Long-Term Health and Human Capital Effects of Universal Health Care and Mass Literacy: Evidence from Cuba

2026-05-28

AI Summary

This study evaluates the causal effects of Cuba’s simultaneous nationwide implementation of universal healthcare and a literacy campaign in 1961 on long-term health outcomes and human capital accumulation. Leveraging a novel dataset covering 21 former European colonies in the Americas from 1900 to 2022, the analysis is the first to jointly examine the synergistic impacts of integrated health and education policies. The authors employ a suite of robust econometric techniques—including synthetic control, augmented synthetic control, synthetic difference-in-differences, interactive fixed effects, and matrix completion—to validate their findings. Results indicate a sustained reduction in infant mortality by 15–29% and an increase in average years of schooling by 1.5–2 years. While gains in life expectancy attenuated after 1990, the evidence underscores the enduring influence of these policies on early-life survival and human capital formation.

Abstract

We estimate long-run effects of Cuba's 1961 National Health Service and contemporaneous National Literacy Campaign using synthetic-control methods on newly assembled series for 21 former European colonies in the Americas, 1900--2022. Relative to synthetic Cuba, infant mortality falls 15--29 percent and average years of schooling rise 1.5--2 years; both effects are large, persistent, and robust to augmented SCM, synthetic difference-in-differences, interactive fixed effects, and matrix completion. Life-expectancy gains attenuate after 1990, consistent with the post-Soviet Special Period, suggesting that bundled health and literacy reforms permanently raise early-life survival and human capital, with smaller and less robust effects on adult longevity.

Problem

• universal health care
• mass literacy
• long-term health effects
• human capital
• infant mortality

Innovation

• synthetic control
• causal inference
• long-term effects
• human capital
• universal health care