Emiliano Valle began his doctoral studies in the Department of History at the University of Iowa in the fall of 2021. There was nothing unusual about his matriculation, but he took a different trajectory to get there.
Valle had come to Iowa from Harvard Medical School. Like most other MD-PhD students, he had completed the first half of his medical studies before embarking on his doctoral work. Unlike most MD-PhDs, Valle was pursuing a degree in history, and at a different institution. Valle says that he was drawn to the University of Iowa’s PhD program in history by the opportunity to study under Associate Professor Mariola Espinosa, whose research focuses on the history of medicine and public health in the Caribbean and Latin America.
“Professor Espinosa wrote a book regarding U.S. intervention in Cuba at the turn of the 20th century,” says Valle. “The book was not only a history of Cuba, but a history of medicine and public health relating to U.S. imperialism. That was what I was interested in exploring in my own research.”
Valle, who is entering the third year of his PhD this fall, is in the process of refining a dissertation project that examines how Cuba, a low-income island nation, was able to mitigate the effects of the United States’ unilateral trade embargo to build a strong healthcare system. Valle’s experiences and proposed work have earned him a Lulu Merle Johnson Fellowship from the Graduate College, and a highly-selective predoctoral Ford Foundation Fellowship.
Valle inspired by Partners In Health
Valle says that his unusual academic path was inspired by the work of Partners In Health (PIH), an international nonprofit public health organization that believes high quality health care is a universal human right. After graduating from Harvard University, Valle worked with PIH in Lima, Peru, while on a Harvard fellowship. As a research analyst and project assistant, he supported efforts to better understand tuberculosis (TB) detection in children and barriers and facilitators relating to HIV medication adherence in adolescents.
“PIH has a history of uncovering the socioeconomic elements of disease and then taking steps to address them, both in its work with patients and in the international health arena,” Valle says. “For example, when international ‘health experts’ claimed that multi-drug resistant TB could not be treated in low-income settings, because cultural factors would lead to low treatment adherence rates. PIH proved them wrong.”
Valle continues, stating that “PIH disproved this ‘immodest claim of causality’ (to use a term coined by the late co-founder of PIH, Paul Farmer) by showing in its own studies that not only was MDR treatable in low-income settings, adherence rates could be on-par or better than high income settings when patients’ basic nutrition needs were met.”
Working with PIH and living in Lima caused Valle to wonder if becoming a physician would be fully satisfying given his interests.
In Peru, as he traveled through socioeconomic and geographic divides daily when going to work, he became more and more interested in how public policy at the local, national, and international levels shapes health.
“Going from one of the wealthier areas of Lima to one of the poorest, you’d see the difference in construction and the difference in services available to the populations,” Valle says. “You would have to reckon with the incredible poverty and deprivation that was present. There would be areas without running water and people without the identity cards necessary to access social services.”
Cuba’s health care under the U.S. embargo
After starting medical school, Valle’s interest in the intersection of policy and health led him to start a Students for a National Health Program chapter at HMS. Learning about various health systems and advocating for a fairer one domestically was exciting, but Valle felt that something was missing.
Then, when a medical school classmate argued that economic sanctions were a good thing, he became interested in their history. This led him to study the Cuban embargo, and he realized that its history aligned with his interests in medicine, public health, and politics.
“His research seeks to learn about the effects of international sanctions on healthcare in Latin America by focusing on the case of Cuba. His work promises to shed light on global health inequalities, Cuba-U.S. history, and the history of medicine.” -- Mariola Espinosa, Valle's mentor
The United States did not initially put economic sanctions on Cuba after the country’s revolutionary forces, led by Fidel Castro, overthrew Fulgencio Batista as Cuba’s head of state in 1959. But after the Cuban government expropriated U.S. land and industry, President Dwight Eisenhower began to implement a plan of regime change for the country. One element of this plan consisted of economic sanctions. President John Kennedy increased this economic pressure in 1962, formally establishing a full embargo, except for food and medicine. President Johnson then eliminated these exceptions in 1964.
Since then, the United States has modified portions of the sanctions (e.g. regarding travel), but the embargo has remained in place. Despite these trade restrictions harming the health sector and economy in general, the Cuban government prioritized investments in education and health.
“This meant establishing schooling and medical care that was free for the population and building the infrastructure necessary for these sectors throughout the country, not just in the urban centers,” Valle says.
Valle says there are lessons to be learned from the embargo going forward, for both the countries that use economic warfare as a policy tool, and the countries that experience it.
“Often there is this idea that selective sanctioning will be effective at discouraging a policy move that the U.S. deems unfavorable to its interests. The sanctions would be isolated to a particular group or sector of the economy, without bleeding into other areas,” Valle says. “However, there’s been ample evidence to suggest that this is not the case. Sanctions have repercussions throughout the economy and on people’s health. And, in the case of Cuba, have lasted over 60 years without producing their intended goal: a change of government.”
Valle continues, “for recipient nations of economic sanctions, understanding Cuba is hugely important. Learning how Cuba has been able to weather economic stress and withstand medical shortages would provide a template for those who endeavor to build and maintain high quality, equitable health systems in the face of economic aggression.”