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By Bernabé Malacalza
“Sometimes the most important changes start in small places,” United States President Barack Obama said in a speech to the Cuban people at the Grand Theatre of Havana. This was in March, during the historic first visit to Cuba by a U.S. president in 88 years. How did Cuba and the United States change their mutual perceptions after decades of confrontation? An obvious explanation is that conditions were ripe for the thaw. But despite the leading role played by presidents, ministers, and ambassadors, political change is often less about “high politics” than about recognizing a longer-term, less visible progress led by civil society.
Cuba is an internationally renowned authority in health diplomacy and humanitarian action. In 1961, Cuba sent a handful of doctors to Chile after a powerful earthquake. This was followed by a team of 50 to Algeria in 1963. Since then, Cuba has conducted health and humanitarian diplomacy with over 100 countries, deploying over 100,000 medical professionals abroad. This medical internationalism is due in no small part to a strong domestic health sector, reaching “one doctor for every 220 people at home, one of the highest ratios in the world, compared with one for every 370 in England.” By 2015, Cuba’s health system was placed 39th internationally by the World Health Organization (WHO) while the United States ranked 37th. According to the CIA World Factbook, the infant mortality rate was 4.63 in Cuba and 7.87 in the U.S. in the same year.
Popularly known as “Cuban health diplomacy,” Cuba’s outreach efforts were no doubt partially motivated by a desire to increase its international standing. Critics have been quick to show how Cuba is using this diplomacy as a tool to increase its trade performance. In 2006, 28 percent, or $2.3 billion, of Cuba’s total export earnings came from medical services. An article in Foreign Policy compared this with cigar exports, which totaled only $215 million in 2011. The profits are even more staggering if we consider that Cuban doctors are paid a paltry amount by the state, an average of between $30 and $50 per month. Nevertheless, the real contributions made by Cuban health professionals have been praised by the WHO and even the United States.
Health and humanitarian issues have always been a central feature of Cuba-U.S. relations, for better or for worse. For instance, four years after the Cuban revolution, nearly half the country’s 7,000 doctors left the island for the U.S. In the 1990s, Cuba offered free medical instruction to Americans, although since 1999 Cuban doctors have not been able to leave the island with proper documentation and permits. In the wake of Hurricane Katrina in 2005, Havana offered to send more than 1,000 Cuban doctors of the Henry Reeve Medical Brigade to New Orleans, but the Bush administration declined. The Brigade was proposed as candidate for the Nobel Peace Prize in 2015, and bears the name of an American soldier who fought against the Spanish Army during the First Cuban War of Independence (1868-78). By 2014, American doctors were working with groups of Cuban doctors in Sierra Leone, Liberia, and Guinea. This informal collaboration likely contributed to an official acknowledgement by Secretary of State John Kerry that Cuban efforts had aided the successful fight against the outbreak of Ebola.
Americans and Cubans have long been cooperating in science, creating conditions that led to the normalization of bilateral relations that finally took place in December 2014. The American Association for the Advancement of Science has worked with the Cuban Academy of Sciences in Havana since 1997, and in 2014 the two institutions agreed to cooperate on medical research and development.
“Traditional” diplomacy is no longer enough. While diplomacy has been linked to the defense of state sovereignty in the international system since its origins in the 17th century, the globalized world of today requires new forms of articulation beyond traditional ones. With the use of technology and the rise of telecommunications, transnational relations between people from different areas are a daily reality. Diplomacy has gone beyond the domain of embassies and consulates; sports, culture, art, and science can become decisive factors in constructing bridges between nations. One of these expressions is science diplomacy, defined by the AAAS as “the use of scientific collaborations among nations to address the common problems facing 21st century humanity and to build constructive international partnerships.”
Cuba’s health diplomacy is an example of science diplomacy, but there are other illustrative cases in history. During the Cold War, scientific exchanges contributed to the reduction of tensions among great powers. Science was crucial for the negotiations of the Antarctic Treaty in 1959 and Strategic Arms Limitation Talks I in 1972. More recently, scientists played a significant role in the historic agreement reached in 2014 in Vienna between the U.S., France, U.K., China, Russia, Germany, and Iran for the reduction of nuclear capacities, lifting economic sanctions and ending Iran’s isolation. In this case, informal meetings between two scientists who studied at the Massachusetts Institute of Technology were key. These two men, U.S. Secretary of Energy Ernest Moniz and Ali Akbar Saleh, chief of the Iranian Atomic Energy Organization, both spoke the language of science.
During the era of military regimes in Latin America, scientists and nuclear professionals from Argentina and Brazil started engaging in serious bilateral nuclear cooperation. While the return to democracy under Presidents Raúl Alfonsín in Argentina and José Sarney in Brazil greatly extended their military predecessors’ more limited institutional design efforts, we should reject the simplistic view that democratization alone produced nuclear cooperation and peace in the Southern Cone. The role of scientists was crucial to developing mutual empathy rather than rivalry or enmity, a phenomenon that may have fed into an incipient epistemic community across the border.
Health diplomacy played a significant role in the normalization of bilateral relations between United States and Cuba, and could also be the key to putting pressure on the U.S. Congress for derogation of the Helms-Burton Law of 1996, which imposes an embargo to the island that explicitly includes medicines and medical equipment. The embargo is a product of the Cold War that ostensibly only remains for security and democratization reasons. But in reality it has only stopped the reform of Cuba's economic system initiated by Raúl Castro in 2008, standing in the way of Cuban entrepreneurs who wish to trade with the U.S. health industry.
For instance, Cuba exports a wide range of medical products (vaccines, medicines, medical supplies, and equipment) and its biotech industry holds 1,200 international patents and earned $350 million in product sales in 2008. According to a report of the American Association of World Health, the United States’ proximity to the island makes Cuban importers a “natural” customer base for U.S. suppliers. Indeed, prior to the embargo, most medicines were imported from the United States. Moreover, pressure on the U.S. Congress could also contribute to the shutting down of the U.S. Cuban Medical Professional Parole Program, which started under President George W. Bush in 2006. The program, which has approved a total of 7,117 applications, weakened Cuban medical internationalization by incentivizing Cuban doctors to defect and work in the United States. It is an expression of distrust and a tool directly aimed at limiting a main source of income for Cuba: the export of medical services, which has reached $8 billion annually. Discontinuing this policy is a necessary step for future interaction based on mutual respect.
Every year, Cuba’s health assistance is given as a reason to justify the near-unanimous vote of the U.N. General Assembly against the U.S. embargo. That said, no embargo has limited, or can limit, the expansion of collaboration between Cubans and Americans in scientific projects. Nearly 60 American doctors are being trained in the Cuban Latin American School of Medicine, working together with Cuban colleagues and fostering new pathways to strengthen bilateral ties. These arrangements can help those in government, scientific communities, and other sectors make decisions by better understanding the positive outcomes that can result from science diplomacy. They can also serve as a call to action to put an end to the anachronistic rationale of the embargo, taking into account how working in areas of mutual scientific interest can advance U.S. and Cuban national, regional, local, or institutional interests.
Bernabé Malacalza is a researcher in international relations at The National Scientific and Technical Research Council (CONICET) in Argentina, based at the National University of Quilmes.
[Photo courtesy of Roel Coutinho]