Why Cuba's Infant Mortality Rate Is so Low

Cuba’s impressive infant mortality rate has a simple explanation: data manipulation.

By Luis Pablo de la Horra. Luis Pablo De La Horra holds a Bachelor’s in English and a Master’s in Finance. He writes for FEE, the Institute of Economic Affairs and Speakfreely.today. Excerpt:

"Surprisingly, Cuba’s IMR in 2017 was lower than that of both the U.S. and Canada: 4.1 deaths per 1,000 live births as opposed to 5.7 in the United States and 4.5 in Canada.

This seems counterintuitive. How could a poor country like Cuba, whose income per capita is a fraction of those of developed countries, outperform two of the world’s wealthiest nations?

There are a few possibilities, both of which involve health care spending. Are these stellar numbers the result of Cuba spending more than the U.S.?

Not according to the data. As the following chart shows, Cuba’s health care spending per capita is substantially lower than that of the United States.

But higher spending doesn’t ensure better results. According to the Bloomberg Health Care Index, which measures cost efficiency in health care, the U.S. spends four times as much as Singapore in per capita terms, yet life expectancy is four years higher in the Asian country. Therefore it could be that, despite spending less, Cuba achieves better results.

Unfortunately, Cuba’s planned economy is far from what anyone would call efficient. This means that there has to be another explanation.

Data Manipulation

In fact, Cuba’s impressive IMR has a simple explanation: data manipulation.

In a 2015 paper, economist Roberto M. Gonzalez concluded that Cuba’s actual IMR is substantially higher than reported by authorities. In order to understand how Cuban authorities distort IMR data, we need to understand two concepts: early neonatal deaths and late fetal deaths.

The former is defined as the number of children dying during the first week after birth, whereas the latter is calculated as the number of fetal deaths between the 22nd week of gestation and birth. As a result, early neonatal deaths are included in the IMR, but late fetal deaths are not.

For the sample of countries analyzed by Gonzalez, the ratio of late fetal deaths to early neonatal deaths ranges between 1-to-1 and 3-to-1. However, this ratio is surprisingly high in Cuba: the number of late fetal deaths is six times as high as that of early neonatal deaths.

This number suggests that many early neonatal deaths are systematically reported as late fetal deaths in order to artificially reduce the IMR. Gonzalez estimates that Cuba’s true IMR in 2004, the year analyzed in the paper, was between 7.45 and 11.46, substantially higher than the 5.8 reported by Cuban authorities, and far worse than the rates of developed countries.

That Cuba’s dictatorship manipulates self-reported statistics shouldn’t come as a surprise. After all, the Castros have been trying for years to prove that, despite the lack of freedom in their country, their regime has built a welfare state where high-quality public services are guaranteed for all citizens.

Nothing could be further from the truth. The only achievement of the 1959 Revolution was to turn Cuba into a huge prison where misery and repression dominate the lives of millions of Cubans that haven’t had the opportunity to flee the country in search of a better life.

Dictatorships have always resorted to data manipulation for political purposes. This isn’t new. What is really disturbing is that Western intellectuals continue to buy the propaganda of the oldest tyranny in the Americas."