Bienvenidos a Cuba! !

Introduction
In 2013, it was estimated that there were more than 2 million Hispanic people of Cuban origin
residing in the United Statesthats twice as many as the population in the 1980s,1 and the
numbers continue to grow. In the Hispanic community, the health concerns are much the
same as the United States population at large; heart disease and cancer are the leading
causes of death.2 Both disease conditions can be largely influenced by diet and lifestyle,
however, access to healthcare resources is limited in this population. According to the CDC,
only 22.7% of Hispanic Americans are insured.2 So when a registered dietitian encounters a
person of Cuban origin, cultural sensitivity will play a large role in how well the patient
perceives the education provided.
Health Beliefs and Practices
Cuban-Americans, along with the majority of Hispanic Americans, do not typically associate
dietary patterns and health risks. Therefore, patients from this population may require more
motivation to learn and implement healthy dietary changes than other populations. Their
cultural beliefs also heavily influence the way they view health and illness.2
For instance, Cuban-Americans may believe that a disease state results from a humoral
imbalance; that is, an imbalance between a person and the environment. These conditions
fall into different categories, such as hot and wet or cold and dry. In order to treat them,
patients may enlist foods or spices that present the opposite quality of the illnesse.g., hot
foods for cold conditions.2 Keep in mind that Cuban-Americans and the Hispanic community at
large rely on a combination of both their own traditional medicine and Western medicine when
it comes to healthcare, so practitioners will be more successful if they allow for both in an
intervention.
Traditional Meal Patterns
Historically, Cuban dietary preferences have been interwoven with the political
climate. Food and energy resources declined worldwide in 1989, which led to a
Cubans reportedly decreasing their caloric intake from approximately 2900 calories
in 1988 to roughly 1860 calories in 1993.3 Though slight economic recovery has
occurred, Cubans are still faced with a high availability of convenience foods (fast
food), but unpredictable availability of fruits and vegetables.3 Healthy foods also tend
to cost more. Therefore, preferred foods include red meat, ham, bread, and soft
drinks.4 !
Although staples in a more traditional Cuban diet include a balance of foods such as
rice, beans, chicken, pork, bananas, and yuca, recently, more refined sugar appears
in the diet. This is largely due to a preference for sugar-sweetened beverages,
perhaps as a result of the higher availability of fast foods.5 Contemporary Cuban
culinary patterns include many fried foods, animal protein (red meat over white),
excess dairy consumption, and high sodium intake.5 According to self-reports,
Cubans spend the most on animal products and the least on vegetables. Thus, only
17% of Cubans consume the recommended servings of vegetables per day.5
!

Traditional Meals
In Cuba, the ham and cheese sandwich reigns supreme.5 According to the 2nd
National Survey on Risk Factors and Chronic Diseases (2001), 90% of Cubans
would eat ham once a day, and the Cubano sandwich tops the favorite foods list.
5 Traditional Cuban dishes, such as fricase de pollo (chicken stew), pernil asado
con mojo (marinated pork shoulder), and Elena Ruz (white bread sandwich with
turkey, jam, cream cheese), are heavy in animal protein and refined
carbohydrates.6!
Barriers to Good Nutrition
Staple diet and food preferences:!
Traditional Cuban foods are high in animal protein, fat, and refined
carbohydrates.4 These foods are a cultural norm, making it difficult to
switch to a healthier diet.!
Lack of nutrition knowledge and education: !
Perception of nutrition-related health risk is low.3!
According to a survey conducted by the Nutrition and Food Hygiene
Institute 90% of the population would eat fried foods at every meal if
available.3!
Limited access to nutritious foods: !
25% of Cubans live in rural areas.3!
The Cuban government controls food security.3!
Nutritious foods are supplied through a subsidized rationing system, which
only provides minimum amounts of healthy food options.3!
Limited agricultural practices:!
Cubas main agricultural products are sugar-cane, tobacco, citrus, rice,
potatoes, beans, and livestock.2!
Actions needed include aggressive training, seed certification, and better
distribution/accessibility for healthier and more diverse agricultural
products.3!

Communication Guidelines
Before a dietitian interacts with a Cuban patient, she must first assess the degree
to which the patient understands English. The patient may be scared in the
hospital and state that he doesnt understand the dietitian. To make the patient and
family members more comfortable, healthcare providers should offer an
interpreter.!
The patriarchal structure of Cuban society means dietitians may have to direct
their questions and education to the elder men in the family. Generally, the men
are the first to hear important information, and then they pass it down to the women
and children. As a sign of respect for a patients culture, dietitans should note how
how his or her family is structured and honor that structure.3!
Many Cubans and Cuban-Americans have a lower education level.3 As with every
patient, dietitians need to figure out the best way to present information to them
based on their level of knowledge. !
Hispanic cultures often use the television and radio as their main source of media.
This is important to remember if a dietitian is attempting to reach large amounts of
people.3 !
Nutrition Counseling Considerations
When counseling, its important that dietitians keep in mind a few key
communication guidelines. Before counseling, they should identify if the patient
was born in the U.S. or Cuba. This shows respect for the patient and will help
healthcare providers to identify a better way of communicating and addressing
his needs. It will also build rapport and strengthen communication.!
For many Cubans, coping with a disease is more difficult than even confronting
death.3 Therefore, a stronger emphasis should be placed on preventing a
disease through nutrition than preventing death. Many Cubans rely on
traditional healing systems due to their culture and the high cost of modern
medicine.3 Dietitians should emphasize nutrition as a cost-effective preventative
medicine. Additionally, Cubans are very group-oriented and look to each other
for information.3 Therefore, group education may be beneficial for spreading
information to a larger amount of the Cuban or Cuban-American population. !

References !
!
1.

Lpez G. Hispanics of Cuban Origin in the United States, 2013. Pew Research Center's Hispanic Trends Project. http://
www.pewhispanic.org/2015/09/15/hispanics-of-cuban-origin-in-the-united-states-2013/. Published 2015. Accessed
November 1, 2016.!

2.

Building Our Understanding: Culture Insights Communicating with Hispanic/Latinos. CDC's Healthy Communities Program.:
1-17. http://www.cdc.gov/nccdphp/dch/programs/healthycommunitiesprogram/tools/pdf/hispanic_latinos_insight.pdf.!

3.

Pena MSB, Patel D, Leyva DR, Khan BV, Sperling L. Lifestyle Risk Factors and Cardiovascular Disease in Cubans and
Cuban Americans. Cardiology Research and Practice. 2012;470705(10):6 pages. !

4.

Gorry C. Cubans Team Up for Better Nutrition. MEDICC Review. 2009;11:20-22. http://www.medicc.org/mediccreview/
articles/mr_117.pdf!

5.

Porrata, C. Cubans Deadly Diet: A Wakeup Call. MEDICC Review. 2008;10(2):52. !

6.

9 Dishes to Make You Fall for Cuban Cuisine. Saveur Website. http://www.saveur.com/article/-/Cuban-Recipes. Accessed
November 1, 2016. !

7.

Nutrition Country Profiles. Agriculture and Consumer Protection Department Website. http://www.fao.org/ag/agn/nutrition/
cub_en.stm. Accessed November 1, 2016. !

Photos

1. Havana, Cuba. Available at: https://stock.adobe.com/stock-photo/havana-cuba/83606761. Accessed October 31, 2016.!

2. Cuban Flag Waving in Blue Sky. Available at: https://stock.adobe.com/stock-photo/cuban-flag-waving-in-blue-sky/76257497.
Accessed October 31, 2016.!
3. Ham and Cheese Toasted Panini Sandwich. Available at: https://stock.adobe.com/stock-photo/ham-and-cheese-toastedpanini-sandwich/106153751. Accessed October 31, 2016. !
4. Cuban Cuisine, Ropa Vieja. Available at: https://stock.adobe.com/stock-photo/cuban-cuisine-ropa-vieja/106116189. Accessed
October 31, 2016.!
5. Cuban Cuisine, Arroz Con Frijoles Negros. Available at: https://stock.adobe.com/stock-photo/cuban-cuisine-arroz-con-frijolesnegros/81503855. Accessed November 16, 2016. !