April 11th, 2013

Cuban History Offers Important Lessons For Global Health Today

A large new study from Cuba shows the impressive benefits that can be achieved with weight loss and increased exercise. Much more ominously, the same study shows the dangers associated with weight gain and less exercise.

In the study, published in BMJ, researchers took advantage of a “natural” experiment that occurred in Cuba as a result of a major economic crisis in the early 1990s. Relying on 30 years of superb health statistics available in the country, the researchers analyzed the dramatic health effects associated with the economic crisis, which lasted from 1991 through 1995, and the subsequent recovery.

During the economic crisis, caloric intake decreased and physical activity increased, resulting in an average, population-wide 5.5-kg reduction in weight and a very high (80%) proportion of the population classified as physically active. Following the crisis, the pattern reversed itself: weight increased by an average of 9 kg between 1995 and 2010, and today only 55% of the population is considered physically active.

Prior to the economic crisis, the incidence of diabetes increased slowly. It then fell sharply during the crisis by 53%. The incidence of diabetes remained lower than before the crisis for several years but subsequently increased by 140% from 1996 to 2009. The changes in diabetes incidence were followed, after a lag, by similar changes in diabetes mortality.

From 1980 to 1996, mortality from coronary disease decreased by 0.5% per year. Following the crisis, from 1996 to 2002, mortality decreased by 6.5% per year. Subsequently, the decline in the rate of mortality slowed to pre-crisis rates.  Stroke mortality and all-cause mortality followed a similar pattern.

The authors were careful to note that the generalizability of their findings was “uncertain,” but said the “data are a notable illustration of the potential health benefits of reversing the global obesity epidemic.”

In an accompanying editorial, Walter Willett points out that other factors, including decreased cigarette smoking during the economic changes and other changes in the diet, may also have played a role in the health changes observed in the study. However, he writes, “the current findings add powerful evidence that a reduction in overweight and obesity would have major population-wide benefits. To achieve this is perhaps the major public health and societal challenge of the century.”

2 Responses to “Cuban History Offers Important Lessons For Global Health Today”

  1. Tina Dobsevage, MD says:

    I agree with Walter Willet that there are other factors such as a likely reduction in meat consumption as well as calorie reduction that contributed to the improvement in population health statistics during and after the economic crisis in Cuba.
    Fighting the worldwide obesity epidemic will require regulating the food industry as pointed out recently in a Lancet article.
    That will be particularly hard to accomplish in the US given the state of our government.

  2. Stephen Hansen, md says:

    The “public health challenge of the century” is going to continue to be issues surrounding climate change.