My two blog posts on the health statistics of Cuba have convinced me to try to assemble a research article on the topic of assessing health outcomes under Castro’s regime. My first blog post was that there is a trade-off (the core of the article) that Castro decided to make. He would use extreme coercive measures to reduce some forms of mortality in order to shore up support abroad. The cost of such institutions is limited economic growth and increased mortality from other causes (dying from waterborne diseases or poverty diseases rather than dying from measles).
When I thought of that, I was inspired by Werner Troesken’s Pox of Liberty on the American constitution and the disease environment of the country. I was mostly concerned by direct medical interventions. However, the extent of coercive measures used by Castro go well beyond simple medical care (or medical imposition). Price controls, rationing and import restrictions on many goods could also help improve life expectancy. Indeed, rationing salt at 10g (hypothetical number) per person per day is a good way to prevent dietary diseases that emerge as a complication from overconsumption of salt. That will, by definition, raise life expectancy.
And so will bans on importing cars.
There is an extensive literature on the role that car fatalities has on life expectancy. This paper in Demography (one of the top demographic journals) finds that male life expectancy in Brazil is lowered by 0.8 years by traffic deaths. And traffic has very little to do with the quality of health care services. Basically, the more you drive, the more chances you have of dying (duh!). But, people don’t care much because the benefits of driving outweigh the personal risks.
In Cuba, people don’t get to make that choice. As a result, the very few drivers on Cuban roads have few accidents. According to WHO data, the car fatality rate is 8.15 per 100,000. There is also only 55 cars per 1,000 persons in Cuba. The next closest country is Nicaragua at 93 cars per 1,000 and the top country is Uruguay at 584 cars per 1,000. When you compute reported (rather than WHO estimated) car fatalities per 1,000 cars (rather than persons), Cuba becomes the unsafest place to drive in Latin America (1.46 fatalities per 1,000 cars) after El Salvador (2.22 fatalities per 1000 cars but only 129 cars per 1000), Ecuador (1.78 fatalities per 1000 cars but only 109 cars per 1000) and Bolivia (1.53 fatalities per 1000 cars and only 113 cars per 1000).
The graph below shows the relation between car fatalities per 100,000 inhabitants and life expectancy. Cuba is singled out as a black square. Low rate of car fatalities, higher life expectancy. Obviously, this is not a regression and so I am not trying to infer too much. However, it seems fair to say that Cuba’s life expectancy can easily be explained by the fact that Cubans face stiff prohibitions on the ability to drive. Those prohibitions give them a few extra years of life for sure, but would you really call that a ringing endorsement of the health outcomes under Castro’s regime? I don’t…