IDEAS home Printed from https://ideas.repec.org/p/arx/papers/2605.29785.html

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

Author

Listed:
  • Giovanni Mellace
  • Rok Spruk

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.

Suggested Citation

  • Giovanni Mellace & Rok Spruk, 2026. "Long-Term Health and Human Capital Effects of Universal Health Care and Mass Literacy: Evidence from Cuba," Papers 2605.29785, arXiv.org.
    • Handle: RePEc:arx:papers:2605.29785
    as

    Download full text from publisher

    File URL: https://arxiv.org/pdf/2605.29785
    File Function: Latest version
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. Victor Chernozhukov & Kaspar Wüthrich & Yinchu Zhu, 2021. "An Exact and Robust Conformal Inference Method for Counterfactual and Synthetic Controls," Journal of the American Statistical Association, Taylor & Francis Journals, vol. 116(536), pages 1849-1864, October.
    2. Grossman, Michael, 1972. "On the Concept of Health Capital and the Demand for Health," Journal of Political Economy, University of Chicago Press, vol. 80(2), pages 223-255, March-Apr.
    3. Mark Dincecco & Mauricio Prado, 2012. "Warfare, fiscal capacity, and performance," Journal of Economic Growth, Springer, vol. 17(3), pages 171-203, September.
    4. Timothy Besley & Torsten Persson, 2009. "The Origins of State Capacity: Property Rights, Taxation, and Politics," American Economic Review, American Economic Association, vol. 99(4), pages 1218-1244, September.
    5. Hoyt Bleakley, 2010. "Health, Human Capital, and Development," Annual Review of Economics, Annual Reviews, vol. 2(1), pages 283-310, September.
    6. Lee, Jong-Wha & Lee, Hanol, 2016. "Human capital in the long run," Journal of Development Economics, Elsevier, vol. 122(C), pages 147-169.
    7. Xu, Yiqing, 2017. "Generalized Synthetic Control Method: Causal Inference with Interactive Fixed Effects Models," Political Analysis, Cambridge University Press, vol. 25(1), pages 57-76, January.
    8. Dmitry Arkhangelsky & Susan Athey & David A. Hirshberg & Guido W. Imbens & Stefan Wager, 2021. "Synthetic Difference-in-Differences," American Economic Review, American Economic Association, vol. 111(12), pages 4088-4118, December.
    9. Barro, Robert J & Becker, Gary S, 1989. "Fertility Choice in a Model of Economic Growth," Econometrica, Econometric Society, vol. 57(2), pages 481-501, March.
    10. Mark Dincecco & Gabriel Katz, 2016. "State Capacity and Long‐run Economic Performance," Economic Journal, Royal Economic Society, vol. 126(590), pages 189-218, February.
    11. Abadie, Alberto & Diamond, Alexis & Hainmueller, Jens, 2010. "Synthetic Control Methods for Comparative Case Studies: Estimating the Effect of California’s Tobacco Control Program," Journal of the American Statistical Association, American Statistical Association, vol. 105(490), pages 493-505.
    12. Susan Athey & Mohsen Bayati & Nikolay Doudchenko & Guido Imbens & Khashayar Khosravi, 2021. "Matrix Completion Methods for Causal Panel Data Models," Journal of the American Statistical Association, Taylor & Francis Journals, vol. 116(536), pages 1716-1730, October.
    13. Sonia Bhalotra & Martin Karlsson & Therese Nilsson & Nina Schwarz, 2022. "Infant Health, Cognitive Performance, and Earnings: Evidence from Inception of the Welfare State in Sweden," The Review of Economics and Statistics, MIT Press, vol. 104(6), pages 1138-1156, November.
    14. Pablo Astorga & Ame R. Berges & Valpy Fitzgerald, 2005. "The standard of living in Latin America during the twentieth century," Economic History Review, Economic History Society, vol. 58(4), pages 765-796, November.
    15. Barro, Robert J. & Lee, Jong-Wha, 2015. "Education Matters: Global Schooling Gains from the 19th to the 21st Century," OUP Catalogue, Oxford University Press, number 9780199379231.
    16. Edward Miguel & Michael Kremer, 2004. "Worms: Identifying Impacts on Education and Health in the Presence of Treatment Externalities," Econometrica, Econometric Society, vol. 72(1), pages 159-217, January.
    17. Alberto Abadie & Alexis Diamond & Jens Hainmueller, 2015. "Comparative Politics and the Synthetic Control Method," American Journal of Political Science, John Wiley & Sons, vol. 59(2), pages 495-510, February.
    18. Alberto Abadie & Javier Gardeazabal, 2003. "The Economic Costs of Conflict: A Case Study of the Basque Country," American Economic Review, American Economic Association, vol. 93(1), pages 113-132, March.
    19. David Cutler & Grant Miller, 2005. "The role of public health improvements in health advances: The twentieth-century United States," Demography, Springer;Population Association of America (PAA), vol. 42(1), pages 1-22, February.
    20. Becker, Gary S & Tomes, Nigel, 1979. "An Equilibrium Theory of the Distribution of Income and Intergenerational Mobility," Journal of Political Economy, University of Chicago Press, vol. 87(6), pages 1153-1189, December.
    21. Garfield, R. & Santana, S., 1997. "The impact of the economic crisis and the US embargo on health in Cuba," American Journal of Public Health, American Public Health Association, vol. 87(1), pages 15-20.
    22. Daron Acemoglu & James A. Robinson & Rafael J. Santos, 2013. "The Monopoly Of Violence: Evidence From Colombia," Journal of the European Economic Association, European Economic Association, vol. 11, pages 5-44, January.
    23. Jutta Bolt & Jan Luiten Zanden, 2014. "The Maddison Project: collaborative research on historical national accounts," Economic History Review, Economic History Society, vol. 67(3), pages 627-651, August.
    24. Keck, C.W. & Reed, G.A., 2012. "The curious case of Cuba," American Journal of Public Health, American Public Health Association, vol. 102(8), pages 13-22.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Dmitry Arkhangelsky & Guido Imbens, 2023. "Causal Models for Longitudinal and Panel Data: A Survey," Papers 2311.15458, arXiv.org, revised Jun 2024.
    2. Taehyeon Koo & Zijian Guo, 2025. "Distributionally Robust Synthetic Control: Ensuring Robustness Against Highly Correlated Controls and Weight Shifts," Papers 2511.02632, arXiv.org, revised Jan 2026.
    3. Garoupa, Nuno & Spruk, Rok, 2025. "Populist constitutional backsliding and judicial independence: Evidence from Türkiye," International Review of Law and Economics, Elsevier, vol. 84(C).
    4. Dennis Shen & Peng Ding & Jasjeet Sekhon & Bin Yu, 2022. "Same Root Different Leaves: Time Series and Cross-Sectional Methods in Panel Data," Papers 2207.14481, arXiv.org, revised Oct 2022.
    5. Sandro Heiniger, 2024. "Data-driven model selection within the matrix completion method for causal panel data models," Papers 2402.01069, arXiv.org.
    6. David Gilchrist & Thomas Emery & Nuno Garoupa & Rok Spruk, 2023. "Synthetic Control Method: A tool for comparative case studies in economic history," Journal of Economic Surveys, Wiley Blackwell, vol. 37(2), pages 409-445, April.
    7. Lea Bottmer & Guido Imbens & Jann Spiess & Merrill Warnick, 2021. "A Design-Based Perspective on Synthetic Control Methods," Papers 2101.09398, arXiv.org, revised Jul 2023.
    8. Arne Henningsen & Guy Low & David Wuepper & Tobias Dalhaus & Hugo Storm & Dagim Belay & Stefan Hirsch, 2026. "Estimating Causal Effects With Observational Data: Guidelines for Agricultural and Applied Economists," Journal of Agricultural Economics, Wiley Blackwell, vol. 77(2), pages 356-382, June.
    9. David Powell, 2026. "Imperfect Synthetic Controls," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 41(3), pages 253-264, April.
    10. Alexander Almeida & Susan Athey & Guido Imbens & Eva Lestant & Alexia Olaizola, 2025. "Estimating Variances for Causal Panel Data Estimators," Papers 2510.11841, arXiv.org, revised Nov 2025.
    11. Jason Poulos & Shuxi Zeng, 2021. "RNN‐based counterfactual prediction, with an application to homestead policy and public schooling," Journal of the Royal Statistical Society Series C, Royal Statistical Society, vol. 70(4), pages 1124-1139, August.
    12. Fry, Joseph, 2024. "A method of moments approach to asymptotically unbiased Synthetic Controls," Journal of Econometrics, Elsevier, vol. 244(1).
    13. Luis Costa & Vivek F. Farias & Patricio Foncea & Jingyuan (Donna) Gan & Ayush Garg & Ivo Rosa Montenegro & Kumarjit Pathak & Tianyi Peng & Dusan Popovic, 2023. "Generalized Synthetic Control for TestOps at ABI: Models, Algorithms, and Infrastructure," Interfaces, INFORMS, vol. 53(5), pages 336-349, September.
    14. Saeyoung Rho & Cyrus Illick & Samhitha Narasipura & Alberto Abadie & Daniel Hsu & Vishal Misra, 2026. "Time-Aware Synthetic Control," Papers 2601.03099, arXiv.org.
    15. Eli Ben‐Michael & Avi Feller & Jesse Rothstein, 2022. "Synthetic controls with staggered adoption," Journal of the Royal Statistical Society Series B, Royal Statistical Society, vol. 84(2), pages 351-381, April.
    16. Chen, Qian & Koch, Christoffer & Richardson, Gary & Sharma, Padma, 2025. "Suspensions of payments and their consequences," Journal of Financial Stability, Elsevier, vol. 78(C).
    17. Viviano, Davide & Bradic, Jelena, 2023. "Synthetic Learner: Model-free inference on treatments over time," Journal of Econometrics, Elsevier, vol. 234(2), pages 691-713.
    18. Li, Xingyu & Shen, Yan & Zhou, Qiankun, 2024. "Confidence intervals of treatment effects in panel data models with interactive fixed effects," Journal of Econometrics, Elsevier, vol. 240(1).
    19. Woo-Mora, L. Guillermo, 2025. "Populism’s original sin: Short-term populist penalties and uncertainty traps," European Economic Review, Elsevier, vol. 172(C).
    20. Chen, Qiang & Xiao, Zhijie & Yao, Qingsong, 2025. "Quantile control via random forest," Journal of Econometrics, Elsevier, vol. 249(PA).

    More about this item

    NEP fields

    This paper has been announced in the following NEP Reports:

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:arx:papers:2605.29785. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: arXiv administrators (email available below). General contact details of provider: https://arxiv.org/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.