry, C. (2013). Primary care forward: raising the profile of Cuba’s nursing profession. MEDICC Review, 15(2), 5-9. https://doi.org/10.37757/MR2013V15.N2.2
Gorry, C. (2019). Six decades of Cuban global health cooperation. MEDICC Review, 21(4), 83-92. https://doi.org/10.37757/MR2019.V21.N4.15
Greenwood, B. N., Hardeman, R. R., Huang, L., & Sojourner, A. (2020). Physician–patient racial concordance and disparities in birthing mortality for newborns. Proceedings of the National Academy of Sciences of the United States of America, 117(35), 21194-21200.
https://doi.org/10.1073/pnas.1913405117
Huish, R. & Kirk, J. M. (2007). Cuban medical internationalism and the development of the Latin American School of Medicine. Latin American Perspectives, 34(6), 77-92. https://doi.org/10.1177/0094582X07308119
Jang, C. J., & Lee, H. C. (2022). A review of racial disparities in infant mortality in the US. Children, 9(2), 257. https://doi.org/10.3390/children9020257
Keck, C. W. & Reed, G. (2012). The curious case of Cuba. American Journal of Public Health, 102(8), e13-e22. https://doi.org/10.2105/ajph.2012.300822
Kim, S. J., Ramírez-Valles, J., Watson, K. S., Allen-Mears, P., Matthews, A. K., Martínez, E., Odoms-Young, A., Daviglus, M. & Winn, R. A. (2019). Fostering health equity research: Development and implementation of the Center for Health Equity Research (CHER) Chicago. Journal of Clinical and Translational Science, 4(1), 53-60. https://doi.org/10.1017/cts.2019.415
Krumrey, Y. (2021, June 23). Englewood: Critical care. South Side Weekly. https://southsideweekly.com/critical-care/
Lamrani, S. (2021). The health system in Cuba: origin, doctrine and results. Études Caribéennes, (7). https://doi.org/10.4000/etudescaribeennes.24110
Lage, A. (2019). Science and challenges for Cuban public health in the 21st century. MEDICC Review, 21(4), 7-14. https://doi.org/10.37757/MR2019.V21.N4.2
Lauderdale, D. S. (2006). Birth outcomes for Arabic-named women in California before and after September 11. Demography, 43(2), 185-201. https://doi.org/10.1353/dem.2006.0008
LaVeist, T. A., Nuru-Jeter, A. & Jones, K. E. (2003). The association of doctor-patient race concordance with health services utilization. Journal of Public Health Policy, 24(3-4), 312–323.
Lee, W. & Park, S. (2016). Similar but divergent pathways: US-Cuba and US-North Korea relations. Pacific Focus, 31(2), 187-210. https://doi.org/10.1111/pafo.12070
Lorenz, J., Ananth, C., Polin, R. & et al. (2016). Infant mortality in the United States. Journal of Perinatology, 36, 797-801. https://doi.org/10.1038/jp.2016.63
MacDorman, M. F., Matthews, T. J., Mohangoo, A. D.& Zeitlin, J. (2014). International comparisons of infant mortality and related factors: United States and Europe, 2010. National vital statistics reports: from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System, 63(5), 1-6.
Machlis, G., Frankovich, T. A., Alcolado, P. M., García-
Machado, E., Hernández-Zanuy, A. C., Hueter, R. E., Knowlton, N., Perera, E. &Tunnell, J. W. (2012). US-Cuba scientific collaboration: Emerging issues
and opportunities in marine and related environmental sciences. Oceanography, 25(2), 227-231. http://www.jstor.org/stable/24861362
Mas-Bermejo, P., Marimón-Torres, N. & Dickinson-Meneses, F. (2024). Cuba-US scientific collaboration: Science diplomacy in challenging times. Perspective, 10, 17. https://doi.org/10.1126/scidip.adt9910
Ministerio de Salud Pública de Cuba. (2024). Anuario Estadístico de Salud 2023. Statistical Yearbook of Health. https://temas.sld.cu/estadisticassalud/2024/09/30/anuario-estadistico-de-salud-2023/
Morrison, J. S. & Gannon, S. (2015). Health cooperation in the new US-Cuban relationship. Health Affairs Forefront.
https://www.healthaffairs.org/content/forefront/health-cooperation-new-u-s--cuban-relationship
Moss, A., Rousseau, J., Lowell, G., Kaintz, K., Cavenagh, Y., Vidis, J., Robinson, C. L., Wilkerson, J. & Logan, C. (2022). Collaborating to advance health equity for families with newborns through public-private partnerships. Journal of Health Care for the Poor and Underserved, 33(4S), 107-123. https://doi.org/10.1353/hpu.2022.0161
Motala, M. & Wyk, J. V. (2019). Where are they working? A case study of twenty Cuban-trained South African doctors. African Journal of Primary Health
Care & Family Medicine, 11(1), Article 1977. https://doi.org/10.4102/phcfm.v11i1.1977
National Oceanic and Atmospheric Administration. (n. d.). United States and Cuba open doors to marine science cooperation. NOAA. https://www.noaa.gov/news/united-states-and-cuba-open-doors-to-marine-science-cooperation#:~:text=Scientists%20from%20the%20two%20countries,of%20the%20larger%20marine%20ecosystem.%E2%80%9D
Ronda-Pupo, G. A. (2021). Cuba-U.S. scientific collaboration: beyond the embargo. Plos One, 16(7), e0255106.
https://doi.org/10.1371/journal.pone.0255106
Ronda-Pupo, G. A. (2024). The dynamics of Cuban international scientific collaboration: A scientometric analysis over a century. Scientometrics, 129, 5211-5226. https://doi.org/10.1007/s11192-024-05137-6
Neggers, Y. H. & Crowe, K. M. (2013). Low birth weight outcomes: Why better in Cuba than Alabama? The Journal of the American Board of Family Medicine, 26(2), 187-195. https://doi.org/10.3122/jabfm.2013.02.120227
Papanicolas, I., Woskie, L. R. & Jha, A. K. (2018). Health care spending in the United States and other high income countries. JAMA, 319(10), 1024-1039. https://doi.org/10.1001/jama.2018.1150
Pastrana, S. J. & Clegg, M. T. (2008). U.S.-Cuban scientific relations. Science, 322(5905), 345. https://doi.org/10.1126/science.1162561
Pyone, T., Smith, H. & Broek, N. v. d. (2017). Frameworks to assess health systems governance: a systematic review. Health Policy and Planning, 32(5), 710-722. https://doi.org/10.1093/heapol/czx007
Polednak, A. P. (1996). Trends in U.S. urban black infant mortality, by degree of residential segregation. American Journal of Public Health, 86(5), 723-726. https://doi.org/10.2105/AJPH.86.5.723
Salm Ward, T. C., Mazul, M., Ngui, E. M. et al. (2013). “You learn to go last”: Perceptions of prenatal care experiences among African-American women with limited incomes. Maternal and Child Health Journal, 17, 1753-1759. https://doi.org/10.1007/s10995-012-1194-5
Singh, G. K. & Yu, S. M. (2019). Infant mortality in the United States, 1915-2017: Large social inequalities have persisted for over a century. International
Journal of Maternal and Child Health and AIDS, 8(1), 19-31. https://doi.org/10.21106/ijma.271
Slaughter-Acey, J. C., Sneed, D., Parker, L., Keith, V. M., Lee, N. L. & Misra, D. P. (2019). Skin tone matters: Racial microaggressions and delayed prenatal care. American Journal of Preventive Medicine, 57(3), 321-329. https://doi.org/10.1016/j.amepre.2019.04.014
Tung, E. L., Hampton, D. A., Kolak, M., Rogers, S. O., Yang, J. P. & Peek, M. E. (2019). Race/ethnicity and geographic access to urban trauma care. JAMA Network Open, 2(3), e190138. https://doi.org/10.1001/jamanetworkopen. 2019.0138
Vilda, D., Hardeman, R., Dyer, L., Theall, K. P. & Wallace, M. (2021). Structural racism, racial inequities and urban-rural differences in infant mortality in the US. Journal of Epidemiology and Community Health, 75(8), 788-793. https://doi.org/10.1136/jech-2020-214260
Wallace, M., Crear-Perry, J., Richardson, L., Tarver, M. & Theall, K. (2017). Separate and unequal: Structural racism and infant mortality in the US. Health & Place, 45, 140-144. https://doi.org/10.1016/j.healthplace. 2017.03.012
Watson, C. C., Rhein, L. & Fanelli, S. (2021). An American perspective of the dental and public health initiatives in Cuba. Journal of Advanced Oral Research, 13(1), 14-21. https://doi.org/10.1177/23202068211030143
Wenham, C. & Kittelsen, S. (2020). Cuba y seguridad sanitaria mundial: Cuba’s role in global health security. BMJ Global Health, 5(5), e002227. https://doi.org/10.1136/bmjgh-2019-002227
World Health Organization (2015). Cuban experience with local production of medicines, technology transfer and improving access to health. World
Health Organization. https://iris.who.int/bitstream/handle/10665/336685/9789241509718-eng.pdf?sequence=1
Xue, Y., Greener, E., Kannan, V., Smith, J. A., Brewer, C. & Spetz, J. (2018). Federally qualified health centers reduce the primary care provider gap in health professional shortage counties. Nursing outlook, 66(3), 263-272. https://doi.org/10.1016/j.outlook.2018.02.003
Zaimi, R. (2021). Rethinking “disinvestment”: Historical geographies of predatory property relations on Chicago’s South Side. Environment and Planning D: Society and Space, 40(2), 245–257. https://doi.org/10.1177/02637758211013041
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