Categories
COVID-19 Diplomacy Geopolitics Health Humanitarianism International Health Latin America Medicine United States

Internationalizing Cuban Medical Internationalism

A doctor’s surgery in Jaimanitas, Cuba. Source: Soydcuba, CC BY-SA 3.0, Wikimedia Commons

By Nicolas Friden, BA

As many different countries choose many different approaches in order to fight the virus, it still remains a huge task, even for the majority of countries in the developed world. As countries with a functioning health care system like France or even Germany struggle to contain the outbreak of the virus.

If the Covid-19 epidemic has shown one thing, it might well be that despite our belief we cannot control any and every disease. While somehow most Western countries might come through this pandemic relatively unharmed, it has still shown us that we have a lot to learn about our approach to a functioning medical system.

One country that frequently eclipses the rest of the World when it comes to medical expertise and a functioning heath care system is Cuba. While many are aware that Cuban doctors are sent to a lot of different countries, especially poorer ones, the proportions of this aid and cooperation system are less known.

However, if this system of health cooperation is functioning so well, why don’t any of the major countries in the World aspire to imitate some of its aspects in order to improve their own health diplomacy? Is the capitalist world too stubborn to adopt good ideas from other systems?

While Cuba is a relatively poor country compared to most of the Western World, this has never been an excuse for not providing medical aid and medical assistance to those most in need in any part of the World. For example, as Hurricane George devastated Haiti in 1998, Cuba immediately sent a force of 200 medical staff to help the local population. But the Cuban model doesn’t stop at immediate medical relief. This is actually only the beginning. After the initial damage is more or less under control, Cuban doctors and medical staff usually stay there and begin to train and treat the patients in the devastated country so as to provide development assistance to the local health authorities. This includes the process of transmitting knowledge to the local population by either training staff on the ground, or, more importantly even, by providing local students with the chance to acquire a medical degree in Cuba. This allows fully trained medical personnel to come back and be able to help the local population where it is most needed.[1]

This feat is even more impressive if you consider that every single step of the way is free of charge. This is seen by some as a true act of solidarity to the ones that are most in need. This is particularly astonishing as Cuba didn’t have a lot of support and of trading partners after the Soviet Union collapsed. In the early 1990s, male body weight in Cuba fell by 20-25 pound on average and public transportation was cut by 80%. Still, even in these difficult times for the country, its foreign policy regarding health remained the same, and Cuba continued assisting others where and when they needed it. [2]

So why is it that Western countries are neither discussing nor adopting the Cuban model to some extent?

The two parts of this question might well be closely linked to each other, as the West and in particular the United States have always had a hard time accepting Cuba’s existence in the first place. Since Cuba has a socialist government, it was always viewed as a possible threat in Washington, which imposed a trade embargo on the country, already in 1958. Writing this in 2021, when the Soviet Union is long gone, and an East West divide is not so visible anymore, it is astonishing that this embargo remains in place.

This might be one reason why Western media and policy-makers remain reluctant to fully acknowledge the real role Cuba plays when it comes to global medical relief. This whole situation really is an indictment on most powerful Western governments, as they remain unable to even acknowledge that their way of thinking might not be the best or even the only way.

As the Covid-19 pandemic rages on stronger than ever (especially in the United States, the one country that will not in any case acknowledge Cuba’s know-how or accept its existence), the Cuban situation compared to the rest of the World remains under control for the moment and Cuba is only waiting for the opportunity to help its neighbours[3].

It remains difficult to see a change of course for the United States, when it comes to its relationship with Cuba and its reluctance to accept any kind of help or advice coming from this country, but maybe if the rest of the World starts implementing some Cuban medical policies, the US eventually could follow the same path.


[1] John M. Kirk, “Cuban Medical Internationalism and Its Role in Cuban Foreign Policy,” Diplomacy & Statecraft 20, no. 2 (August 5, 2009): 275–90.

[2] Ibid.

[3] Worldometers.info/coronavirus

Categories
Class Ethnicity Health Medicine United States Vulnerability

Social vulnerabilities and determinants of health

By Victoria Frohnhofer, BA

“Drawing attention to the central role of human freedoms in health is a statement of philosophical position and a call to social action. ”[1](Marmot)

Ethnic minorities, socially vulnerable people or marginalized groups are terms, which are often associated with struggle. The struggle to find housing, the struggle to vote (if the possibility exists) or the struggle to receive appropriate health care to name a few of these. This struggle has continued into the global COVID-19 pandemic, making it more threatening to certain groups of people than others. 75% of people who died of COVID-19 in Washington D.C. up until June 2020 were of African American descent.[2] This reality within the capital shows just how different realities can be, depending on how much melanin your skin contains. Different reasons have led to this palpable scenario. However, these reasons have been apparent long before the year 2020.

The Crux of Health and Wealth

One may think that health is solely determined by wealth, however this conclusion is a bit too linear. The complexity behind linkage of health and wealth comes with the addition of political or socio-economic progress as well as inequities. Because progress is not produced homogeneously, inequities are a side effect of it. Inequity is therefore what determines health perhaps even to a much greater extent than just wealth does,[3] even though wealth is one of the biggest forms in which inequity can be seen. For this reason, the gaps of health within even wealthy countries can be seen in crisis much more clearly. It is the amount of inequity within a country, which determines the health of its citizens, not how large its GDP (gross domestic product) is. Crisis such as the Covid-19 Pandemic have made this painfully apparent.           

Nevertheless, the GDP is important for tracking the growth and development of wealth of a country. The GDP is able to show the income of a nation as well as the proportion of its productivity within one year[4]. It is certainly a limited form of measurement for a country’s wealth since many factors are left out of the calculation or are up for interpretation. The reason for this is that wealth is defined within the GDP only in an economic way. However, other factors such as the environmental wealth of a nation, the wealth of education, health or diversity within a nation are neglected. As explained below, this is especially interesting when observing the United States of America for the reason of its ethnic diversity. However, by using the GDP, it is possible to examine the relationship between wealth and health to a certain degree and enable us to analyze how and were these two aspects of life seem to relate.

Disparity in Diversity

Socioeconomic differences and the social gradient in health[5] are, amongst other things, determining health in most countries. The social gradient in health is a concept which recognizes the correlation between inequities between social classes and population health.[6] The United States makes for a compelling example because of its ethnic diversity and its use of statistical measurements on the basis of these multiple ethnic groups. It is in this country with the highest GDP globally[7] in 2019, that ethnicity still plays perhaps the largest role in one’s health. Being of African American descent in the United States automatically places your life expectancy on the lowest scale[8] compared to other ethnicities. With ethnicity as the major determinants of health within this exceedingly wealthy nation, it is clear that the overall economic wealth of a nation does not automatically produce health in all of its citizens.                                       

It must be said that ethnicity, economic wealth and therefore health are nevertheless interconnected. Even though the economic wealth of a nation may not automatically produce health in its citizens, the lack of personal financial wealth can very well be the cause of a lack in health. An example is the African American community, for whom the poverty rate was more than 10% higher in 2010 than for other US Americans.[9] Reasons for this high amount of African Americans living below the poverty line are that many African Americans work in the low wage sector and in general, earn lower wages than Americans of other ethnicities, regardless of their workplace.[10] This increases the chance of falling below the poverty line. Thus, by understanding that there is an interconnection between low income and low health,[11] it becomes clear that the African American community faces a much greater struggle in obtaining and preserving their health. The most recent health crisis in the United States, the COVID-19 Pandemic, has made this inequity once more exceedingly visible through a death toll that was different for specific ethnic groups.

Feasibility vs. Possibility 

Considering the knowledge we have in todays global world regarding the correlation between health, wealth as well as ethnicity, the inequity within a nation such as the United States of America is logical and at the same time disheartening. Therefore, it is necessary to view the possibilities that a nation with the largest GDP has to implement political and economic changes in order to produce a shift in this inequity. The fact that this inequity has been a known issue for decades, makes it even more confounding as to why this predicament has not yet been tackled in a sustainable way. One may even hypothesize that it has suited successive governments not to eliminate the factor of ethnicity as a determinant of health. As a result, the possibilities of advancement in health for African Americans are limited, making social vulnerability a continued determinant of health.

References

Bloom, David E. “The Health and Wealth of Nations” American Society for the Advancement of Science, vol. 336 (18th February 2000), pp. 1207-1209.

Deaton, Angus “The Great Escape – Health, Wealth, and the Origins of Inequality”. Princeton: Princeton University Press, 2013.

Kosteniuk, Julie G, and Harley D. Dickinson. “Tracing the social gradient in the health of Canadians: primary and secondary determinants. Social Science & Medicine vol. 57;2 (July 2003), pp. 263-276.

Marmot, Michael “Health in an unequal world: social circumstances, biology, and disease”. The Lancet, vol. 336 (9th December 2006), pp. 2081-94.


Websites:                    

https://coronavirus.dc.gov/release/coronavirus-data-june-5-2020 (5.12.2020)

https://data.worldbank.org/indicator/NY.GDP.MKTP.CD?locations=US&most_recent_value_desc=true (2.1.2021)


[1] Michael Marmot “Health in an unequal world: social circumstances, biology, and disease” The Lancet, vol. 336 (9th December 2006), 2081-94.

[2] https://coronavirus.dc.gov/release/coronavirus-data-june-5-2020 (5.12.2020).

[3] Angus Deaton The Great Escape – Health, Wealth, and the Origins of Inequality. Princeton, Universtiy Press, 2013.

[4] Ibid.

[5] Marmot, 2006.

[6] Julie Kosteniuk and Harley D. Dickinson “Tracing the social gradient in the health of Canadians: primary and secondary determinants” Social Science & Medicine vol. 57;2 (July 2003), 263-276.

[7] https://data.worldbank.org/indicator/NY.GDP.MKTP.CD?locations=US&most_recent_value_desc=true (2.1.2021)

[8] Deaton, 2013.

[9] Ibid. (see Figure on p.180)

[10] Ibid.

[11] David E. Bloom “The Health and Wealth of Nations”. American Society for the Advancement of Science, vol. 336 (18th Febuary 2000), 1207-1209

Categories
COVID-19 Epidemics and Gender HIV Social activism United States

Communicating disease: Keith Haring’s AIDS paintings as a means for social activism

Picture taken by the author at a recent Keith Haring exhibition at the Bozar in Brussels (2019-2020)

by Viola Ziehaus, MA

The current crisis triggered by the COVID-19-pandemic can be described as many things, including as a giant magnifying glass that sheds light on the injustices and the systematic political and social malfunctions of the world. For many of us, it might be the first time experiencing such a pandemic. Nevertheless, it is not the first time in history that a health crisis unleashes profound changes that not only affect the sanitary domain, but also economics, politics and, more broadly, development itself by generating fears, inequalities, but also a sense of hope for a better world. There are different ways in which individuals deal with the threat posed by a disease, including art, an activity that constitutes a pivotal component of the social world. This blog post focuses on how the US-American artist Keith Haring used art as a means of social activism in order to raise awareness about AIDS and help people to make sense of the disease in emotional and cognitive terms.

Why art matters in times of crisis

Artists have always played a crucial role in communicating the injustices of the world, nurturing hopes through their work, acting as spokespersons for those who do not have the means or the power to raise their voices and being a motor of social activism. Especially in times of crisis, art has proven itself to be a tool that allows mankind to process experiences, to find a source of strength and comfort, to feel connected to a holistic experience, to understand each other on a deeper level and to see ourselves within a larger society. While it could never save lives in the way that science may be able to, art can nevertheless deliver a strong message – as American artists Keith Haring once said, “Art should be something that liberates your soul, provokes the imagination and encourages people to go further.”

When AIDS hit the world

This ideology of delivering a message through art was particularly prevalent during the AIDS pandemic that had its outbreak in the early 1980s. The illness is caused by the human immunodeficiency virus, or HIV, that is transmitted through bodily fluids and that attacks the body’s immune system. According to the World Health Organization, HIV is still one of the world’s most serious public health challenges. For the Centre for Disease Control and Prevention, the virus originated in Central Africa and may have jumped from chimpanzees to humans in the late 1800s. At that time, it spread slowly across Africa and into other parts of the world, and eventually also arrived in the United States around 1970, even if it did not come to the public’s attention until the early 1980s. In that decade, one American city was hit especially hard by the crisis: New York City.

There‘s a new guy in town

The AIDS pandemic led many artists and activists in New York City to identify new forms of supporting social causes by using art as a mean of resistance. Among those artists was Keith Haring, an openly gay advocate for safe sex. Haring grew up in Pennsylvania and moved to New York City in 1978 where he enrolled in the School of Visual Arts and dived into the art and social scene of the East Village. There he found an alternative art community outside of galleries and museums. He started experimenting with chalk graffiti over unused advertising spaces in subway stations. Little did he know that with a piece of chalk and a combination of pop art and graffiti, he was setting the scene to changing the world. Throughout his career, Haring devoted his time to public works that often-carried powerful social messages. Especially during the last years of his life, Haring generated activism and awareness about AIDS during a time where little was known about a virus that not only was a taboo topic, but particularly affected the gay community.

A social construction of reality

In his work, Haring created attention and awareness of HIV and AIDS by breaking with taboos and using explicit sexual iconography to inspire the general public for a more open conversation about the virus and its prevention. He promoted safe sex campaigns and constructed a social reality, in which he portrayed the virus not as a biological entity, but as an enemy – the devil of the people. Since the pioneer work of sociologists Peter Berger and Thomas Luckmann[1], scholars have studied how social reality is constructed in intersubjective exchanges and interactions. As a constitutive domain of the public sphere of a society – including the global –, art is a major field for the construction of reality. By representing AIDS though black shapes that somehow resemble a devil with horns, Haring loaded the disease with specific negative connotations, which help raise awareness about the dangers it poses to human beings. Even if this was not Haring’s only approach to deal with the disease from an artistic perspective, it showcases clearly how he intended to provoke discussions about AIDS by depicting the disease itself as a threat to humanity and by employing resources that are easily linked by the audience as evil.

Why Keith Haring’s work still matters

Haring was diagnosed HIV positive in 1988 and died of AIDS related complications in 1990 at the young age of 31. But his art has never been forgotten. Even though he might be dead for more than three decades, his work keeps inspiring people, organizations and movements all over the world. If he were still alive, public spaces would probably already be painted with coronavirus-images, depicting it as an “evil enemy” or a “social monster“, bringing it to life by means of representations that are beyond the scientific domain to educate people about the illness rather than live in fear of it. Just like Haring created a sort of visual identity for AIDS, he would have probably also created one for the coronavirus, accompanied by words like “Ignorance = Fear, Silence = Death”[2] in order to enact social change and bring conversations into the mainstream. There is no better way to summarize Keith Haring’s intention than with his own words: “I don’t think art is propaganda; it should be something that liberates the soul, provokes the imagination and encourages people to go further. It celebrates humanity instead of manipulating it.”


[1] Berger, P. & Luckmann, T. (1966). The Social Construction of Reality: A Treatise in the Sociology of Knowledge, Garden City, NY: Anchor Books.

[2] Whitney Museum of American Art: https://whitney.org/collection/works/46387, accessed 24 January 2021.

General References:

HERO Magazine. 12.08.2020

Dazed Digital. 29.06.2017

https://www.dazeddigital.com/artsandculture/article/36252/1/important-lessons-keith-haring-taught-us-about-life-and-art

The Guardian. 02.06.2019. https://www.theguardian.com/artanddesign/2019/jun/02/public-has-right-to-art-keith-haring-tate-liverpool-exhibition

Deutsche Welle. 21.08.2020

https://www.dw.com/en/relevant-as-ever-keith-haring-works-on-show-in-essen/a-54623367

U.S. Department of Health & Human Services, accessed 23 January 2021

https://www.hiv.gov/federal-response/pepfar-global-aids/global-hiv-aids-overview

Centers for Disease Control and Prevention, accessed 23 January 2021

https://www.cdc.gov/hiv/basics/whatishiv.html

New York City AIDS Memorial, accessed 24 January 2021

https://www.nycaidsmemorial.org/timeline

The Keith Haring Foundation, accessed 24 January 2021

https://www.haring.com/!/about-haring/bio

Moreno Barreneche, S. “From a Biological Entity to a Social Monster. A Semiotic Construction of the Coronavirus During the Covid-19 Pandemic.” Revista di Sociologia del Territorio, Turismo, Tecnologia 7, no. 1 (2020) http://www.serena.unina.it/index.php/fuoriluogo/article/view/7041

Categories
1918 flu pandemic Humanitarianism Red Cross United States

Podcast: the American Red Cross and the 1918 flu pandemic

Volunteer nurses from The American red cross during flu epidemic (1918). Original image from Oakland Public Library. Digitally enhanced by rawpixel.

By Cedric Carlier, BA, and Viola Ziehaus, BA

The podcast discusses the role of the American Red Cross during the 1918 flu pandemic. It features an interview with a person from the time, the journalist Ms. Porter. Disclaimer: The historical character of “Ms. Porter” in this podcast is fictitious.