Year of Publication

2004

Document Type

Dissertation

College

Public Health

Department

Gerontology

First Advisor

John F. Watkins

Abstract

Cubas provision of free health services to the entire population via neighborhood-based family doctors produced dramatic health gains and achieved a relative state of health equality. Since 1989, however, the termination of Soviet trade, a grave economic crisis, intensification of the US embargo, welfare reductions, and population aging have placed Cubas health successes and elder care services in jeopardy. Little independent research, though, has focused on the influence of post-Cold War circumstances on citizen attitudes about health programs and resources targeting Cubas older population. This research examined global and domestic factors since 1989 that have most influenced perceptions of the equitability and inequitability of health resources among older Cubans. Its multi-layered design drew on new International Political Economy, crystallization, and aspects of Grounded Theory. In-depth narrative interviews were conducted with Cubans age 60 years or older, their families and community support group members, family physicians and other medical personnel, and key health and government informants. Perceptions of health equity were found to correspond most with the geographic proximity and nearly unhindered physical access of older patients to their family doctors and the temporal availability of family physicians to their older patients. Conversely, perceptions of health inequity corresponded most with the older persons experience of medicine shortages and health resource rationing following global socio-political-economic change and domestic policy shifts after 1989. Furthermore, the life course influences of the pre- and post-revolutionary eras and pre-1989 and post-Cold War period were seminal in shaping the perceptions and expectations of the older participants regarding health care, the leadership, and Cuban socialism. The findings have added to the international health and cross-cultural gerontology literature. Decision-makers and health practitioners in Cuba and elsewhere have been informed about the importance of popular perceptions of the impact of health and elder policy change in an era of globalized social relations and capital. The research also has contributed a gerontological dimension and a narrative perspective to further the development of new International Political Economy.

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