Social Work in Cuba
Abstract and Keywords
This entry discusses the development of social work in Cuba since the revolution of 1959. It describes a community-oriented social work initiative created by the government in 2000 to identify vulnerable populations and to address their needs for support services. It also discusses a social work educational initiative begun at the University Havana in 1997. Together these two initiatives transformed social work in Cuba. This entry also notes that Cuba implemented major economic reforms in 2008 and it discusses the relationship of these reforms to the closure in 2011 of the two social work initiatives noted above. How social work will develop in Cuba in the future is unclear. Information for this entry comes from research the writer has conducted on the development of social work in Cuba over the past decade and from a review of the relevant literature.
The breakup in 1989 of the Former Soviet Union (FSU) had a devastating impact on economic and social conditions in Cuba. Cuba depended heavily on the FSU for economic support. After the FSU withdrew support from Cuba, social inequalities grew and the living conditions of vulnerable populations worsened. This entry describes a community-oriented social work initiative created by the government in 2000 to identify vulnerable populations and to address their needs for support services. After the breakup of the FSU the needs for services by vulnerable groups increased. The entry also discusses a social work educational initiative begun at the University Havana in 1997. Together these two initiatives transformed social work in Cuba. Cuba implemented major economic reforms in 2008; the relationship of these reforms to the closure in 2011 of the two social work initiatives noted above will be discussed.
The Cuban Revolution
The Cuban revolution of 1959 was one of the most remarkable phenomena in the history of Latin America (Kaplan, 2009) and was one of the most profound social transformations ever seen in the Americas (Fagen, 1969). The dictatorship of Fulgencio Batista was toppled January 1, 1959, by a revolutionary movement that soon thereafter mobilized workers, peasants, and other sectors of society. Government leaders introduced new laws that restructured society and promoted egalitarianism. Cuba transformed its political culture; socialized its economy; redistributed its wealth; and mobilized its population to address illiteracy, poor health, and other social and economic problems. Social justice defined in terms of collective, social rights and obligations, including universal employment, health care and education, and subsidies of food and medicine among other citizen rights (Fernández & Hansing, 2008) have always been an integral part of the revolutionary vocabulary. Social policy enacted by the revolution’s leaders resulted in increased salaries and pensions, in advances in education, public health, and medicine. The economy was highly redistributive and Cuba was one of the most egalitarian societies in the world through the early 1980s. These revolutionary transformations occurred at the national level. They were implemented locally through a top-down decision-making process.
The Breakup of the Soviet Union
The collapse of the FSU devastated the fragile base of the Cuban economy, since Cuba depended on the Eastern Bloc for most of its foreign trade (Castro Mariño & Pruessen, 2012). Cuba had accepted economic assistance from the Soviet Union, because the United States had isolated Cuba from the Western Hemisphere to destroy the revolution (Domínguez, 1978). Cuba sought help where it was offered, and was especially open to assistance from the socialist bloc countries of Eastern Europe. The economic crisis had a catastrophic impact on living standards and led to worsening economic and social conditions, including rising unemployment, increased poverty and social differentiation. The crisis had an especially deleterious impact on the youth of the country, who were not attending school or working, the elderly population, and single mothers. Cubans refer to this period of economic crisis as “The Special Period in Time of Peace,” which lasted through the mid-1990s (Cole, 2002). Economic class differences sharpened from 1989 to 1998, threatening social cohesion (Burchardt, 2002). Real average wages from 1989 to 1998 declined precipitously (Comisión Económica de América Latina y el Caribe [CEPAL], 2000), as did salaries in the state sector. Income was insufficient to meet basic household needs (Togores González, 1999). Cuba became a less egalitarian society and a segment of the urban and rural population began to live in poverty (Espina Prieto, 2010). Expenditures for social services when adjusted for inflation fell by 40% between 1989 and 1998, although expenditures remained high in comparison to other Latin American countries. The economic crisis forced the Cuban government to abandon its policy of universal access to services and to begin to implement a program that targeted the most vulnerable populations for special assistance, a policy that has been called “targeting in universalism” (Barbería, Briggs, de Souza, & Uriarte, 2004), although universal access to education, health care, and social security have remained in place.
Battle of Ideas and the Neighborhood Movement
The government introduced a series of training programs in education, nursing, social work, and other fields in response to the deteriorating economic and social conditions noted above. These programs were part of the so called “Battle of Ideas” campaign. The Battle of Ideas campaign also sponsored rallies and organized youth in support of socialism and in opposition to the United States trade embargo of Cuba. The stated purpose of this campaign was to strengthen Cuba economically, socially, and ideologically. Some argue its primary purpose was to reinforce ideological orthodoxy and revolutionary renewal in an effort to politically stabilize a fragile economy (Font, 2008).
The intractable economic and social problems of the Special Period caused the government to reconsider the top-down decision-making process for implementing health care and other local programs, which had been in place since the beginning of the revolution. It began to pay greater attention to the barrio or neighborhood as a geographical and social space, because the government lacked transportation to bring resources to poor outlying communities. This stimulated community members living in these neighborhoods to develop local support systems. Natural helping networks developed spontaneously as members of poor communities sought to survive economically (Ramírez, 2004).
The government looked increasingly towards the community to become a locus of social action for addressing the support service needs of at-risk groups, including alienated youth, single mothers, older persons with scarce resources, and families living in overcrowded housing. The need to promote social action at the local level, to identify members of vulnerable groups in need of services and to train social workers for work at the community level were factors that led the government to transform social work as it existed through the 1980s.
Social Work Before the 1990s
The first Cuban school of social work (SSW) had been established at the University of Havana in 1943. It was not a university degree program and ended when the university closed its doors in 1956 due to social turmoil leading up to the Cuban Revolution in 1959. Cubans expected that the revolutionary government would assume responsibility for social services. Cuba’s post-revolutionary government did not see a need for professional social workers because its economic and social programs were designed to provide universal access to education, employment, healthcare, housing and nutrition, and to remove rural–urban disparities. The revolutionary government implemented a cradle-to-grave welfare system that covered practically the whole population (Uriarte, 2002). Powerful mass organizations, especially the Federation of Cuban Women (FMC), were created after the revolution and entrusted with a variety of public health, educational, and security functions within the community (De Urrutia Barroso & Muñoz Gutiérrez, 2006; Diaz-Briquets, 2002).
By the 1970s, however, national leaders decided that Cuba needed trained social workers to assist healthcare professionals in bolstering the country’s public health infrastructure, which had deteriorated considerably due to the emigration of large numbers of health professionals at the time of the revolution (Bravo, 1998). In 1973, the Cuban Ministry of Public Health (MINSAP) established two-year technical training institutes at 14 locations across the country to prepare social work technicians (técnicos medios) to assist doctors, nurses, and other healthcare professionals in hospitals and medical clinics. Students received little information about community practice as part of this training, but were prepared for practice in medical centers, rather than neighborhood health clinics (Fierro, 1988). This changed somewhat as Cuban medicine became more community based in the late 1970s.
A comparatively small number of social workers were also trained at government ministries, such as the Ministry of Work and Social Security (MWSS) [Ministerio de Trabajo y Seguridad Social], to provide direct assistance as case workers within this ministry to people on benefits, including individuals receiving pension and disability payments. Multiple sectors of society, including teachers, doctors, psychologists, and sociologists and, to a lesser degree, social workers in healthcare and untrained “empirical social workers,” were employed by national, provincial, and municipal authorities to function as “agents of transformation.” “Empirical social workers” were quasi-volunteer community members affiliated with mass community organizations who provided informal guidance and support to delinquent youth, older persons living alone, and other at-risk individuals whom they linked to grassroots organizations for help. They were called “empirical social workers” because they were guided by practical experience rather than theory. They were not formally trained in social work.
The Transformation of Social Work: A Two-Pronged Social Work Initiative
The need to promote social action at the local level in the aftermath of the Special Period, to identify members of vulnerable groups in need of services, and to train large numbers of community-oriented social workers led the government to develop a two-pronged social work education program outside of the Ministry of Public Health (Strug & Teague, 2002). This initiative comprised two separate educational programs: (a) a university-level program (UP) at the University of Havana for advanced education of social workers, most of whom were working for the Ministry of Public Health (MINSAP), and (b) schools of social work (SSWs), which offered rapid social work training for youths who went to work in their communities of origin after graduating from an SSW.
The University Social Work Concentration at the University of Havana (UP)
The Cuban Ministry of Education in 1997 approached the Sociology Department at the University of Havana to develop and implement a degree program in sociology with a concentration in social work to provide advanced training for Cuban social workers. Most of these social workers worked in the health field and were trained in the technical training schools for social workers as discussed above. The government felt that health social workers would benefit from additional education in the field of social work and that this education was necessary for them to work more effectively with vulnerable populations in the country’s poorest neighborhoods. In 1998, students began to enroll in the university’s six-year degree program. Two years later, the University of the Oriente in Santiago, Cuba, started a similar UP. Both offer the licenciatura degree (roughly equivalent to a master’s degree in the United States) in sociology with a concentration in social work. Licenciatura students were high school graduates, and the majority of them were part-time students with full-time jobs as healthcare social workers. Every 21 days, they received time off from their jobs to attend classes at the university and to study for exams. They received their regular income while they were students.
The UP’s goal was to advance Cuban social work education and training by teaching students to integrate social work practice skills with theory. The hope was this would not only increase their practice skills, but also enhance their understanding of their role as change agents and elevate their professional status in the wider society. The Sociology Department spent considerable time and effort developing a curriculum based on those of other Latin American countries and Spain. The UP curriculum integrated sociological theory and social work practice. Two introductory courses that were offered in the first year were Introduction to Sociology, and Theory and Practice in Social Work. First-year students also took classes in philosophy, political economy, and the history of the Americas. They studied demography, sociological methods, and statistics in their second year. In years three to five, students took Social Work I (community intervention), Social Work II (intervention with groups, organizations, and institutions), and Social Work III (interventions with individuals and families), which is similar to casework in U.S. SSWs. Students also studied the history of social work, political sociology, anthropology, sociology and health, and sociology and the family. Much of the sixth year was devoted to writing a professional thesis. Starting in their first year, students attended a research workshop every semester in which they examined their on-the-job practice. This workshop was an important source of supervision for these students because Cuba lacked social workers with advanced training to supervise them where they worked.
Social Work Schools for Youth: Training for Community-Oriented Practice
In September 2000, the Cuban government opened its first SSW in Cojímar on the outskirts of Havana for people aged 16 to 22 and, subsequently, opened three other SSW. Two thousand students attended each of these schools.
This social work educational initiative, like the UP in Havana and Santiago, represented an emergency response by the government to address social problems. Students at the SSW were known as emergentes because they were trained to respond to serious emergent social problems.
The purpose of these social work training schools was to provide a short-term (initially six and then it increased to12 months the following year), concentrated social work learning experience, combining classroom experience with field practice. According to program directors, Cuba did not have the luxury of waiting to solve its economic problems. The idea was to not leave young people behind uneducated and to educate young people who could then go out and help other young people.
Many SSW faculty members were advanced social work students studying in the UP. They were not reimbursed for their teaching because they were on paid leave from their regular jobs. The academic program for emergentes integrated courses from various fields into a unified curriculum. In addition to studying sociology, social work, psychology, law, and other disciplines, emergentes also took courses in the historical development of social work in Cuba, the United States, and elsewhere in the world, adolescence, the family, community social work, and social intervention techniques. To graduate, emergentes had to pass exams in each disciplinary subspecialty. The required field work, directed by a multidisciplinary faculty team, involved interviewing youths from poor neighborhoods to determine the prevalence of problems among them and to assess their level of need for services. Emergentes participated in government social projects, such as Cuba’s campaign to eradicate the mosquito-carrying dengue fever, which is an important ongoing public health campaign in Cuba.
After their training was completed, emergentes were guaranteed social work jobs. It was required that they return to live and work in their home communities. They worked with youths and other groups at risk, such as children and senior citizens. They received a salary of 300 pesos a month, which was considered a good salary for young Cuban workers—it was equivalent to what técnicos medios (social work technicians) in health care received even after many years of work. Emergentes also had the opportunity to study for their licenciatura on a part-time basis in any of eight university degree programs, including the UP program in sociology, social work, social communication, psychology, and law. They were expected to remain with their community-based social work jobs if they decided to subsequently study on a part-time basis at one of these eight university degree programs.
With time and experience, government officials and educators in psychology, social work, law, and other disciplines discovered how to educate more close to 50,000 graduates (de Urrutia Barroso & Muñoz Gutiérrez, 2005). For the most part, social work education in Cuba has comprised “rapid training” in community-based practice in the two-year training programs at the special schools for young social work students. Over time, social policy makers decided that social work needed to become multisectoral; that is, social workers were expected to coordinate their practice more closely with community members and leaders, with family doctors, healthcare centers, municipal and regional authorities, and professionals from different ministries to support the work of the popular councils or regional decision making bodies. This allowed social workers to interact more effectively with local and regional decision-makers and community members. Increased contact with popular councils and municipal bodies enabled them to better comprehend the service needs of individuals, groups, and families and serve as channels of communication between the community and external state structures.
Assessment of the Emergente Program
The government has not published an evaluation of the emergente program. Published references to the program tend to be descriptive and impressionistic (Donates, 2011; de Urrutia Barroso & Muñoz Gutiérrez, 2005; de Urrutia Barroso & Strug, in press). Program descriptions do not indicate how many emergentes continued to work as community-oriented social workers in their communities of origin over the years. Program descriptions do not evaluate the effectiveness of the work of the emergentes.
Some observers have been critical of the emergente program. One writer has reported that a significant number of graduates of the SSWs eventually left the profession, suggesting that a considerable amount of government money went into the education and the salary of social workers who did not stay in the field (Mesa-Lago, 2011). Others have criticized the government for using emergentes in unorthodox ways; for example, placing them at gas stations to monitor the sale of petroleum in an effort by the government to control the illegal sale of gas on the black market. Critics of the emergente program have also argued that it served a primarily ideological purpose. They suggest that it represented a public relations effort by the Cuban government to promote the image of the country as a viable socialist state, still able and willing to send “doctors of the soul” (as Fidel Castro called the emergentes) (Cameron, 2009) to the country’s poorest neighborhoods, despite the fragile state of the economy. It has also been suggested that the program served to prevent alienation and political disaffection from growing among unemployed, out-of-school youth by giving them the opportunity to study social work and to get good paying jobs after graduation (Donates, 2011).
This entry suggests that the emergente program was a significant achievement of the government despite criticism. It is undeniable that Cuba, a poor country with scarce resources, successfully trained tens of thousands of social workers in a comparatively short period of time and that these workers provided a wide range of support services to poor Cubans. It is true that the long-term effectiveness of the work of the emergentes has not been studied. However, it is widely acknowledged by most Cubans that emergentes worked closely with representatives of mass organizations and with local and regional officials from various government ministries to deliver needed services (de Urrutia Barroso & Strug, in press). Community members increasingly perceived emergentes as engaged community change agents (de Urrutia Barroso & Strug, in press). Also, the well-known Cuban social scientist Edmundo Morales pointed out that the emergente program functioned as an important, affirmative action program that provided many young people, including blacks and mestizos, the opportunity for education and for work at the community level (Morales, 2013).
The Impact of the 2008 Global Economic Crisis on Society and on Social Work
The global economic crisis of 2007–2008 occurred at a time when the Cuban economy was already experiencing a deceleration and an exhaustion of surpluses and reserves. The crisis reduced levels of external financing and foreign demand for exports (Mesa-Lago & Vidal-Alejandro, 2010). This further destabilized the economy. In 2008 Raúl Castro announced a series of major economic and social policy guidelines for reforming or “updating” the economy (Peters, 2012). The goal of these ongoing reforms is to make the economy more efficient and sustainable.
Reforms aim to reduce state payrolls and to stimulate the economically productive forces of society through various means. The government has begun to move more than a million workers from employment by the state to the private sector. In one important reform initiative, the state has granted licenses to almost 400,000 individuals allowing them to open small businesses to sell coffee, food, clothing and other items, usually from small stores connected with their homes or from street pushcarts. The government hopes this displacement of state workers to the private sector will reduce state expenditures and promote a more dynamic mixed economy. Cuba’s leaders emphasize that the promotion of private sector employment is not an abandonment of socialism, but represents an update (actualizacion) of socialism. This updating of the economy stems from the urgent need to strengthen the country’s chronically underproductive economy.
This updating of socialism has had an impact on social welfare policy and on social work. These economic reforms may weaken the welfare state (Farber, 2012) and may have a negative impact on vulnerable populations, like older persons who depend on the state for fixed pensions that are too small to live on (Ravsberg, 2013), for subsidized food rations, for health care, and for other social benefits (Farber, 2012). Economic reforms and a depleted Cuban economy have generated new social inequalities, have increased poverty, and threaten to produce conflicts and differentiation of interests. An anti-egalitarian trend has emerged that undercuts equity-based policies, which puts women, blacks, and mixed race people at a disadvantage. Raúl Castro noted that socialism means social justice and equality, but that equality is not egalitarianism (Weissert, 2008). He acknowledged that income equality may grow in the short run as a result of economic reform measures now underway. These reforms allow some individuals with the resources to start a business while those lacking the resources may not have the same opportunity.
The ongoing economic crisis has also challenged the country’s ability to maintain universal access to social services. The government proposes concentrating scarce state resources to provide services for those persons with the greatest needs. Cuba has stated that it can no longer provide a cradle-to-grave social policy, which has been in place from the beginning of the revolution, whereby all members of society receive social services on a gratuitous basis regardless of need. President Raúl Castro has called for the gradual elimination of what he has called “unjustified gratuities and excessive subsidies,” including the ration book that all Cubans have used since the time of the revolution to purchase basic food and other necessary household items at subsidized prices (Cameron, 2010). Government has cut back staples from the ration book and has closed many state-subsidized cafeterias for workers. It has also reduced the size of its budget for the health sector (Revista Bohemia, 2012).
The Reform Process and the Closure of the SSWs
Cuba’s social work program, in place since the 1990s, may not fit with the government’s present day need to reform an underproductive economy and to reformulate social policy, given limited economic resources. In September 2011, the government passed Decree Law 286, which called for the immediate closing of the SSWs in existence since 2000.
This government decree stated that the emergente program had been a success, implying that the almost 50,000 social workers trained at the SSWs were sufficient for the country’s needs. The decree also eliminated the special budget that the government had dedicated for operating the social work schools (Gaceta Oficial, 2011).
Decree Law 287 gave the MWSS responsibility for overseeing social work activities at the national, provincial, and local levels except for those activities carried out by social workers employed by the Ministries of Public Health and Education. The MWSS created a Department of Social Work within the MWSS to integrate social assistance, social work, and social prevention activities. The MWSS created education and training programs for its social work staff and it finances social work programs under its jurisdiction. The Minister of the MWSS reports on social work to the national Council of Ministers. The MWSS oversees the work of the emergentes who had been trained at the SSWs.
The economic reform process has prioritized funding to support education in the hard sciences and has reduced funding in the social sciences except for economics. This is a major reason why the University of Havana is now ending the social work concentration program in sociology (UP). The UP is no longer accepting new students. The last class of students in this concentration will graduate in 2014 according to its director (Rebeca Padrón Ramos, personal communication, January 22, 2013). The social work initiative created by the government in the aftermath of the Special Period appears to have fallen victim to the economic reform policies herein described.
It may be that the cash-strapped government can no longer afford to pay for the SSWs and for the social work concentration program. Cuba’s National Council of State (a high level state entity with legislative power) has already eliminated some government ministries and merged others to improve the operation of institutions as part of the reform process. The decision to incorporate social work into the MWSS may also reflect the increased need by this ministry to provide social assistance to individuals who have lost employment in the state sector or who are in the process of being transitioned from the state to the private sector as a result of the economic reform process. No official statistics exist on the number of workers who have already lost their jobs as a result of the government’s plan to move a million state workers to the private sector.
One wonders if social work will become less academic and community-oriented and become more bureaucratic and individualistic in orientation now that the emergente program has been incorporated into the MWSS and now that the University of Havana is ending the social work concentration program. Will social work become more “assistentialist?” Assistentialist is a term used to refer to the tradition of social work practice as it existed in Cuba up until the late 1980s and in other Latin countries. In this kind of practice, social worker intervention is limited to assisting the individual rather than serving as an agent of community transformation, helping community members to work together to meet community needs (de Urrutia & Strug, in press).
Relevance of the Cuban Social Work Model to Social Work in the United States and Elsewhere
The community-oriented social work program that evolved in Cuba at the end of the Special Period reflected the country’s socialist ideology and value system. Therefore, Cuba’s social work model as it existed through 2011 may have limited applicability to the United States and to other capitalist countries. The more individually-oriented social work approach of these countries may reflect the ideology and value system associated with a capitalist economic system.
Social workers in the United States and other countries can nevertheless benefit from learning about how social work developed in Cuba, even though it may not serve as a role model. The U.S. social work community has become increasingly interested in global social work education and practice models (Gatenio Gabel & Healy, 2013). The Council on Global Learning, Research and Practice, of the Council on Social Work Education sponsored a delegation of social work professors and administrators to Cuba in 2011 to learn about social work on the Island and to explore the possibility of collaboration between the U.S. and the Cuban social work communities. This is indicative of the U.S. academic social work community’s interest in global social work practice and theory. The members of the June 2011 delegation that visited Cuba returned with a positive impression of what they learned about the community-oriented nature of Cuban social work and several delegation members have since invited social work professors from the University of Havana to visit their universities in the United States (Council on Social Work Education, 2012). Also, The National Association of Social Workers sent two groups of social work practitioners to the Island in 2011 (Herman, Zlotnik, & Collins, 2011).
Cuban social work from 2000 to 2011 demonstrated a number of characteristics that may interest those concerned with developing global social work models. For example, the social work profession in other countries may be interested in learning how Cuba, a poor country of only about 11 million people, trained and deployed tens of thousands of social workers for practice in their community of origin to work with targeted vulnerable populations. They may want to learn about the multisectoral and community-oriented approach Cuban social workers used to coordinate practice with community members and leaders, grassroots organizations, and regional and municipal authorities.
Social work educators developing community curricula in the United States and elsewhere might wish to examine how their Cuban counterparts have incorporated community-oriented methods and practice skills into their social work curricula. They could learn how Cuban social workers have worked with community leaders and regional and municipal authorities to promote community development. Finally, the innovative core curricula that characterized the social work educational program in Cuba integrated social work practice skills with political sociology and political economy. It represents a strong model for social work training in other developing countries to address social problems related to national economic difficulties.
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