The Health in the Americas+ country profiles are based on the interagency indicators available as of the dates referenced. The sources are referenced in this table. In some cases, the values of the indicators may differ from the most recent data available in the country.
Environmental and social determinants of health
In 2000 the total population of Cuba was 11 105 791 inhabitants; by 2023 this figure had risen to 11 194 449, representing a 0.8% increase. Regarding the country’s demographic profile, in 2023 people over 65 years of age accounted for 16.1% of the total population, an increase of 6.2 percentage points compared to the year 2000. In 2023, there were 101.6 women per 100 men and 103.4 older people (65 years or older) per 100 children under 15 years of age, as can be seen in the country’s population pyramids, distributed by age group and sex (Figure 1). Considering the population between 15 and 64 years of age to be potentially active (i.e., potential participants in the labor force), this group represented 68.3% of the total population of the country in 2023 (7 648 736 people). When we add these figures to the potentially passive population (1 742 912 under 15 years of age and 1 802 801 over 65 years of age), the result is a dependency ratio of 46.4 potentially passive people per 100 potentially active people. This ratio was 45.2 in 2000.
Life expectancy at birth in 2023 was 78.3 years, higher than the average for the Region of the Americas and 2.1 years higher that in 2000.
Figure 1. Population pyramids of Cuba, years 2000 and 2023
Between 2002 and 2012, the average number of years of schooling in Cuba increased by 13.1%, reaching an average of 11.5 years in the latest year for which information is available. The unemployment rate in 2022 was 1.4%. Disaggregated by sex, the rate was 1.5% for women and 1.3% for men. The literacy rate was 99.9% in 2021. In men, this figure was 99.9%; in women, 99.9%.
Between 2002 and 2012, the average number of years of schooling in Cuba increased by 13.1%, reaching an average of 11.5 years in the latest year for which information is available. The unemployment rate in 2021 was 2.8% for the total population. Disaggregated by sex, the rate was 3.0% for women and 2.6% for men. The literacy rate was 99.7% in 2021.
During the period 2000-2021, the country improved its score on the Human Development Index, with an increase of 10.2% (from a score of 0.693 to a score of 0.764); during the same period, the index rose 13.5% internationally and 9.4% in Latin America (Figure 2).
Figure 2. Human Development Index in the Region of the Americas, 2021
In 2020, public expenditure on health accounted for 11.37% of gross domestic product (GDP) (Figure 3) and 16.43% of total public expenditure, while out-of-pocket spending on health accounted for 8.92% of total health expenditure.
Figure 3. Domestic general government health expenditure as percentage of gross domestic product, 2020
In 2021, 71.1% of the population had an internet connection, representing a considerable increase from 2000, when .5% of the population had an internet connection.
Maternal and child health
Between 2000 and 2019, infant mortality in Cuba decreased from 7.2 to 5.031 deaths per 1000 live births, a decrease of 30.1% (Figure 4). The percentage of low-weight births (less than 2500 g) decreased from 6.1% to 5.6% between 2000 and 2020, while exclusive breastfeeding in the child population up to 6 months of age was 52.8% in 2006 (the latest year for which information is available).
Regarding the immunization strategy, measles vaccination coverage was 100% in 2022, an increase of 6.0 percentage points from 2000.
The maternal mortality ratio for 2020 was estimated at 39.3 deaths per 100 000 live births, a reduction of 16.5% from the estimated value for 2000 (Figure 5). In relation to fertility, it is estimated that in 2023 women had an average of 1.5 children throughout their reproductive lives. In the specific case of adolescent fertility, there was a 0.5% decrease, from 47.9 live births per 1000 women aged 15 to 19 years in 2000 to 48.1 in 2023. In 2019, 99.9% of births were attended by skilled birth personnel. Between 2014 and 2019 the percentage of pregnant people who had four or more consultations for antenatal care decreased from 97.8% to 79.3%.
Figure 4. Infant mortality per 1000 live births, 1995–2020
Figure 5. Maternal mortality per 100 000 live births, 2000–2020
In 2021, there were 5 new cases of tuberculosis per 100 000 population in Cuba. In 2019, the overall tuberculosis mortality rate (age-adjusted and per 100 000 population) was 0.3 (0.1 in women and 0.4 in men).
In 2021, the estimated human immunodeficiency virus (HIV) infection incidence rate (new diagnoses) was 13.3 per 100 000 population. The age-adjusted mortality rate for HIV was 3.8 per 100 000 population in 2019. It should be noted that during the 2000-2019 period this indicator decreased by 227.6%. There was one reported cases of human rabies in the country in 2021.
Noncommunicable diseases and risk factors
In Cuba in 2023, the prevalence of tobacco use among people aged 15 and older was 15.9%. In the same age group, the prevalence of overweight and obesity was 58.5% in 2016.
Also in 2016, 73.8% of the population reported insufficient physical activity.
In 2015, the reported prevalence of arterial hypertension (high blood pressure) among people aged 18 years or older was 19%, a decrease of 6.2 percentage points compared to 2000 (25.2%). The prevalence of diabetes mellitus, which stood at 7.3% in 2000, increased to 8.4% in 2014.
In 2019, the adjusted rate of potentially preventable premature mortality in Cuba was 210.9 deaths per 100 000 population, a decrease of 16.3% compared to the rate of 252 in 2000. This meant that in 2019 the rate in the country was 7% lower than the average rate reported for the Region of the Americas as a whole. Among potentially preventable premature deaths, the rate for preventable causes was 125.2 per 100 000 population in 2019, which is 8.7% lower than the regional average rate; and the rate for treatable causes was 85.7 per 100 000 population, below the regional average of 89.6.
The overall age-adjusted mortality rate was 5.3 per 1000 population in 2019, a decrease of 6.0% compared to 2000 (5.6 deaths per 1000 population).
When deaths are categorized into three main groups, it is observed that, in 2019, the age-adjusted mortality rate from communicable diseases was 49.3 per 100 000 population (59 per 100 000 in men and 40.7 per 100 000 in women), while the age-adjusted mortality rate from noncommunicable diseases was 431 per 100 000 population (519.6 per 100 000 in men and 353.7 per 100 000 in women). The rate of age-adjusted mortality from external causes was 45.5 per 100 000 population (62.9 per 100 000 in men and 28.3 per 100 000 in women), including road traffic accidents (7.4 per 100 000 population), homicides (5 per 100 000 population) and suicides (10.2 per 100 000 population). In 2000, the percentage distribution of causes was 81.3% for noncommunicable diseases, 8.8% for communicable diseases, and 9.9% for external causes; in 2019, the percentages were 83.3%, 9.2%, and 7.5%, respectively (Figure 6).
Figure 6. Proportional mortality in Cuba, 2000 and 2019
Regarding cancer mortality from tumors, in 2019, the adjusted mortality rate from prostate cancer was 32.2 per 100 000 men; lung cancer, 67.7 per 100 000; and colorectal cancer, 13.2 per 100 000. In women, these values were 15.8 deaths per 100 000 for breast cancer; 38.1 per 100 000 for lung cancer; and 14.4 per 100 000 for colorectal cancer.
The health situation and the COVID-19 pandemic
In Cuba in 2020, there were a total of 11 863 cases of COVID-19, representing 1054 per million population. In 2021, there were 954 141 identified cases, equivalent to 84 764 per million population. In 2022, 144 898 cases were reported. In 2020, there were 146 deaths directly caused by COVID-19 in people diagnosed with the disease, or 13 per million population; in 2021, 8176 deaths were reported, or 726 per million. For the year 2022, 208 deaths were reported, or 18 deaths per million population. In 2020, Cuba ranked 46th in the Region of the Americas in terms of the number of deaths from COVID-19, 35th in 2021, and 49th in 2022, with a cumulative 757 deaths per million population over the three years (Figure 7).
According to World Health Organization estimates, fewer deaths than expected were recorded in 2020, while 18 395 more deaths than expected were estimated in 2021, for an excess mortality rate of 163 per 100 000.
As of 31 December 2021, at least one dose of COVID-19 vaccine had been given to 94% of the country’s population. As of 20 April 2022 (latest available data), 88% of the population had completed the vaccination schedule.
Figure 7. Cumulative COVID-19 deaths in the Region of the Americas, to July 29th, 2023
Measures to achieve universal health coverage
Since the implementation of the family medicine program, Cuba has managed to achieve universal health coverage, even in the most remote and hard-to-reach areas. Moreover, the interventions that are continuing at the first level of care are aimed mainly at sustaining these achievements.
Challenges related to population health
Currently, the most important challenge for Cuba is to strengthen its health system in the post-COVID-19 pandemic era. The focus of public policies focuses on improving first-level care through the Family Doctor and Nurse Program, which aims to meet more than 70% of the population's health needs. Efforts are also directed at developing better information systems based on complete and accurate data, updating training programs for health personnel, strengthening the health system's infrastructure, reorganizing health services, and developing health-related innovation and technology.
These policies address health problems such as an ageing population and control of noncommunicable diseases, which account for the highest morbidity and mortality rates in the Cuban population, including premature deaths. Efforts are also directed at continuing and strengthening the Maternal and Child Care Program, and preparing the health system for possible future emergencies.
COVID-19 pandemic response
The most important public policies that have been conducted in response to the health situation caused by the pandemic include:
- Periodically updating the care protocol for COVID-19, in accordance with the latest scientific and technological advances.
- Implementing preventive strategies, including the administering of vaccines and the availability of other types of domestically produced medicines.
- Increasing national development of medicines (such as Heberferon, Itolizumab, and Jusvinza) and medical devices (such as pulmonary ventilators and mobile UVC germicidal lamp units), based on scientific developments in Cuba.
- Expanding international health control capacities, both at points of entry and at the primary care level.
Measures to reduce inequalities in health
The Cuban Constitution explicitly enshrines the principle of equality before the law, and declares that all persons enjoy the same rights, freedoms, and opportunities, without discrimination in any form.
With regard to health, Article 72 of the Constitution stipulates that “public health is a right of all persons, and it is the responsibility of the State to guarantee access to free, quality care, protection, and recovery services. In order to make this right a reality, the State establishes a health system which, at all levels, is accessible to the population, along with programs for prevention and education, in which society and families contribute."
In addition, the country has a National Action Plan that is a Follow-up to the Beijing Conference, which is of key importance for the implementation of national policies, with the health sector playing a predominant role in many of its strategies and actions. The Plan aims to strengthen national and local capacities to meet the Sustainable Development Goals, including promoting gender equality and the autonomy of women.
The country also has a National Economic and Social Development Plan 2030, in which the gender perspective and reduction of inequalities, among other policies, cut across its six strategic axes.
The National Program for the Advancement of Women is aimed at promoting more comprehensive and effective efforts to prevent and eliminate all forms of discrimination against women.
Lastly, national public policies include these important initiatives:
- Working intensively on the social determinants of health.
- Conducting comprehensive interventions and advocating for intersectoriality and social participation.
- Involving civil society actors in improving the quality of life of the population.
- Including the results of social, economic, and health research in planning and implementing the actions contained in local health system strategies.
- Improving the Family Doctor and Nurse Program, as part of efforts to strengthen primary care.
- Strengthening the work of the Integrated Health Services Networks.
National strategy to address inequalities in health
Conceiving of the health system as a single, universal system, with coverage for the entire population, national policies and strategies have focused on eliminating all inequalities in health. One of the objectives of analyzing the health situation at the primary care level is to identify potential inequalities in the health status of the population and/or in the social determinants of health.
A good example of this is the programs for the sexual health of women, girls, and boys, which clearly establish sexual and reproductive rights as basic human rights, and provide individualized attention based on the specific needs of each group (women and men, girls and boys, adolescents, and youths).
Lastly, along the same lines, the National Strategy for the Prevention and Control of Noncommunicable Diseases and their Risk Factors carries out differentiated actions to promote the consumption of fortified foods and the use of nutritional supplements for children, women of childbearing age, pregnant women, and older people.