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The average life expectancy in Cuba is almost 76, about the same as in the United States. And at 9 deaths per 1,000 newborns—down from 70 at the outset of the Castro regime 41 years ago—the country’s infant mortality rate is impressively low.

Moreover, Cuba now boasts more than 30,000 physicians, the highest doctor-patient ratio in the world. But though Cuban biotechnology has met the challenge of the loss of Soviet subsidies and the squeeze of the U.S. trade embargo with reasonable success, public health in Cuba and the country’s health care have fared less well.

Visitors to Cuba, for example, are told to buy bottled water—something few Cubans can afford—because the local water is unfit to drink. The embargo is to blame in two ways. One is that replacement parts for the aging U.S.-made water treatment system are unavailable.

The other is that water purification chemicals are exorbitantly expensive and often unobtainable. According to the American Association for World Health, the U.S. committee for the World Health Organization, illness due to waterborne causes in Cuba has soared as a result and some hospital-acquired infections have been traced to tainted water, too.

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