Leading a Delegation to Cuba

Press Coverage: Kansas City Call, Kansas City Globe and Missouri State Post, December 2000; Councilman Leads Delegation to Cuba; Nash Leads Mission to Cuba; Troy Nash Leads Group to Cuba; Cuba Healthcare and Education Systems Viewed as Success (2001)

In December 2000, I led a People to People International delegation of about 30 professionals from around the country to Cuba. At a time when few American politicians were willing to engage with the island nation, I organized a trip to study two things that Cuba does better than most countries on earth: healthcare delivery and public education.

This was not a diplomatic mission. It was a fact-finding trip. I wanted to see firsthand how a small island nation with limited resources had achieved healthcare outcomes and literacy rates that rivaled or exceeded the wealthiest nations in the world. And I wanted to understand whether any of those approaches could be applied to the underserved communities I represented back home.

What We Found

Cuba's healthcare system is built on a model of community-based primary care that puts a doctor in every neighborhood. Not a clinic miles away. A doctor on your block. Cuba reported an infant mortality rate that ranked among the lowest in the region, despite having a fraction of the resources.

Cuba's education system has achieved near-universal literacy through a commitment to public education that treats it as a national priority, not a budget line item. Every child goes to school. Every school is funded. The results are measurable and documented.

These outcomes are not about politics. They are about priorities. Cuba decided that healthcare and education were too important to leave to market forces. Whether you agree with their system of government or not, the outcomes in these two areas are difficult to argue with.

Why I Went

I went because the neighborhoods I represented in Kansas City had healthcare outcomes that resembled a developing nation, not a global superpower. High infant mortality. Low life expectancy. Limited access to primary care. These were not new problems. They were decades old, and the conventional American approach — building hospitals and hoping people could afford to use them — was not working.

Cuba offered a different model. A model that started with the community and built the healthcare system around it, rather than building a system and hoping the community could navigate to it. I wanted to see whether that model could inform how we delivered services in Kansas City's underserved neighborhoods.

The delegation included professionals from across the United States. We toured hospitals, clinics, schools, and community centers. We met with Cuban officials and professionals who explained their systems. And we returned to Kansas City with ideas that we incorporated into our work.

The Connection to Our Development Work

The Cuba trip reinforced a principle that has guided every Nash Group project since: you cannot solve community problems in isolation. Housing is connected to healthcare. Healthcare is connected to education. Education is connected to economic opportunity. Effective development addresses the whole ecosystem, not just one component.

The Ville Wellness Campus in St. Louis, which integrates 120 affordable housing units with a 45,000 square foot health center, is a direct descendant of the thinking that began on that trip to Cuba. The idea that you should co-locate healthcare with housing, that proximity to services matters as much as the services themselves, was reinforced by what I saw in Cuba's neighborhood-based healthcare model.

Leading a delegation to Cuba required courage. This was not a politically safe trip. Relations between the United States and Cuba were contentious. Some people questioned why a Kansas City council member was engaging with a country that many Americans viewed with suspicion.

I went anyway because the lessons were too important to leave on the table. Good ideas do not carry passports. They work or they do not, regardless of where they originated.

The press outlets that covered the trip documented it: "Councilman Leads Delegation to Cuba." "Nash Leads Mission to Cuba." "Troy Nash Leads Group to Cuba." "Cuba Healthcare and Education Systems Viewed as Success."