From 1991 to 1995, Cuba was hit particularly hard by international embargo. Its population suffered. But scientists have now identified the only benefit of the embargo: it led to a population-wide weight loss, and with this a decrease in cases of diabetes and heart diseases.

October 1990: the US Congress passes the Mack Amendment, which prohibits all trade with Cuba by subsidiaries of US companies, going as far as threatening sanctions against any country that purchases Cuban sugar. A few months later, Congressman Robert Torricelli introduces the Cuban Democracy Act to, in his own words, "wreak havoc on the island." These sanctions coupled with the dissolution of the Soviet Union—a helping hand—plunge Cuba into a "special period" during which it is unable to adequately provide food or transport to its people.

Such opaque embargoes kill and the western powers who apply such sanctions are fully aware of this. In 1996, a journalist interviewing the then US secretary of state, Madeleine Albright, pointed out that more than 500,000 Iraqi children had died because of sanctions imposed by western nations on Iraq. To this, Albright famously responded: "we think the price is worth it."

Despite all the atrocity and machiavellianism that trail economic embargoes, science has somehow found a way to profit from the Cuban "special period." Thanks to the impressive Cuban healthcare system which diligently collected health data even during the "special period," Manuel Franco, at the University of Alcalá in Spain and colleagues from US and Cuban institutions, were able to analyse some of the health indicators of the time. What they found underlines the atrocity of the embargo on the Cuban people but does come with a surprising silver lining which they report in a paper published last week by the British Medical Journal (BMJ).

The shortage of food caused by the embargo led to a population-wide weight loss of about 5.5 kg. The food shortage was a direct result of Cuba's inability to import anything. Physical activity was another important contributing factor to the weight loss. The Cuban government somehow got its hands on more than one million bicycles for the population. During the "special period," Cubans were forced to walk or cycle, sometimes for kilometres, as public transport was saddled due to the virtual nonexistence of petrol.

Interestingly, the weight loss matched with declines in cases of diabetes and heart diseases. Essentially, the embargo spurred a mini health revolution. As the authors state in the paper: "so far, no country or regional population has successfully reduced the distribution of body mass index or reduced the prevalence of obesity through public health campaigns or targeted treatment programmes." Where campaigns and targeted programmes failed, the embargo succeeded.

But it gets more interesting. After 1995, the Cuban economy started to pick up again and has risen steadily since—especially post-2000. Coupled to this steady economic rise was a resurgence of obesity, and with it diabetes and heart diseases. The resurgence was predominantly due to an increased energy intake from food and drinks consumed since physical activity only marginally decreased. Energy intake reached pre-crisis levels by 2002 and obesity rates had tripled that of 1995 by 2011.

What the embargo tells us is that even meagre loss of weight throughout a population, if sustained, can lead to a decline in non-transmissible diseases such as diabetes and heart diseases. How to achieve such sustained decline without having an embargo imposed however is another question. The usual strategies put forward include sensitisation through education and policy changes to promote physical activity, taxes on unhealthy food, etcetera.

The authors kept the best for last however. The best paragraph in the paper comes in the footnotes:

"We would like to acknowledge our great respect and admiration for the Cuban people who faced extremely difficult social and economic challenges during the special period—and by making common cause against this tragedy held up with courage and dignity. This tragedy was "man made" by international politics and should never happen again to any population."

This paragraph shows that these scientists are not in the same league as Madeleine Albright and the likes. Scientists want to say lives. Some others... well, you already know.

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Reference: Franco, M., Bilal, U., Orduñez, P., Benet, M., Morejón, A., Caballero, B., Kennelly, J.F. & Cooper, R.S. (2013) Population-wide weight loss and regain in relation to diabetes burden and cardiovascular mortality in Cuba 1980-2010: repeated cross sectional surveys and ecological comparison of secular trends. BMJ. DOI: 10.1136/bmj.f1515.

Image credit: Doug88888 (from flickr)

More from BMJ:

Video abstract of the paper (included with the paper)

Mainstream coverage of the Franco et al. paper:

Sarah Boseley, Guardian, Hard times behind fall in heart disease and diabetes in 90s Cuba, says study

Information about the ongoing Cuban embargo: