The Cuban enigma: (fresh) air, obesity and happiness

I am recently back from Cuba – a country I've always wanted to visit. Despite ostensibly there as a tourist on a cycling holiday, I realised mid-way through the trip that I was also still very much wearing my ‘health and environment’ hat. The extraordinarily sharp fractures in the island’s political history (the Spanish, slavery, the Revolution) are evident everywhere in the urban and its urban environments. There is simply nowhere else like it.

Fresh air?

Cuba has long been associated with beautiful old American cars – and there are indeed Chevys, Lincolns and Buicks everywhere, all bought before the Revolution, at which point US companies were summarily kicked out of the country and the blockade began. What I hadn’t previously appreciated was that, from 1960 onwards, the car of choice was the Soviet-made Lada. So most traffic on the roads today (outside Havana, with its smattering of Hyundais) falls into four categories: old US, slightly-less-old Soviet, bicycle, and horse-and-trap.

You have to admire the ingenuity that goes into keeping all these aging cars on the road – but I found myself bemoaning our throwaway culture at home (who in the UK would keep a car for 50 years?) while also choking on diesel fumes. I’ve looked up Cuban air pollution statistics: 36 deaths per 100,000, compared to 26 in the UK. Given that, by day three of the cycling, several of our group had already developed a cough, and the air in the towns absolutely stank of diesel, this surprised me – surely urban areas must be more damaging to health than those statistics suggest, but I can't find the data.

If and when the trade blockade is further lifted, car manufacturers will doubtless be at the front of the queue. But this could be an opportunity for Raul Castro’s successor in 2018 to lead the way in promoting the next generation of cleaner vehicles. It would not be out of the question for the government to go all-out in mandating electric or hybrids – the technology is fast coming onstream, and Cuba could genuinely lead the way. It is far from a typical developing country – just look at its astonishing success in training (and exporting) doctors.

Obesity?

Even obesity, always a complex issue, is closely linked to Cuba's political history. During the ‘special period’ (Castro’s phrase) following the collapse of the USSR, Cubans lost an average of 5kg in weight, and the proportion of the population who were physically active more than doubled (to over two-thirds) – the bicycle was, for many, the only available mode of transport. Given the hardship of those years, it is ironic that health dramatically improved, with a subsequent drop in type 2 diabetes of a half, and of a third in coronary artery disease.

As that crisis has long since ended, waistlines have expanded; today, about 30 per cent of women and 18 per cent of men (according to the WHO) have obesity. Much of the food in Cuba – even fish, our tour guide told us – is imported, although alcohol (rum) forms a surprising proportion of what was on sale in the local supermarkets. There seemed to be a long way to go before fully functioning food systems are in place locally – but there must be the danger that opening up for trade (for all its potential benefits for agriculture) could further exacerbate obesity, even as the options for more varied and healthier eating also increase.

Happiness??

Before I arrived in Cuba, I had been concerned that our group (of lycra-clad, wealthy foreigners) would be a source of entirely understandable animosity. But our local guide told us that ‘No one will resent you for being here’ – and so it proved. Tourism is the country’s primary income and, because no one pays tax (the average salary is a very, very low CUC30 a month, about $30), we were, in effect, paying for all the health care and education for which Cuba is rightly famed. (We passed several major hospitals, and many local health clinics – although alas there was no chance to visit.) Even though we were surrounded by grinding poverty, we were welcomed.

In 2012, Cuba came in the top 20 in the New Economics Foundation's Happy Planet Index (although in 2016 it didn't to feature at all - I'm digging into why). So, for all its myriad challenges, could it be that Cuba is an exemplar for the way in which a society that is relatively poor but equal is (on average) happier than a society that is better off but with much more inequity – as Wilkinson and Prickett argue in The Spirit Level?

Cuba fascinated me; I would love to go back. I’d be particularly keen to hear from anyone who can enlighten me on the air-quality issue, on obesity and the food system, and on the applicability of the equity/happiness argument...