How the Latin American Medical School in Cuba Promotes Health Equity Through Socially Accountable Medical Education

Health as a human right has not been globally embraced. Much of the world experiences health inequities, made worse by the lack of qualified health providers globally. Primary health care promotes health equity and social accountability, but traditional medical education models add to global inequities because the high costs of medical education may discourage the selection of primary care specialties, and students of low economic and minority status cannot afford medical school. The Latin American Medical School (la Escuela Latinoamericana de Medicina, or ELAM) is Cuba’s answer to global health inequity by training foreign students from low economic backgrounds and minority status, free of charge to the student, promoting socially accountable medical education around the world. Chapter II explores how Cuba’s sociopolitical and historical context led to the development of ELAM, evolving from aide to foreign countries experiencing natural disasters and/or conflicts, to medical diplomacy that provided professional assistance in return for symbolic capital (goodwill, status) and economic advantages, and finally to training foreign students at ELAM who could then return home to provide primary care in their own communities. Chapter III details a survey study done with 56 United States (U.S.) graduates of ELAM to determine to what extent graduates embrace social accountability, evidenced by providing primary health care to disadvantaged populations, how many completed licensing exams and obtained residencies, and how much additional debt was accrued during ELAM. Chapter IV reports on a case study done with a focus on processes and quality by which ELAM provides socially accountable education, with an emphasis on current and former students from the U.S. Guided by the World Health Organization’s (WHO) criteria of relevance, quality, cost-effectiveness, and equity, interviews with 4 current U.S. students, 8 faculty members, and survey written comments from 56 past U.S. graduates of ELAM were thematically analyzed. Findings support that ELAM’s mission and core activities meet the WHO’s criteria for social accountability and advance current understanding of such programs. This dissertation speaks to a significant public health problem by offering insights on a medical school that promotes primary care practice in a socially accountable model of medical education. Chapter II provides an understanding of how ELAM came into existence and Chapter III clarifies that graduates of ELAM are able to pass licensing exams and go into primary care practice with disadvantaged populations. Chapter IV supports that ELAM meets the WHO’s criteria of social accountability, showing that such programs can provide quality medical education. These studies will be of interest to professionals who study medical education science as well as administrators and faculty member involved in medical education programs