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ABSTRACT

This poster has emanated from a Doctorate in Governance thesis entitled � Public Health: why are the Cubans so successful?
For the purpose of the conference, the main focus will be the role of community nursing in Cuba�s success in public health. And in particular the emphasis which Cuban practitioners place on community participation and the social contract with citizens.
Health outcomes: infant mortality and life expectancy are closely correlated with GDP. Countries with higher GDP generally have better health outcomes. Cuba is the classic outlier in this regard. Economically a third world country, life expectancy in Cuba is equivalent to the Republic of Ireland, one of the richest countries in the world. Similarly Cuba�s infant mortality rates are comparable with all of the high income countries. A case study research design was used to examine the reasons behind these conspicuously good health outcomes. Twenty weeks of fieldwork, divided into two phases, was carried out in Cuba, in 2005/6.
The poster will set the context and rationale for the study, by highlighting critical junctures in modern Cuban history; analysing public health in Cuba and describing the case study design. A variety of methods: participant and non-participant observation, reflective diary, focus group interviews and semi structured interviews, were used, in the study. Analysis of the data resulted in ten explanatory themes, which are combined in a theoretical model to explain Cuba�s success.
The study concludes that Cuba is successful in public health because health has become emblematic of the revolution and that political will is central to this achievement. Recommendations distilled from the study include: development of health policy based on systematic needs assessment; placing Primary Care at the centre of health service provision and making the social contract between citizens and policy makers/nurses explicit.

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