To the Editors:

Your recent article on personal responsibility in Cuba’s universal health system is timely.[¹1 Luis-Gonzálvez IP. Personal Responsibility in Cuba’s Universal Health Model. MEDICC Rev. 2017 Apr–Jul;19(2–3):76.]

Cuba’s sociopolitical changes beginning in 1959 established government responsibility for population health and have ensured access to health services for all Cubans. But universal access to health services, free medical care and subsidized medications are not the be-all and end-all of health. We Cubans benefit from a socialist state that takes responsibility for our health in a paternalistic way; we have grown up under this model and we have not fully absorbed the message of the posters we see in our family doctor-and-nurse offices, declaring, “Health care is free, but it costs.” The public needs to be educated in the concepts Luis- Gonzálvez describes, about every citizen’s responsibility for their own and their community’s health.

Since health is a social product, achieving personal responsibility means everyone needs to be empowered to take part in a preventive model.[²2 Levin MB. A Model for Personal Responsibility of Health. HUFFPOST. The Blog [Internet]. 2012 May 11 [cited 2012 Jul 11]. Available from: http://www.huffingtonpost.com/marc-b-levin/personal-health_b_1508048.html
http://www.huffingtonpost.com/marc-b-lev... ] Cuba’s health reform needs more active personal and community participation in actions to preserve health. Maximizing individuals’ knowledge and skills will provide important tools to face health challenges. If people think there is no “cost” to their behavior, even supposedly educated people may not take care of their environment, may smoke, may have unhygienic food-handling practices or be sexually irresponsible. Just as chronically ill people need to learn to live as well as possible with their disease, healthy people need to learn how to preserve their quality of life.[³3 Bennett HD, Cleman EA, Parry C, Bodenheimer T, Chen EH. Health coaching for patients with chronic illness: Does your practice “give patients a fish” or “teach patients to fish”? Fam Pract Manag [Internet]. 2010 Sep–Oct [cited 2017 Aug 16];17(5):24–9. Available from: http://www.aafp.org/fpm/2010/0900/p24.pdf
http://www.aafp.org/fpm/2010/0900/p24.pd... ]

Teaching and learning about individual responsibility is an important determinant of health, one that needs to be incorporated in Cuba’s health reforms.

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