Cuban Policy Research Articles

Therapeutic Imaginaries in the Caribbean: Competing Approaches to HIV/AIDS Policy in Cuba and Belize

In this article, I put forward a therapeutic imaginaries framework, developed from previous geographic work on therapeutic landscapes. In particular, I briefly trace the history of HIV and HIV policy in these countries, resulting from field work I have conducted in Havana since 1997 and in Belize since 2005. I highlight how therapeutic imaginaries are created and experienced through governmental AIDS policies, and how these strategies in Cuba and Belize influence individuals’ perceptions of the salubriousness of these countries’ natural and built landscapes. These case studies demonstrate how countries in the same region can develop health care policies that represent different biomedical and sociocultural outcomes. For example, Cuba's policies result in the lowest HIV/AIDS prevalence rates in the Caribbean, whereas Belize experiences the second highest rates. On one hand, the Cuban government espouses comprehensive and centralized health care as a political goal. On the other hand, Belize has a health care system characterized by a decentralized knowledge base and a reliance on Cuban medical personnel. I argue that geopolitics, gender dynamics, economic philosophies, and cultural norms intertwine to create differing disease outcomes in these countries. In both cases I emphasize the roles of HIV policies in influencing perceptions (from individual to international) about whether a particular landscape is healthy or diseased. These perceptions inform the relationship among therapeutic landscapes, therapeutic narratives, and therapeutic imaginaries. Although the causes and outcomes of risk, from geopolitical to individual behavior, vary in each context, the importance of places, filtered through these different scales, remains constant.

Economic Development and Housing Policy in Cuba

Since the triumph of the Cuban Revolution in 1959, Cuba's economic development has been marked by efforts to achieve four basic objectives.

Anti-Embargo Activism and Us Cuba Policy: A Rational Departure

AbstractSince 1969, more than one hundred organisations in the United States have been attempting to change US Cuba policy. Collectively, they constitute a dynamic social movement clamouring for change on family, tourist, cultural and academic travel, remittances and trade to Cuba. This article attempts to explain why this movement, identified as the 'anti-embargo movement', has persisted in attempting to change US Cuba policy for decades although it has met with such limited success over time. A social movements theoretical framework is employed to analyse the persistence of the movement and to explain the impetus accounting for its sustained activism in the post-Cold War era. Drawing on the popular resource mobilisation literature, the article contends that the rational, utilitarian model is inadequate to understand the multifarious attributes of the movement. Therefore, it turns to alternative social movements perspectives such as tactical frames, solidarity networks and co-option, for possible answers.Keywords: activism, embargo, United States, Cuba, popular resource modelIntroductionThis article is part of a broader research project of my PhD dissertation entitled 'Down with the Embargo: Social Movements, Contentious Politics and U.S. Cuba Policy (1960-2006)' (Rampersad 2007). The research methods are diverse ranging from content analysis of major American newspapers to archival research on official documents, books, journals, newspapers, magazines and websites. A significant contribution to this article are the findings obtained from a series of unstructured and semi-structured elite interviews undertaken in the US between 2005 and 2006 amongst scholars, leaders of both hardline and moderate Cuban and American groups as well as non-Cuban American organisations, their staffmembers, congresspersons and congressional staff.The Anti-Embargo MovementThe anti-embargo movement in the United States comprises more than one hundred organisations which seek to change US policy to Cuba. They are led by both Americans and Cuban Americans located mainly in Washington DC, New York and Miami, though a few are found in other states like California and New Jersey. They fall into three main categories. The first includes older and larger organisations, some of which are international activists which do not have Cuba as a special project but have taken up the Cuban cause. Amongst these are the American Civil Liberties Union, Human Rights Watch, Madre (an international human rights organisation), Global Exchange, Oxfam America and faith-based groups like the World Council of Churches, Church World Service, the United States Conference of Catholic Bishops and the Episcopal Church. The second group consists of organisations which treat with other Latin American/Caribbean issues but have a specific Cuba project. These include the Center for International Policy (CIP), the Washington Office on Latin America (WOLA), the Latin American Working Group (LAWG), World Policy Institute and the Lexington Institute. The third group comprises organisations concerned only with US Cuba policy such as Venceremos Brigade, the Center for Cuban Studies, the Emergency Coalition to Defend Education Travel (ECDET), Pastors for Peace, and business interests including USA Engage and the US-Cuba Trade Association. It also includes a host of moderate Cuban American organisations. The most prominent are the Cuban Committee for Democracy, Cambio Cubano, the Emergency Network of Cuban American Scholars and Artists (ENCASA), the Cuban American Alliance Education Fund (CAAEF), the Cuba Study Group, and the Cuban American Commission for Family Rights.This article focuses primarily on organisations in the second and third categories which either have a specific Cuba project, or treat with US Cuba policy as their sole agenda. These are the most active on the contentious embargo issues treating with tourist, academic and family travel, remittances, trade and cultural exchanges to the island. …

CUBAN MEDICAL COOPERATION WITHIN ALBA: THE CASE OF VENEZUELA

Cuba's policy of medical internationalism still remains a great mystery for many, despite its existence for fully five decades, and a record that puts the 'developed' world to shame. Perhaps this is because it is not presented as 'aid', but rather as cooperation, and humanitarian solidarity-a concept which the industrialised nations and their paternalistic approach fail to understand. By far the largest degree of medical cooperation is found in Venezuela, where in March 2010 there were 29,255 Cuban medical personnel, including 11,322 doctors ('Medicos cubanos' 2010). There is a substantial body of literature published on this decade-long relationship, although sadly it has been reduced to the simplistic concept of a 'doctors for oil swap'. This article seeks to trace the evolution of bilateral cooperation between Venezuela and Cuba, to provide an analysis of these close ties, and to explore the nature of the medical cooperation that is such a key to the relationship.

Similar but different: Health and economic crisis in 1990s Cuba and Russia

The collapse of the Soviet Bloc caused devastating economic crises in Cuba and in the Russian Federation but triggered remarkably different public health responses: while mortality rates in Russia increased substantially the crisis was barely visible in Cuban public health statistics. Fundamental social, political and cultural differences in the two countries and the respective specificities of the crisis in either country seem responsible, including different long-term health trajectories and different traditions of health-related agenda setting. Cuban policies combined traditional top down activism with grass root activities, strengthening social capital, while the “shock therapy“ adopted in Russia had a corrosive effect on society, increasing psycho-social pressure and weakening support.

Solidarity, Counter-Hegemony, and Development: Exploring New Dimensions of Cuba's Sport-Based Internationalism

Cuban internationalism has been recognized as a unique foreign policy approach that merges “soft power” with comprehensive development. While much has been written about the country's programs of cooperation, outreach, and solidarity, notably within the health sector, little has been mentioned to date about the extensive cooperation Cuba seeks with other nations in the global South through sport and physical education. This is a significant gap given the recent attention paid to sport within international development. In this article we explore Cuba's sport-based internationalism by illustrating how EI Instituto Nacional de Deportes, Educación Física y Recreación (INDER) employs hundreds of Cuban personnel to engage in sport programs in three unique streams. First, Cuban sport professionals work alongside other Cuban health and social workers in marginalized communities throughout the global South; second, INDER trains hundreds of students from other parts of the global South as coaches and physical trainers; and third, elite Cuban athletes fulfill for-profit coaching contracts with elite sport teams in the global North. We argue that Cuba's international sport programs are representative of a commitment to sport that is grounded in national discourses of both universal participation and international solidarity; as such, Cuban sport policy should be further recognized as a notable process within the burgeoning Sport for Development and Peace sector.

Cuba’s National HIV/AIDS Program

As scientifi c data emerged elucidating the pathology of the disease, public health understanding and Cuban policy evolved with it. As of 1993, an ambulatory care system made sanatorium treatment an option rather than an obligation.[1] By then, thanks to the global introduction of antiretrovirals (ARV) in 1987, AIDS was no longer assumed a death sentence. Cuba’s challenge at the time was to fi nd the funds to afford costly medications, and simultaneously turn more attention to nationwide prevention. The pro-active incorporation of people living with HIV in educational campaigns organized within the National HIV/AIDS Program—most notably the founding of the AIDS Prevention Group (GPSIDA, its Spanish acronym) by patients in Havana’s Santiago de Las Vegas Sanatorium in 1991—underscored this effort. Over two decades later, UNAIDS has lauded Cuba for its “exceptionally low 0.1% prevalence rate,”[2] and low rate of AIDS-related mortality.[3] Still, despite systematic efforts to contain the spread of the disease and improve quality of life for those living with it, HIV/AIDS continues to present serious challenges to the Cuban health system and the country’s at-risk populations. HIV/AIDS in Cuba: The Current Picture Today, the pathways of HIV/AIDS in Cuba are different from other countries in some respects: transmission by intravenous drug use is extremely rare, as is infection from blood or blood derivatives, all of which are screened. Rates of mother-to-child HIV transmission are negligible. In Cuba, HIV is largely urban and male, with 99% of cases contracted through sexual relations. The epidemiological profi le of infection has shifted from early predominance of heterosexual transmission to that of men who have sex with men (MSM), who now constitute over 80% of people living with HIV in the country. Provinces with the most new cases in 2010 were Havana City, Isle of Youth (special municipality), Havana, and Cienfuegos.[4] HIV prevalence in Cuba is slowly increasing, partly because people with HIV are living longer. However, more worrisome is the fact that incidence is also increasing: from 13.9 to 16.2 per 100,000 population between 2009 and 2010. Recent national surveys relate low risk perception and social constructs such as machismo to increases in HIV infection in Cubans under age 49. Cuba provides comprehensive care to all people living with the disease, and guarantees antiretrovirals (ARVs) for those needing them. Despite deep fi nancial diffi culties, treatment in Cuba, including medication, is free. In 2003, Cuba achieved universal antiretroviral therapy with domestically-manufactured ARVs for patients meeting international clinical criteria. In 2010, over 5,600 people received ARV therapy in Cuba, more than a 10% increase from the previous year.[4] The Cuban government estimates it costs US $6000 annually to treat each person with HIV/AIDS.[5] A strategy to further decentralize services for HIV/AIDS counseling, testing, treatment and support groups was begun in 2005. Establishing and equipping additional clinical microbiology and pathology laboratories, locating specialized services in Havana City, Villa Clara, Sancti Spiritus, Holguin, and Santiago de Cuba provinces, and closing 11 sanatoria deemed superfl uous are results of this strategy, designed to improve access.

A Cuban Policy Approach to Sex Education

Las iniciativas en el campo de la sexología y la educación sexual en la Cuba prerevolucionaria apenas son conocidas, ya que no se ha investigado continuidades entre aquellas experiencias y el esfuerzo llevado a cabo en los años posteriores a la revolución de 1959. Sin embargo, hay que ver la fundación de la Federación de Mujeres Cubanas (FMC) como el producto de un largo proceso de madurez por parte de las mujeres cubanas durante la primera mitad del siglo xx, y en el contexto mas amplio de la FMC también hay que ver los acontecimientos en los campos de la sexología y la educación sexual de los últimos cincuenta años. Basado en materiales de archivo de la FMC, este artículo esboza una periodización de cuatro etapas principales en el período revolucionario en la institucionalización de la educación sexual en Cuba, a la vez que señala sus mayores desafios.

The Cuban alternative to neoliberalism

PurposeIn response to its profound economic crisis, in the 1990s Cuba adopted a tourism‐based development strategy. As an approach to development, tourism has been both heralded and critiqued. One concern is that for less diversified economies it has large imported input requirements. The purpose of this paper is to analyze Cuba's efforts to address this weakness.Design/methodology/approachThe paper draws on interviews conducted with Cuban policy makers and researchers working in the area of tourism, and one hotelier operating in Cuba. Also, extensive secondary data collected while conducting the fieldwork in Cuba and relevant existing literature are reviewed.FindingsIt is found that Cuba has increased significantly its reliance on domestic production for inputs for its tourist sector since the mid‐1990s, thereby reducing its dependence on imported inputs.Practical implicationsThese findings suggest that, by reconfiguring domestic production to provide inputs for the tourism sector, foreign exchange leakages typically associated with tourist development in less diversified economies can be diminished and that it can provide an infusion of foreign exchange and investment that benefits the local economy.Social implicationsThis case presents an alternative to the neoliberal approach to policy making in the Global South, one that has the potential to avoid some of the negative social and economic consequences of that approach.Originality/valueIn addition to highlighting the alternative represented by Cuba's approach to tourism, the paper evaluates the extent to which it approximated the novel strategy of development proposed by the neostructuralists almost simultaneously. It concludes that Cuba's approach did approximate the neostructural model in a number of important ways.

Más allá del azúcar: política, diversificación y prácticas económicas en Cuba, 1878-1930 (review)

Reviewed by: Más allá del azúcar: política, diversificación y prácticas económicas en Cuba, 1878-1930 Jorge L. Chinea Antonio Santamaría García and Consuelo Naranjo Orovio, eds. 2009. Más allá del azúcar: política, diversificación y prácticas económicas en Cuba, 1878-1930. Madrid: Ediciones Doce Calles. ISBN: 9788497440471. Caribbean specialists are well aware of the impact that plantation-grown sugar has had in the region's environment, economy and society. Understandably, it is to the enduring legacy of the sugar plantation complex that students of the Antillean chain have aimed a great deal of their interests. The disproportionate outpouring of research and writing on Cuba's experience with the "sweet malefactor," which elevated the Spanish Caribbean colony into a leading world sugar producer during the nineteenth century, confirms this general pattern. To be sure the volume of work devoted to such themes as the island's indigenous people, peasantry, subsistence farming, cattle ranching and free artisanry, for example, pales in significance when compared to those [End Page 220] focusing on the sugar-slavery duet. Más allá del azúcar is an effort to take a closer look at the other face of Cuba, one that is not entirely dominated by cane fields, ingenios and gangs of nonwhite men, women and children forced to toil against their will. As historian Allan J. Kuethe observes in the book's prologue, the sugarocracy did not make up a homogeneous block nor speak or act with one voice on economic, cultural or scientific matters. In her introduction fellow Cuban specialist, Consuelo Naranjo Orovio, echoes his sentiments when she notes that sugar did not blot out reformist and diversification projects that gained currency during the 19th century. To the contrary, she adds, appeals for the aforementioned proposals, many of which were incompatible with the interests of the agrarian elite, grew stronger each time an economic crisis threatened the plantation system. Naranjo Orovio's own chapter traces the shifting discourse amongst the island's competing social groups surrounding the founding of white colonias and calls for the blanqueamiento (whitening) of Cuba's population. At various junctures Spain favored both, mostly in words rather than deeds, to safeguard the territory, but also to keep separatists in check by raising the specter of an impending race war. By the late nineteenth century, however, metropolitan overseers and Cuban reformers revived the debate in their respective attempts to influence the course of Cuba's uncertain social, economic and political future. Antonio Santamaría García synthesizes the last thirty years of Cuba's economic history, and attempts to make sense of the island's agricultural, mercantile and railroad expansion of this interval. Here sugar joins other factors, including the growing transportation infrastructure and global competitors, in steering Spanish commercial policy in Cuba. The metropolis' balancing act becomes more evident in its management of Cuba's growing trade with the U.S. According to Oscar Zanetti Lecuona, the imposition of protectionist tariffs by Spain (until 1898) and the U.S. (after 1898) alone does not do justice to the complicated trading dynamics of this period. While Spain experienced a sizeable economic loss after 1898 at the hands of hegemonic U.S. capital, some of its goods continued to have a modest competitive edge due, in no small part, to heavy Spanish immigration and prevailing cultural tastes. Other factors such as the variety, quality, price and accessibility of specific Spanish products may have also helped to keep mercantile flows from the former metropolis to Cuba economically viable. Much of the published scholarship on this period, as suggested by the work of the late María A. Marqués Dolz, overlooks the growth of domestic industrial and manufacturing activity. She notes that many of the enterprises that were set up in the last decade of Spanish rule were fundamentally artisanal in organization, were centered on the urban [End Page 221] enclaves, catered to local needs, and were not always directly connected to the plantations and the sugar export sector. Some of the private wealth generated through these and other transactions eventually found their way overseas, as shown by Martín...

The immigrant divide: how Cuban Americans changed the US and their homeland

Are all immigrants from the same home country best understood as a homogeneous group of foreign-born? Or do they differ in their adaptation and transnational ties depending on when they emigrated and with what lived experiences? Between Castro’s rise to power in 1959 and the early twenty-first century more than a million Cubans immigrated to the United States. While it is widely known that Cuban emigres have exerted a strong hold on Washington policy toward their homeland, Eckstein uncovers a fascinating paradox: the recent arrivals, although poor and politically weak, have done more to transform their homeland than the influential and prosperous early exiles who have tried for half a century to bring the Castro regime to heel. The impact of the so-called New Cubans is an unintended consequence of the personal ties they maintain with family in Cuba, ties the first arrivals oppose. This historically-grounded, nuanced book offers a rare in-depth analysis of Cuban immigrants’ social, cultural, economic, and political adaptation, their transformation of Miami into the northern most Latin American city, and their cross-border engagement and homeland impact. Eckstein accordingly provides new insight into the lives of Cuban immigrants, into Cuba in the post Soviet era, and into how Washington’s failed Cuba policy might be improved. She also posits a new theory to deepen the understanding not merely of Cuban but of other immigrant group adaptation.

Challenges for Housing Policy in Cuba: Case Studies from Havana

Housing remains one of the most severe and politically sensitive social issues facing the Cuban nation. While Cuba maintained its reputation for high standards in education and public health through the difficult years of the Special Period, meeting the housing needs of the population proved much more challenging. This paper begins with an overview of revolutionary Cuba’s housing system and achievements up to the 1990s and documents some of the challenges of the subsequent economic crisis. Its main thrust, however, is on research on housing strategies and initiatives in the post-2000 period, mainly focused on the capital city, Havana. The research identifies changing approaches to housing policy in response to the broader national and international economic climate. The evidence confirms the significance of structures for the governance of housing within the state apparatus; the important role of professional analysts and practitioners in innovative practice; and the importance of community participation in achieving new solutions to housing problems. Improvements through initiatives such as the regeneration of Old Havana and collaboration with international NGOs present valuable models but have been limited in quantity and geographical scope, relative to the scale of need.

Washington-Miami-Havana 1999-2009: Towards the End of a Ménage à Trois?

Although comparatively recent immigrants and a very small group of hardly more than 1.3 million, Cuban Americans have been very influential in Washington’s confrontational policy toward Cuba over the past thirty years. While the end of the Cold War should have undermined the rationale for the embargo, they maintained a hard line on Cuba and proved quite convincing in their arguments with both the Clinton and the George W. Bush Administrations. This piece focuses on the past decade and will explore Washington’s continuing hard line toward Cuba as well as the serious challenges this posture is facing today. Increasing pressure from competing powerful lobbies to end the embargo, a growing uneasiness in Congress with the policy’s failure, a severe split within the Republican party over the issue, and a declining radicalism among younger Cuban Americans and more recent Cuban immigrants, all tend to signal a change in Washington’s Cuban policy in the near future, and with it a redefinition of Cuban American influence.

Cuban Home Gardens and Their Role in Social–Ecological Resilience

Cuba’s political and economic isolation in today’s globalised world demands constant adaptation by its inhabitants. The Cubans’ capacity to adapt increases their ability to cope with change and to reshape local ecological and social systems, creating a more resilient system. Worldwide, home gardens are a community’s most adaptable and accessible land resource and are an important component in reducing vulnerability and ensuring food security. The role of Cuban home gardens in relation to political change and economic crisis was investigated in Trinidad de Cuba using standard ethnobotanical research methods. Major events, such as the collapse of the Soviet Union and the subsequent economic crisis as well as frequently changing Cuban policies on agriculture, food security, religious freedom and healthcare, have had an impact on household decision-making, influencing home garden composition and management. Social networking surrounding home garden produce plays an essential part in the continuous adaptation to change, aiming to increase a diversity of resources and strategies, hence resilience.

Cuban Medical Internationalism and its Role in Cuban Foreign Policy

Cuba's medical internationalism is extraordinary, and in many ways the extent of its outreach programme puts the developed world to shame. It is impossible to fit Cuba's actions into any neat theoretical box—quite simply the revolutionary process follows no established paradigm. This exceptionalism is seen both in its approach to foreign relations and in its medical internationalism policy. Indeed, even during the days when it was economically dependent upon the Soviet Union, Cuban actions showed an exceptional degree of political independence. But because Cuba is so different, it is also difficult for developed nations to understand. This is a tremendous pity, for there is much to learn from Cuba's approach to developing sustainable public health systems in poor, Third World countries. There is also a great deal that, on a moral basis, wealthy nations can also learn about Cuba's policy of internationalist solidarity.

Cuban Social Policy

The logic that has guided the development model of the Cuban Revolution since its inception has always prioritized social development. Significant achievements in education, health, and social security have not, however, necessarily been the result of comprehensive and systematic social planning, and therefore development in the social sphere has not progressed evenly. To strengthen what has been achieved, social policy in Cuba must become more holistic. Women and children have been the central focus of social policy from the beginning, but recent changes in Cuba's demographic structure are requiring policy attention to the needs of the elderly. New social programs introduced since 2000 are aimed at improving the quality of life for these three groups.

Stephen Harper's Cuba policy: From autonomy to Americanization?

(2009). Stephen Harper's Cuba policy: From autonomy to Americanization? Canadian Foreign Policy Journal: Vol. 15, No. 1, pp. 21-39.

From Havana to Miami: U.S. Cuba Policy as a Two-Level Game

or thirty years, Cuba was a focal point of the Cold War. Before the demise of the Soviet Union, Cuba's close ideological and military partnership with the communist superpower posed a challenge to U.S. foreign policy, especially in the Third World (see, e.g., Dominguez 1989). With the end of the Cold War, Cuba retrenched, ending its aid programs for foreign revolutionaries and regimes. Without the Soviet Union's sponsorship, Cuba could no longer afford the luxury of a global foreign policy exporting revolution. Instead, its diplomats focused on reorienting Cuba's international economic relations toward Latin America and Europe, building friendly relations with former adversaries. Ordinarily, such a massive shift in the international system would be expected to produce a significant change in U.S. policy, as it did in the cases of Russia, Eastern Europe, Angola, and even Vietnam. But U.S. policy toward Cuba changed hardly at all. That is an anomaly we endeavor to explain herein, using Robert D. Putnam's (1988) theory or metaphor of international bargaining as a two-level game. (For elaborations on Putnam's model, see Evans et al. 1993). The two-level game model also provides a coherent explanation of President Bill Clinton's handling of the 1994 Cuban refugee crisis and the 1996 shootdown of two small planes by Cuban fighters. Putnam argues that in any international bargaining situation, national leaders are actually involved in two negotiations simultaneously: the international negotiation (level 1), wherein the leader seeks to reach agreement with other international actors; and a domestic negotiation (level 2), in which the national leader must persuade his domestic constituency to accept (ratify) the level 1 agreement. For leaders, the problem is that rational moves in the level 1 game may prove impolitic at level 2, or vice versa. The set of all possible agreements that domestic constituents will ratify is called the level 2 win-set. To achieve a successful agreement, the leader must locate the intersection, if any, between his constituency's winset and what the other level 1 negotiators will accept (that is, the level 1 win-set). The negotiation is complex because each negotiator is playing a similar two-level game. Putnam's contribution lies in his emphasis on the interactive nature of the international and domestic processes.l

Ethical dilemmas in individual and collective rights‐based approaches to tertiary education scholarships: the cases of Canada and Cuba

One of the ongoing debates in Canadian higher education is the dilemma of the brain drain and the seemingly conflicting goals between the strategies and intentions of various government departments. While Citizenship and Immigration Canada aims to recruit the brightest students from across the globe to study in Canada and to enable their long‐term stay as permanent residents and ultimately as citizens, the Canadian International Development Agency is mandated to strengthen human capacity in developing countries. This paper provides a critical analysis of the brain drain problem by juxtaposing Canadian policies with Cuban policies as manifested in the two countries’ divergent approaches to international students and tertiary education scholarships for students from poorer countries. Following an overview of the existing scholarship programmes in both countries, ethical and philosophical considerations are examined that appear to underlie the two countries’ individual‐rights‐based and collective‐rights‐based justifications for making decisions about the terms on which students from other countries are permitted to study in Canada and Cuba.

Comparative Policy Brief: Status of Intellectual Disabilities in the Republic of Cuba

Abstract It is estimated that 3.2% of Cuba's population of 11.4 million persons has a severe disability of some kind. Recent economic difficulties have, it may be assumed, had a negative impact on health service provision – which is free to all – and thus, on population health outcomes and nutritional levels. There is a traditional culture of family care for children and adults with intellectual disabilities (IDs), although it is apparent that unfounded beliefs about the etiology of disabling conditions as well as social stigma persist. The Constitution indicates that it is necessary to provide education for children with intellectual and other disabilities in primary schools, while other ministerial resolutions create special schools. ID is construed chiefly as a social problem. Children with IDs are the responsibility of the Minister of Education; it is possible that children with severe levels of disability may not attend school and rely on family support. For adults, rehabilitation includes physiotherapy and other services such as “defectology”; strategies for adults who are evaluated include both segregated and institutional elements. The author suggests that two key issues are related to policy and practice in Cuba. One is the minimal content on special education in teacher preparation programs, and the other, that despite a cultural tradition of family care, family involvement in special education, or in rehabilitative services, remains limited.