Ushered in with the rampage of Hurricane Matthew, later days brightened in this month that has often been harbinger of both good and bad news for Cuba and the world.

Hurricane Matthew ripped through Eastern Cuba, devastating the historic town of Baracoa (Cuba’s first capital, founded in 1511) and the village of Maisí, where the morning sun first rises over Cuban territory. Wind and flood leveled hundreds of homes, brought down the power grid and destroyed crops. Yet there was no loss of human life, unlike in neighboring Haiti and other countries in Matthew’s path, and unlike in Cuba in 1963, when Hurricane Flora caused more than 1200 deaths. In Haiti, efforts of health workers—including hundreds of Haitian graduates from Cuba’s Latin American Medical School and 600 Cuban health professionals already there—were bolstered by dozens of specially trained Cuban disaster medical personnel in the wake of the storm.

Two articles in this issue draw upon Cuba’s experience in urgent care and disaster management: an Editors’ Choice is Véliz-Martínez’s original research on professional competencies required by specialists in emergency medicine, in tune with a worldwide movement toward competency-based professional training. And this issue’s Viewpoint by Castell-Florit Serrate and Más-Bermejo points to the success of Cuba’s disaster-response strategy, arguing that its cross-sector principles of health in all policies should be applied to other pressing public health concerns.

On October 14, the month brought a surprise of another sort: US President Barack Obama used his executive authority to expand and encourage “authorized engagements” with Cuba, increasing possibilities for travel and commerce.[¹1. The White House [Internet]. Washington, D.C.: Office of Press Secretary; c2016. Full text of President Obama’s statement regarding the Presidential Policy Directive on Cuba; 2016 Oct 14 [cited 2016 Oct 17]. Available from: https://www.whitehouse.gov/the-press-office/2016/10/14/statement-president-presidential-policy-directive-cuba
https://www.whitehouse.gov/the-press-off... ] While some of the new regulations may raise more questions than answers about US policy, one area clearly stands to benefit: bilateral cooperation in health and medical research. Contained in amendments to embargo rules issued by the US Treasury Department’s Office of Foreign Assets Control, the decisions allow US medical research centers to collaborate with Cubans in commercial as well as noncommercial research. The changes also permit Cuban-developed pharmaceuticals to enter normal FDA regulatory channels, and be sold in the United States if FDA approved. The latter Anally breaks through the licensing impasse faced by innnovative Cuban products such as Heberprot-P (for diabetic foot ulcers) and cancer therapies.

Two research centers—Roswell Park Cancer Institute and Cuba’s Molecular Immunology Center (CIM), featured on our cover—are already moving towards US testing for Cuban cancer therapies, as Dr Tania Crombet, CIM’s Director of Clinical Research notes in her Interview with senior editor Gorry in this issue.

Cancer was one of two key health issues that brought US Secretary of Health and Human Services Sylvia Mathews Burwell to Cuba this month. She signed a memorandum of understanding with Dr Roberto Morales, Cuba’s Minister of Public Health, laying the groundwork for further collaboration with Cuba in cancer prevention, management and research. She also attended a two-day hemispheric meeting to devise a regional strategy for confronting Zika, dengue, chikungunya and other arboviral diseases. According to PAHO, 520 million people in the Americas are at risk of these diseases, and PAHO Director Dr Carissa Etienne told the opening session that they “take an especially heavy toll on our region’s most vulnerable populations.”

Original research presented in this issue covers important topics for population health improvement, two concerning surveillance and population health assessment. Domínguez-Alonso’s work on diabetes burden among Cuban children and adolescents provides essential data for policy and planning to reduce the impact of diabetes in the pediatric population. Varona-Pérez’s analysis of physical activity and related factors from Cuba’s Third National Survey on Risk Factors and Chronic Diseases serves a similar function for public health approaches to prevention and control of major causes of death and disability.

Two more papers concern human resources and their training: Castañeda-Guillot reviews the history of pediatric gastroenterology, which has yet to be recognized as an official medical specialty in Cuba. This, despite the existence of multiple clinical and research contributions to an international community of practice, leading the author to conclude that it is high time to formalize recognition of the relatively new medical specialty. A Perspective by Torralbas-Fernández and Calcerrada-Gutiérrez provides insights from research in Holguín Province, and recommends further training for Cuban health professionals in primary care to better prepare them to address domestic violence against women.

Bosch-Bayard’s Policy & Practice outlines the introduction of a Cuban national strategy for Alzheimer disease and dementia syndromes, particularly important in this country, which has one of the fastest-growing populations of older adults in the hemisphere. The fact that in 2015 nearly one in five Cubans were aged ≥60 years suggests the scope of the challenge.

Our congratulations go to Dr Pastor Castell-Florit Serrate, Director of Cuba’s National School of Public Health, on receiving the 2016 PAHO Award for Health Administration in the Americas, in recognition of his 45-year leadership contribution to the Cuban health system. Dr Castell-Florit is a member of MEDICC Review’s Editorial Board and co-chair of the Joint Academic Council of our publisher, MEDICC.

Finally, one last surprise this October: For the first time, the United States abstained on a UN General Assembly resolution calling for an end to the US unilateral economic, financial and commercial embargo against Cuba. For 24 previous years, the US Ambassador to the UN has voted against similar resolutions, its defense of the embargo isolating Washington from the Assembly’s consensus. This month’s vote was 191 governments in favor of ending the embargo, zero against, and 2 abstentions (the USA accompanied by Israel).

Ending the embargo is not only an action overwhelmingly demanded by the international community, but certainly the healthy thing to do.

The Editors

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