How Economic Crisis Helps Fight Obesity And Ward Off Diabetes And Heart Disease Deaths (In Cuba)

The fall of Communism in the late 1980's had disastrous consequences for the economy of one of the world's last Communist countries, Cuba. Situated just 90 miles (145 km) south of the United States, the United States had placed an economic embargo on its island neighbor, and Cuba had curried economic favors from the old Soviet Union as a diplomatic irritant and military threat to the USA. But with the changes to the Soviet economy begun under perestroika under Mikhail Gorbachev, and then the collapse of the Soviet Union, Cuba lost its patron, and a large part of its trade.

Before 1989, Cuba had trade with the Soviet Union that brought its economy food and oil roughly $8.5 billion per year. After Russia left the Soviet Union and began to develop a capitalist economy, Cuban trade with Russia fell to just $750 million per year. The late Venezuelan leader Hugo Chavez subsidized the Cuban economy with several billion dollars worth of oil, but the Venezuelan assistance amounted to less than 10% of the former level of trade with the Soviet Union, and came at the cost of Cuba's sending many of its doctors to Venezuela and the rest of South America.

Cuba's economic crisis at first had profound effects on medical care

An estimated 800,000 Cubans were not able to get asthma medicine. During the years 1988 through 1990, many Cubans gave up plans to expand their families. There were 9 abortions for every 10 births. And in the late 1980's, over 50,000 Cubans suffered optical neuritis, causing loss of sight, because they were not able to find even minimal meat and fortified flour containing B vitamins.

As the Cuban economy stabilized, however,  it turns out that there were several areas of public health that actually benefited. A recent report in the British medical journal BMJ tells us that:

• The average Cuban lost 5.5 kilos (11 pounds) of body fat in the late 1980's due to the inability to obtain food, and
• The rate of diabetes in the Cuban population fell from 1.8% just before the economic crisis to just 1% five years into the economic crisis.
• The rate of heart disease deaths in the Cuban population fell from 120 deaths for every 10,000 people per year just before the crisis, to 80 deaths for every 10,000 people 5 years into the crisis, a reduction of about 33%.
• The rate of obesity fell from 15% to 6%.

It took from 1989 until 2011 for the Cuban economy to recover sufficiently that most Cubans once again were able to obtain adequate calories, carbohydrates, fat, protein, and vitamins in their diets. As Cuba received more fuel from abroad, Cubans were more able to take buses for local travel and farming required far less manual labor. However, as Cubans began to eat more, some of the diseases associated with overweight rebounded, too.

• The rate of diabetes fell 53% during the economic crisis, and then rose 140% as the economy recovered.
• The rate of deaths from heart disease did not increase as people got more to eat, but did not fall with the introduction of new technology, either.
• Four times as many Cubans were obese in 2011 than in 1996.

It's worth noting, however, that even now, Cuba's rates of diabetes and heart disease are less than 1/6 of the rates of diabetes and heart disease of the American state with the economy most similar to Cuba's, Mississippi. Mississippi suffers shortages of many things, but there has not been, at least in nearly 150 years, any kind of food shortage in the Mississippi. Could a food shortage actually be a good thing?

Famine Is Never A Good Thing, But a Food Shortage, Maybe

There is no doubt that a severe food shortage is never beneficial to public health. One of the surprising results of the Dutch "hunger winter" in 1944 and 1945 was that not only did children born mothers who were pregnant during this time fail to grow to expected height and weight as adults, but their children also were smaller than normal even though they were conceived during a time of prosperity. The Chinese Great Leap Forward famine of 1959 through 1961 resulted in changes in the reproductive health not only of women who were in their child-bearing years during that time, but also in their children. And the famines in Ethiopia during the 1970's resulted in totally unexpected reactions to nutritional supplementation. Aid workers were horrified to learn that parasites in children's bodies could be awakened, often with fatal consequences, by the sudden restoration of normal nutrition--sometimes with as little as a single dose of an iron supplement.

None of these long-term biological changes seem to have resulted from the widespread calorie deprivation of Cubans during their economic crisis from the late 1980's to the mid-1990's. The key difference between the Cuban experience and the famines of many other countries during the twentieth century seems to have been that the Cubans were deprived, but not starved. Obesity became very rare indeed, but many people managed to maintain normal, even slightly higher than "ideal" weight. They did this in the context of getting lots of exercise, as fuel shortages required people to walk for transportation and to carry heavy loads by hand.

So what's the take-away from the studies of food shortages in Cuba? Here are the conclusions of research:

• The benefits of having less food appear in weeks or months, not years or decades. It only took a matter of a month of two for certain kinds of disease rates in Cuba to plummet.
• Starvation is not beneficial to anyone. Not having as much food as one wants, however, tends to be associated with less diabetes and less heart disease. (Cuban cancer rates were not significantly affected by the food shortage.)
• The lowest rates of mortality occur in people who have a body mass index (BMI) of 24 to 29--slightly above "ideal" weight. A little extra weight is especially beneficial to small children and the elderly.

Eating a little more than your body's basic needs, but not so much as to become obese, seems to be key to good health. And sharing food with one's neighbors seems to compensate for the effects of minor shortages on public health.