Health progress in the 1960s and 1970s placed Cuba at the vanguard of longevity in Latin America and the Caribbean. This success has often been attributed to equity of access to the health care system and its cost-effectiveness in the country. Cuba also has a small gender gap in life expectancy. In this study, we examined how this pattern is reflected in the gender differences in health among the population aged 60+ in Havana. We compared gender differences in health in samples drawn from Havana, Mexico City, and the US Hispanic population: three geographic settings with very different political, health care, and social systems. The data come from the Survey on Health, Well-Being, and Aging in Latin America and the Caribbean and the 2000 Health and Retirement Study. Age-adjusted prevalence and logistic regressions were estimated for poor self-rated health, limitations on activities of daily living, depression, and mobility limitations. While an absolute female disadvantage in health was apparent in all three populations, the relative gender differences were inconsistent across all four health domains. Gender differences were most pronounced in Havana, even after adjusting for age, socio-economic status, family characteristics, and smoking behaviour. Despite having higher overall life expectancy and more equitable and universal access to primary care and preventive medicine, women in Havana appear to have a larger burden of ill health than women in less equitable societies. The study provides indirect evidence that Cuba faces challenges in combating the health threats posed by chronic diseases and other diseases and conditions common among the population aged 60+.

1960 年代和 1970 年代的卫生进步使古巴成为拉丁美洲和加勒比地区长寿的先锋。这一成功通常归功于获得医疗保健系统的公平性及其在该国的成本效益。古巴在预期寿命方面的性别差距也很小。在这项研究中，我们研究了这种模式如何反映在哈瓦那 60 岁以上人口的健康性别差异中。我们比较了来自哈瓦那、墨西哥城和美国西班牙裔人口的样本在健康方面的性别差异：三个地理环境具有非常不同的政治、医疗保健和社会制度。数据来自拉丁美洲和加勒比地区的健康、福祉和老龄化调查以及 2000 年健康和退休研究。对自评健康状况不佳、日常生活活动受限、抑郁和行动不便的年龄调整患病率和逻辑回归进行了估计。虽然在所有三个人群中，女性在健康方面的绝对劣势都很明显，但所有四个健康领域的相对性别差异并不一致。即使在调整了年龄、社会经济地位、家庭特征和吸烟行为后，哈瓦那的性别差异也最为明显。尽管哈瓦那妇女的总体预期寿命更长，获得初级保健和预防医学的机会更加公平和普遍，但与不平等社会中的妇女相比，哈瓦那妇女的健康状况不佳的负担似乎更大。