Medicine in the community: The ideology and substance of community medicine in Socialist Cuba

‘Medicine in the community’ is the name given in Cuba to the dominant model for health services organization at the area and sector levels in the regionalized structure of Cuban health promotion. The recent historical evolution of the model is here analyzed in terms of ideological and structural factors. From this perspective, the origin of medicine in the community is found to be related to a Cuban critique of community medicine in capitalist societies. But the substantive evolution of the concept is principally explained by reference to a critique of revolutionary Cuban health organization itself. The strength of this Cuban critique and also the strength of the consequently formulated model appear to be related to (1) social constituency formation in prior revolutionary years, (2) administrative separation of community health centers (or area polyclinics) from hospital administration. (3) commitment by the Ministry of Public Health to the area polyclinic as the focal unit of organization and (4) trends in Cuban society toward greater institutionalization, decentralization, and democratization of social forms. These trends coincided with increasing vitality of local government generally. The general elements of the model of medicine in the community are described and some implications are discussed.