The Right to Live in Health: Medical Nationalism, Race, and Poverty in Post-independence Havana, Cuba

In recent years, there have been a number of studies exploring the history of medicine in Cuba, mostly addressing the scientific and institutional developments that shaped Cuban medicine. This study takes a different tack, examining debates over Havana’s disproportionate black tuberculosis mortality to unpack the social history of disease and the politics that shaped new demands for healthcare as a right of citizenship in post-independence Cuba. Based on the writings of Cuban nurses, social reformers, journalists, politicians, and health officials, this paper explores how Cubans confronted the limits of a limited, “medicalized” approach to a disease rooted in unequal economic relations. More than any other disease in the early twentieth century, tuberculosis provides a lens onto the broader social and economic dynamics that shaped the health conditions of the Cuban people. Havana’s disease landscape mirrored—even emerged out of—the city’s racial economy, with Cubans of color relegated to higher levels of unemployment, lower wages and substandard housing. If, as observers argued, the root cause of the city’s disturbingly high tuberculosis rate was economic, then what was needed was more than new hospital beds or dispensaries. Over the 1910s and 1920s, there began to emerge a growing sense of the need for deep structural reforms: new public medical institutions to address the immediate healthcare needs of the poor combined with broad economic reforms to increase wages and bring down rents and the cost of basic necessities. But as journalists of color insisted, neither poverty nor disease were color-blind; rather, the disproportionate rates of black poverty and disease in Cuba represented a failure of the Cuban state to fulfill its historical promise of a nation “with all, and for the good of all.”