Challenging many of the assumptions scholars have made about the Cuban Revolution’s impact on healthcare, this volume recounts one anthropologist’s quest to discover the truth behind the complicated relationship between Cuba’s revolution, politics, and healthcare system.

Katherine Hirschfeld became interested in Cuba in the mid-1990s, after reading numerous laudatory books and articles describing the Castro regime’s achievements in health and medicine. Cuba’s population health indicators seemed to be far superior to those of neighboring countries, the national health costs low, and medical care free at point-of-service to the entire people. Historical records indicated that most of these positive health trends resulted from the changes instituted by Castro in 1959. Few of these authors, however, had actually spent time on the island. Thus, Hirschfeld found that academic writing on Cuba was often long on praise, but short on empirical research about what exactly had changed in Cuban medicine since 1959.

After much bureaucratic wrangling, Hirschfeld managed to secure permission to conduct long-term ethnographic research in Cuba, where she lived with families from Havana and Santiago, conducted clinic observations, interviewed doctors and patients, and was treated in a Cuban hospital during an epidemic of dengue fever. The reality of the Cuban healthcare system turned out to be different than the scholarly ideal: it was bureaucratized, authoritarian, and repressive, and most people preferred to seek healthcare in the informal economy rather than endure the material shortages, red tape, and political surveillance of the public sector.

Written in the form of a first-person narrative, Health, Politics, and Revolution in Cuba Since 1898 not only critically reevaluates Cuban healthcare after the 1959 revolution; it includes chapters detailing Cuban health trends from the Spanish-American War (1898) through the fall of Fulgencio Batista in 1959 and into the present.

Katherine Hirschfeld is assistant professor of anthropology at the University of Oklahoma. She is the recipient of the Marjorie Shostak Award for Ethnographic Writing, and has had a photography exhibit, Havana: City on the Edge of Forever, on display at a number of universities across the United States.

"[I]t is surprising to learn in this ethnographic account by a US medical anthropologist that the Castro government has apparently been cooking the books... Her [Hirschfeld’s] idealistic preconceptions dashed by ‘discrepancies between rhetoric and reality,’ she observes a repressive, bureaucratized and secretive system, long on ‘militarization’ and short on patients’ rights, with state-employed ‘family doctors’ responsible not only for health but also for exposing political dissent... [T]he author, resorting to historical documents, concludes that the regime did foster public health gains after 1959, but concomitantly manipulated both health statistics and the impact of earlier US involvement in Cuba to highlight the 1959 revolution’s alleged successes. A revealing and persuasive glimpse into public health under socialism. Highly recommended.”
--Choice

“An exceptionally informative and original study of public health in Cuba that encompasses both its historical dimensions and the developments under Castro...This volume also provides a revealing grass roots portrait of Cuban society that benefits from the author’s extensive personal contacts and experiences during her stay there.”
--Paul Hollander, author of Political Pilgrims, Western Intellectuals in Search of the Good Society

Health, Politics and Revolution in Cuba Since 1898 is a reflection of a new generation of courageous, fact-based researchers who validate that eclectic qualitative/quantitative comparative anthropological techniques can be mighty effective—when objectively implemented—for deconstructing a closed society’s crafty propaganda. In sum, this tome is exemplary science making in the best Millian-Popperian tradition with implications transcending ever-growing Cubanology.
--Cuban Affairs