World Health Organization (WHO)

Cuba’s Success and Problems with an Aging, Declining Population

One of the successes of the Cuban Revolution has been better health care for average Cubans and thus their increasing life spans. Simultaneously, however, the number of younger Cubans has been declining. The result, Cuba has a declining, aging population that is now the oldest in Latin America,

The average life expectancy for a Cuban man is 76.8 years and 81.3 years for a woman, according to 2018 data from the World Health Organization. To address the challenges of this changing demography, the Cuban government has made the following changes:

Several years ago, the Cuban government began to progressively raise its retirement age from 60 to 65 for men and from 55 to 60 for women. It also allowed people to collect their pensions and still work.
In December 2018, the government raised the minimum pension from 200 Cuban pesos to 249 Cuban pesos, which amounts to less than $10. Many pensioners complain they are barely getting by.
Cuba’s Ministry of Public Health provides funding for Círculos de Abuelos (Grandparents Circles), which provide adult daycare for the elderly with meals, games, conversation and socialization.

On the other hand, Cuba’s low fertility rate and birth rate are seen as markers of low confidence in Cuba’s future. The same is shown by high out-migration of younger Cubans looking for a better life and future prospects in other countries. Nor is Cuba attracting in-migration of younger people from other countries for the same reason.

In short, for this aging U.S. gringo, Cuba needs to adopt policies that give younger Cubans solid reasons to believe that their future on the island will be better. And that is not more of the same.

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Whitefield, ‘Circulos de Abuelos’ serve Cuba’s rapidly aging population—the oldest in the Americas, Miami Herald (Mar. 7, 2019); Cuban Realities Adversely Affecting Normalization with the U.S., dwkcommenaries.com (Nov. 12, 2015).

New U.S. Annual Report on Human Rights Around the World

On April 20 the U.S. State Department released its 2017 Country Reports on Human Rights Practices. Acting Secretary of State John J. Sullivan wrote the Preface to the Reports and made remarks upon their release while a Special Briefing on the Reports was conducted by Ambassador Michael G. Kozak, the head of the Department’s Bureau of Democracy, Human Rights and Labor.

These three introductions to the Reports will be discussed below, and a future post will review the report on Cuba.

Preface by Acting Secretary of State Sullivan[1]

“We are a nation founded on the belief that every person is endowed with inalienable rights. Promoting and defending these rights is central to who we are as a country.”

“The 2017 Country Reports on Human Rights Practices . . . document the status of human rights and worker rights in nearly 200 countries and territories. These reports are required by U.S. law and are used by a variety of actors, including the U.S. Congress, the Executive branch, and the Judicial branch as a factual resource for decision-making in matters ranging from assistance to asylum.”

“The 2017 U.S. National Security Strategy recognizes that corrupt and weak governance threatens global stability and U.S. interests. Some governments are unable to maintain security and meet the basic needs of their people, while others are simply unwilling. States that restrict freedoms of expression and peaceful assembly; that allow and commit violence against members of religious, ethnic, and other minority groups; or that undermine the fundamental dignity of persons are morally reprehensible and undermine our interests. The Governments of China, Russia, Iran, and North Korea, for example, violate the human rights of those within their borders on a daily basis and are forces of instability as a result.”

“Our foreign policy reflects who we are and promotes freedom as a matter of principle and interest. We seek to lead other nations by example in promoting just and effective governance based on the rule of law and respect for human rights. The United States will continue to support those around the world struggling for human dignity and liberty.”

Remarks by Acting Secretary of State Sullivan[2]

The Acting Secretary noted that this was the 42^nd year of such reports, which “are a natural outgrowth of our values as Americans. The founding documents of our country speak to unalienable rights, fundamental freedoms, and the rule of law – revolutionary concepts at the time of our founding that are now woven into the fabric of America and its interests both at home and abroad.”

“Promoting human rights and the idea that every person has inherent dignity is a core element of this administration’s foreign policy. It also strengthens U.S. national security by fostering greater peace, stability, and prosperity around the world. The Human Rights Reports are the most comprehensive and factual accounting of the global state of human rights. They help our government and others formulate policies and encourage both friends and foes to respect the dignity of all individuals without discrimination.”

“This year, we have sharpened the focus of the report to be more responsive to statutory reporting requirements and more focused on government action or inaction with regard to the promotion and protection of human rights. For example, each executive summary includes a paragraph to note the most egregious abuses that occurred in a particular country, including those against women, LGBTI persons, persons with disabilities, indigenous persons, and members of religious minorities.”

Sullivan then had comments about some countries “with the most egregious human rights records:” Syria, Burma, North Korea (DPRK), China, Iran, Turkey, Venezuela and Russia. He concluded by noted three countries with improvements: Uzbekistan, Liberia and Mexico.

Briefing by Ambassador Kozak[3]

Responding to a journalist’s question whether the U.S. issuance of this report could be regarded as hypocrisy because of U.S. human rights problems, the Ambassador said that this would be an unfounded charge. The report criticizes some country’s revoking licenses of media that criticize the government and even killing journalists; the U.S. does not do that. He also said the U.S. has laws to protect foreigners from being returned to countries where they are likely to face illegal persecution.

Nozak rejected the notion that the report was weakened by President Trump’s calling the U.S. press an enemy of the people and suggesting changing U.S. libel laws to protect politicians like him from unfounded reporting. In contrast he said independent journalists in Cuba “are routinely slapped around, they also get called names, “

This year’s report omitted a special section on women’s reproductive rights because it is not a term derived from an international treaty or from the U.S. statute requiring these annual reports; the latter refers to coerced family planning, coerced abortion or involuntary sterilization. In addition, the new U.S. report has a hyperlink to a WHO report on the subject.

Kozak rejected the notion that this report was undercut by President Trump’s meetings with leaders of countries with poor human rights records.

The U.S. as a matter of policy supports NGOs around the world that are working to improve human rights.

For North Korea, the U.S. is concerned about the nuclear issue and about human rights. The report “pretty starkly [discusses] the kinds of abuses, and over the last year or two, we’ve supported . . . a commission of inquiry on North Korea, we support NGOs that are working on North Korea and exposing the human rights abuses that occur in the camps there and so on. But some of the stories that are contained in the report are just overwhelming. There’s one about 11 people who were arrested for supposedly making a pornographic film and they were executed by shooting anti-artillery weapons at them, and then they brought out tanks and ran over the bodies, and this is supposed to be a civilized country.”

The Preface to the report calls China, Russia, Iran and North Korea as “forces of instability.” This is not a defined term, but refers to situations where internal actions generate international problems like refugee flows and humanitarian crises.

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[1] U.S. State Dep’t, Preface to Country Reports on Human Rights Practices for 2017 (April 20, 2018).

[2] U.S. State Dep’t, Remarks on the Release of the 2017 Country Reports on Human Rights Practices (April 20, 2018).

[3] U.S. State Dep’t, Briefing on the Release of the 2017 Country Reports on Human Rights Practices (April 20, 2018).

Death Certificates’ Documentation of Mortality

The April 7^th issue of the New Yorker has a fascinating article by Kathryn Schulz[1] on death certificates, a subject you never thought you would want to know about.

She says, “every dead body is a mystery. Death is an assassin with infinite aliases, and the question of what kills us is tremendously complex. . . . Today, ‘Why do we die?’ is one of the fundamental questions of epidemiology, and we have developed a vast and macabre bureaucracy to answer it.”

Only one half of the 50 million people who will die this year, she reports, will get a death certificate. The half who do not are in the world’s poorest places that do not have the infrastructure for such documentation.

The antecedent of the modern death certificate was the Bill of Mortality in early-sixteenth century England that recorded the weekly numbers of death by the plague.

In 1836 they were replaced in England by what would become the global prototype of the modern death certificate.

In 1893 the International List of Causes of Death was published by a committee headed by the French statistician and demographer Jacques Bertillon. That list after 10 revisions is still used today and now is managed by the World Health Organization. The latest version has over 8,000 ways to die.

Today the one-page death certificate has 250 pages of instructions on how to fill it out by physicians, funeral directors, medical examiners and coroners. Although 90% of the certificate can be filled out easily, the problem arises with the four lines for cause-of-death.

The certificates for deaths in hospitals typically are filled out by residents who have inadequate training for doing so. This results in errors that “overstate leading causes of death, obscure emerging ones, and distort the data we use to allocate funds for research, education, prevention and treatment.”

The author concludes that a death certificate “provides the pathological basis of death, determined by some combination of fact, convention, and guesswork, and described in terms that most non-doctors struggle to understand.” She adds, “The bureaucratization of death . . . has evolved over time into a massively complex checkpoint at the border between the living and the dead; Charon’s[2] T.S.A. [Transportation Security Agency].”

I now add the history of the death certificate to my prior post’s reflection on mortality.

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[1] Schulz is a journalist, author and book critic for New York Magazine. Her book Being Wrong: Adventures in the Margin of Error was described as a “funny and philosophical meditation on why error is mostly a humane, courageous and extremely desirable human trait.” She has spoken at TED on “Don’t regret regret” and “On being wrong.”

[2] In Greek mythology, Charon is the ferryman of Hades who carries souls of the newly deceased across the rivers Styk and Acheron that divided the world of the living from the world of the dead.