Substantive Justice and Healthcare System Reform in Cuba: Challenges for Real Equity
Justicia Sustantiva y Reforma del Sistema de Salud en Cuba: Desafíos para una Equidad Real
Keywords:
substantive justice, healthcare system, equity, Cuba, health reformAbstract
This article explores the current challenges facing Cuba’s healthcare system from the perspective of substantive justice, focusing on the pursuit of real—not merely formal—equity. Although Cuba has long been recognized for its universal and free public healthcare model, recent years have revealed emerging tensions related to resource shortages, territorial inequalities, and differentiated services among population groups. Through a critical review of recent health policies and interviews with healthcare professionals, the study assesses whether ongoing reforms are effectively advancing the right to health with genuine equality. The paper argues that substantive justice requires more than nominal access—it demands quality conditions, dignity, and citizen participation. It concludes by proposing structural reform strategies grounded in social justice, institutional transparency, and sustainability, as foundations for achieving real healthcare equity in the Cuban context.
Este artículo examina los desafíos actuales del sistema de salud cubano desde la perspectiva de la justicia sustantiva, con un enfoque en la equidad real y no solo formal. Si bien Cuba ha sido históricamente reconocida por su modelo de salud pública universal y gratuito, en los últimos años han surgido tensiones vinculadas a la escasez de recursos, las desigualdades territoriales, y la coexistencia de servicios diferenciados entre sectores de la población. A partir de una revisión crítica de políticas sanitarias recientes y entrevistas con profesionales del sector, el estudio evalúa hasta qué punto las reformas en curso logran materializar el derecho a la salud con criterios de igualdad efectiva. Se argumenta que la justicia sustantiva exige no solo acceso nominal, sino condiciones de calidad, dignidad y participación ciudadana. El artículo concluye proponiendo líneas de reforma estructural que integren los principios de justicia social, transparencia institucional y sostenibilidad, como base para avanzar hacia una equidad sanitaria real en el contexto cubano.
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