The changing face of inner-city Havana
In the crowded streets of inner-city Havana, Cuba, housing had crumbled and ill-health flourished — a result of Cuba’s "special period" of the 1990s.
The collapse of Cuba’s Soviet trading partner and the continued U.S. embargo brought hard economic times on the communist country, and led to serious social ills. But one neighbourhood in Havana’s inner-city, known as Cayo Hueso, stands out — not for its problems, but for one of the country’s most successful community-led projects aimed at revamping the decaying urban scene.
The project might also stand out for the joint efforts of researchers from the University of Manitoba and Cuba’s National Institute of Hygiene, Epidemiology and Microbiology (an arm of Cuba’s Ministry of Health), who have been creating a framework for future community "interventions."
The fight against urban decay
In 1996, the community of Cayo Hueso began an extensive project to improve housing and infrastructure in its neighbourhood. Dubbed the "Cayo Hueso Intervention" it quickly became a model in Cuba for fighting urban decay and ill-health. Today it’s used almost as a catch-phrase. "Fidel Castro even talks about doing a ‘Cayo Hueso Intervention’ in other communities around Cuba," says Dr Annalee Yassi, who led the University of Manitoba contingent.
Inner-city Havana, which is called Centro Habana, is Cuba’s most densely populated area, with about 170,000 people crowded in just over 3 km2 of tenements — most lacking even basic sanitation and safe drinking water.
Infrastructure in Centro Habana, an area founded more than 450 years ago, deteriorated throughout the 1990s. With community involvement and government support, including subsidized building materials, housing conditions in Cayo Hueso have improved, says Yassi. And researchers hope this might be the first step in improving overall human health across Centro Habana.
Building on the community’s strength
The project, funded by Canada’s International Development Research Centre (IDRC), was invited by its Cuban partners to help evaluate the project. The work included analysis of interviews and surveys done in Cayo Hueso.
With that information, researchers can compare the results of the Cayo Hueso project with other areas in Centro Habana, says Cuban researcher Dr Pedro Mas, speaking from Havana. "The question of priority now is to know what’s happening with the people who received the improvement (in housing)," says Mas. "We are now comparing this area with another area in the same municipality."
There are still major health risks in Centro Habana, as the survey results show. But, according to Yassi and her fellow researcher Dr Jerry Spiegel, the area has one pivotal strength: the community itself. "It’s so strong, the social capital that exists in that community. I found myself saying at one point: ‘I wish I brought my kids up here’. And this is an inner-city community that’s the most crowded community in all Cuba," says Yassi.
The community and the Cuban government
Access to health care and education in Cuba means the community "has a good capacity to address problems," says Spiegel. "The thing that is exhilarating is that there seems to be good links among researchers and the local community," he adds.
Participation ranged from an elderly woman making sandwiches for workers, to entire government ministries taking responsibility for the work in one block of the neighbourhood. This type of organization and community participation would be tough to imagine in other countries, says Yassi.
The willingness of all levels of government to mobilize around the neighbourhood was also an important strength of the Cuban community, say the researchers. Cuba seemed unique in "the focusing of government, as well as nongovernment funds to address the needs of one community," says Yassi.
Spreading the word
"Yet there’s no reason why it couldn’t happen elsewhere," she adds. The project could become a model for other countries as well. Yassi and other researchers have used the Cayo Hueso experience to create training materials for countries struggling with urban health issues.
In late October 2001, Yassi and Spiegel shared the results of the Cayo Hueso Intervention at the American Public Health Association Conference — a meeting drawing thousands of other researchers, this year to Atlanta. "Being able to bring to the world the story of the Cayo Hueso project is itself a major contribution... there’s so much to learn from that particular intervention," says Yassi.
Yassi and Spiegel expect to finish with the Cayo Hueso project in December this year, but add their partnership with their Cuban colleagues continues on other projects. Both have recently moved to the University of British Columbia.
Colin Campbell is a freelance writer based in Ottawa.