Castro and the 100,000 bicylces: Visionary or delusional?

Amid the endless comment following the death of Margaret Thatcher, it was widely claimed that she played a significant role in the eventual demise of communism. Of course, such a claim can't yet be made as long as the rather curious state of North Korea continues in its current bizarre format. That said, she did indeed play her part along with Reagan in bringing down the Berlin Wall much to the surprise of many in my generation.

This event was to have unforeseen consequences for an island in the Caribbean. Since Fidel Castro's coup, Cuba had famously remained a communist state but had long since lost the support of the former Soviet Union. Life was to become very challenging for the people of Cuba until about 2005 when the process of capitalism slowly began to creep in.

One of the consequences of this period in Cuban history may be crucial as a pointer for our dear old NHS. Put simply, times in Cuba were so hard that food quickly became a luxury. Over eating was not a choice because there was rarely enough. Meat became a luxury and the Cuban diet, like it's mediterranean cousin, becmae rich in fresh fruit, vegetables and fish. This resulted in a fall in waist sizes, heart disease, strokes and diabetes. The link between obesity and cardiovascular disease has of course been documented to death. The stark reality of what happens to the strain on healthcare systems has only emerged recently and the results are truly amazing. Cars became too expensive to run so the government was forced to invest in 100,000 bikes so that people could travel from A to B. An average loss of 5Kg per head over a five year period halved the death rate due to diabetes and reduced death due to cardiovascular disease by a third. The average Cuban between 1990 and 1995 expended more calories than they were able to consume. Thus we are provided with a really valuable example of how the global obesity epidemic can be addressed.

It is seldom that straightforward though. Even though the Cuban example shows us clearly the way to do it, there is one big snag. The Cubans did not have the choice to eat any more because there wasn't any more to eat. Unfortunately, the Western way of life means that we are often guilty of throwing away more food energy than what we expend through exercise - never mind what we actually eat.The key of course is choice. Choice is a wonderful thing in many ways but when is enough enough?

While still Leader of the Opposition, David Cameron was asked what he felt people should do regarding the growing wave of violence and swearing being shown on prime time television. His answer was excellent. He suggested that everyone could regulate what they were watching by simply pressing the "off" button on the remote control. The trouble is that not everyone is willing to press that button. In the same way, not everyone is willing to eat less and exercise more. I fear that the status quo will remain until such time as choice is once more removed as was the case for our grandparents in the 1940s. Of the seven deadly sins, at least three are on display here. Greed, sloth and gluttony all play their part in promoting obesity and its associated health risks. Only this week, Lord Coe presented a startling statistic; half of children in the UK between the ages of 8 and 14 reduce their levels of exercise by half. It has also this been revealed that the average UK child now consumes the equivalent of a bath full of sugary, fizzy drinks every year. Compare that with Castro's Cuba and be very worried about your (our) NHS.

It is well known that the health systems with the greatest focus on Primary Care deliver the best health outcomes (greater life expectancy, earlier detection of cancer and less deaths from cardiovascular disease). This leads to fewer hospital admissions, lower cost and less health inequality. In recent years, the Department of Health has been spending less on Primary Care. Given that the research assures us of improved outcomes when Primary Care becomes the main point of focus, this is counter-intuitive. To put this in to context, 11% of the NHS budget was being spent on Primary Care just 10 years ago. The current 8% level represents a £3.8 billion annual deficit. To try and put that in to context, the cost of the HS2 project (which will inevitably make access to London more viable for more people) is estimated to be £55.7 billion. In the end, it all comes down to priorities.

Under Castro, Cuba boasted (and continues to boast) a free health service which remains the envy of many countries. Priorities. Castro had the insight to recognise that his country could only prosper if decent healthcare was available to everyone. So while the citizens of Cuba may have been considered "backward" by the standards of the"developed" world, they were really trailblazing in what they achieved just by getting their priorities right. Much is now written about equity and fairness. Castro converted the talk in to deeds. Granted, he achieved it with a dictatorial approach, but his legacy stands up to scrutiny.

Abram Maslow was the famous psychologist who espoused a hierarchy of human needs. At the bottom of his pyramid are the basic physiological needs of food, water, fresh air, warmth and rest. As the pyramid goes up, it recognises the need for safety, love and esteem before people are properly equipped to be able to reach their true potential. It is as valid today as when he first proposed it in 1943. Given its obvious logic, it really is hard to understand why a succession of governments in the UK have failed to take note. Castro on the other hand might have been the first example of a Maslowian disciple. For him, a project like HS2 would miss the point. How true?

So while the all powerful right wing media will remind us of what a cruel tyrant Castro was, his true legacy reveals a very different picture which points the way forward for the "developed world".