Resumo em Inglês:

ABSTRACT This paper discusses integration and implementation of population health and social determinants approaches to the health-disease-care process in the context of ongoing changes to Cuba’s health system. Ideas for strengthening the social conceptualization of public health and prioritizing population health actions over those of individual medical care are discussed, with a view to encouraging rethinking of these as social practice. The paper aims to advance new and renewed strategic proposals for change, based on a broad view of public health and a focus on social medicine that favors a population health perspective and inclusion of a wide range of health determinants. It advances the need to develop or extend debate on the theory and social practice of epidemiology and public health while implementing needed changes in health services and medical care. The paper recommends embarking on technical discussions among all actors and protagonists, not just in the health care system but in the entire health sector, to better integrate and practice a population health approach with social determinants of health.

Resumo em Inglês:

ABSTRACT Cuba’s accelerated trend to lower fertility and consequent contraction of population reproductive capacity have now become concerns for various social and political actors, including, of course, Cuban demographers, who have been sounding the alarm for more than three decades. The most striking characteristic of Cuba’s fertility transition is undoubtedly its abrupt onset, rapidity, and the fact that it took place in the absence of accompanying economic development. Hence the current debate focusing on the roles of the various determinants that led to the transition, and especially of economic factors at different stages, particularly in conditions of heightened population vulnerability during economic crises. This article provides elements to help fill gaps in knowledge of the fertility-development relationship today.