Addressing Cuba's Care Crisis: Insights from Elaine Acosta and Mayra Espina on Demographic Shifts (Part One)| May 14, 2024
Dear Friends,
This week, in Cuba news, the historic San Carlos Institute in Key West, Florida, faces a legal battle over its ownership, with claims that it belongs to Cuba’s government. Meanwhile, a resumption of remittance services by Western Union provides much-needed relief for Cubans amid economic hardships. In other developments, Cuba’s struggling sugar harvest prompts consideration of imports, and Mexico announces plans to hire 1,200 Cuban doctors to bolster its healthcare system.
In this week’s installment of the U.S.-Cuba Interview Series, Mayra Espina, Doctor of Sociological Sciences, independent consultant, and associate researcher of the Academic Program of the Christian Center for Reflection and Dialogue (CCRD-C), and Elaine Acosta, Sociologist, Associate Researcher at the Cuban Research Institute, Florida International University, and Executive Director of Cuido60-Observatory on Aging, Care, and Rights - www.cuido60.com share their thoughts on the impact of demographic changes on Cuba’s care crisis.
*The views and opinions expressed by interviewees are their own and do not necessarily reflect the views or positions of CEDA.
What are the regional variations in Cuba’s demographic trends? Are there significant differences in population growth, fertility rates, and aging patterns between urban and rural areas? How do these regional disparities influence social and economic development within the country?
Mayra: Among the regional variations of demographic trends, historically, there have been significant differences, such as higher fertility and birth rates in rural areas and towards the eastern part of the country, with more pronounced adolescent fertility in the east, and internal migrations from east to west. Aging is widespread but is markedly observed in urban centers such as Santa Clara and Havana.
However, the general trend, without many regional differences, is towards demographic aging, low birth rates, emigration of young people and people of working age in general, and the emptying of rural and agricultural areas.
In this way, demographic trends compromise the country's development, especially due to labor resource deficits for food and agricultural production, internal migration and emigration, below-replacement-level fertility, and a growing dependency ratio (relationship between the active population and the population outside the working age).
Elaine: According to the classification by the UN Economic Commission for Latin America and the Caribbean (CEPAL), Cuba has one of the oldest populations in the region, situated in the last stage referred to as very advanced aging. At the close of 2022, Cuba had a Total Fertility Rate of 1.41 children per woman, making it the country with the lowest fertility rate in Latin America and the Caribbean, with a proportion of elderly people at 22.3%, with a population of 60 years and older of 2,478,087 people. As a result of a fertility rate below replacement levels–less than one daughter per woman–which the country has had since 1978, there has been a simultaneous reduction in the percentage of people under 15 years of age. Consequently, according to the latest population projection by the National Office of Statistics and Information (ONEI), it is expected that by the year 2050, the elderly population will represent 35.9% of the country's population. The accelerated growth of this age group on the island remains a distinctive characteristic, considering the average annual growth rate of 33.3% in 2021 and 2022. It is worth noting that between the publication of the National Population Aging Survey (ENEP) in 2019 and the latest yearbook of 2022, the proportion of elderly people has increased by over two percentage points in just three years.
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2. Taking into account the long-term implications of demographic aging, including the increased number of senior citizens and the strain on social and health services, what challenges does Cuba face in terms of providing adequate care and support for its aging population?, and how might the emigration of younger individuals exacerbate these challenges?
Mayra: It is necessary to consider the conditions under which demographic aging and the sustained increase of older adults occur. There are multiple crises that affect diverse dimensions of life on a macro and micro level: economic, health, social, and the expansion of anomie.
This poly-critical situation, which has its basis in the combination of the long-term effects of the U.S. embargo and the barriers it imposes on Cuba to access resources for development, as well as failed, erroneous, or incomplete national policies, is compounded by the aftermath of the Covid-19 pandemic.
As a result, poverty, vulnerabilities, and inequalities are expanding in the country, preventing access to a dignified standard of living (especially due to the lack of food, medicines, health services, community hygiene, and adequate housing) for a large part of the population and turning everyday life into an uncertain and insecure scenario, especially for the elderly.
From this, it follows that Cuba's challenges in providing adequate care for its older adults are strongly associated with the need to overcome the crisis.
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Elaine: To understand these challenges, it is important to understand the context in which the rapid increase in the elderly population in Cuba is occurring and the pressure this puts on social and health services. These processes take place in a highly adverse political, economic, institutional, and familial scenario, especially due to the profound crisis of a structural and systemic nature that the Cuban society is going through, which multiplies and complicates the several challenges that this demographic process entails. Some of the challenges are related to the following processes or factors:
A care crisis resulting from an increase in demand versus a reduction/deterioration of service supply and a burden on women as unpaid caregivers;
A reorientation of social policy that shortens welfare parameters, reducing resources allocated to social protection and transfers caregiving and social service solutions to families and the market;
An insufficient normative framework; the Family Code, which does not provide conditions for enforceability and guarantees of the rights of older people and their caregivers, is not implemented well;
An increase in poverty, inequality, and food insecurity affecting mainly older people;
A deficit and unequal distribution of social and health services and a growing commodification of the supply, against a decrease in the purchasing power of older people and pensioners, in particular;
Insufficient institutional approach and intervention, with government initiatives lacking comprehensiveness, transversality, sustainability, and territorial focus in actions;
Growing shortage of human resources for social and health care and the need for ongoing training for the specific needs of older people;
Unsustainability of the pension system and uncertainty in the face of the imminent silver tsunami (retirement of the baby boomer generation);
Significant political obstacles and resistance to the development of community initiatives and civil society, both national and transnational, in the provision of social and care services;
Deficit of data and research on poverty and inequality in Cuba and the impossibility of sustaining a democratic and politically effective debate on these issues.
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U.s.-cuba relations
Remittance Services are Resumed in Cuba: Last Thursday, Western Union announced that it had resumed its remittance service from the U.S. to Cuba after a three-month disruption of services (Reuters). On January 28 of this year, the leading money transfer financial institution, Western Union, halted its remittance services following a “cybersecurity incident” in Cuba (Miami Herald). The return of services from Western Union has been welcomed by many Cubans who rely on remittances as a vital source of income, especially amid economic hardships exacerbated by the ongoing crisis on the island.
Legal Debate Over Cuban Heritage Landmark: The San Carlos Institute in Key West, a historic building founded by Cuban exiles in 1871, is at the center of a legal dispute over its ownership (Miami Herald). The plaintiffs of the case argue that the institute is the sole property of Cuba’s government. In contrast, the defendants claim that the not-for-profit corporation Instituto Patriótico y Docente San Carlos, Inc. is the “beneficial owner” of the institution. The debate lies in an action taken in 1920 when San Carlos Institute’s board members transferred ownership of some of the institute's real estate to Cuba. However, according to the board of the San Carlos Institute, this transfer was made with the intention that the properties would be held in trust by the Republic of Cuba for the benefit and use of the San Carlos Institute. The outcome of this case is dependent on property laws and interpretation of the ownership, raising concerns about the institute’s future as a cultural landmark.
El Toque Faces Accusations of U.S. Government Intervention: On Thursday, May 9, the independent news outlet El Toque published an article titled “The Cuban Peso Plummets: A New Exchange Rate Instability?” The article focused on the depreciation of the Cuban peso and the island's increased dollarization–many of these issues were indirectly attributed to Cuba’s government. In response, the State-Owned media outlet Razones de Cuba released an article titled “El Toque y el terrorismo financiero contra los Cubanos” in English: El Toque and the financial terrorism against the Cubans. The article alleged that the United States government had been secretly funding El Toque in an attempt to destabilize Cuba’s government and artificially inflate the value of the US dollar against the peso to incite unrest.
El Toque has since denied these claims in a video posted to its YouTube channel on May 11, stating that in the articles published by Razones de Cuba, they have “lied about the reference rate of the informal currency market they publish and the causes of the Cuban economic crisis.” Cuba’s peso has sharply depreciated against the dollar, worsening the island's ongoing economic crisis (Reuters). El Toque insists that it is being scapegoated for Cuba’s government’s failures. Independent economists attribute the peso’s decline to “a crippling contraction in domestic production and exports, a ballooning fiscal deficit, and high demand for scarce dollars.”In December of 2023, Cuba’s Prime Minister Manuel Marrero announced that new economic measures would be instated in 2024, but these measures have still not been implemented (Reuters). In October 2023, Cuban economist Pavel Vidal with the Pontifical University Javeriana Cali, Carlos Muñiz Cuza with Aalborg University, and Abraham Calas with El Toque published a joint paper that details the algorithm used by El Toque, a new methodology using AI algorithms for natural language processing to analyze Cuba's informal currency market and calculate a parallel exchange rate.
IN CUBA
Import Pressures Increase as Cuba’s Sugar Harvest Faces Challenges: As the sugar harvest in Cuba comes to an end, this season marks the lowest crop yield since 1900, prompting pressure on Cuba’s government to import sugar (Reuters). During a tour of Cuba’s municipalities, President Miguel Díaz-Canel disclosed that only 71 percent of the projected total sugar production had been achieved, totaling around 300,000 metric tons, over 100,000 fewer tons than the projected 412,000. President Díaz-Canel attributed the low yield to weather, unstable fuel availability, and unforeseen breakages affecting the milling (Prensa Latina). The decline in sugar production has resulted in a significant reduction in the output of sugar cane-derived alcohol, impacting various industries dependent on the product.
Interested in learning more about Cuban migration to the US? Check out CEDA’s updates on Cuban migration charts here!
CUBA’S FOREIGN RELATIONS
Mexico’s Government to Hire Cuban Doctors: Mexico’s government has revealed its intentions to recruit an additional 1,200 doctors from Cuba to supplement the existing Cuban workforce in Mexico’s public healthcare sector (Telesur). This decision came following a meeting last Friday between the Mexican Institute of Social Security’s director, Zoé Robledo, and Cuba’s President, Miguel Díaz-Canel.
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*The views and opinions expressed by authors are their own and articles do not necessarily reflect the views or positions of CEDA.