International comparisons also support a critical role for primary care in population health. Costa Rica has a relatively good health profile compared to other countries and some evidence suggests that this country’s introduction of integrated primary care teams may be a key contributor to its positive health profile.162 Similarly, although Cuba is a poorly performing country in economic terms, it has health outcomes that are similar to those of the highest income countries in the world, and markedly better than those of countries with similar economic status. The delivery of primary care may well be the explanation of Cuba’s paradoxical status. Cuba has the highest physician-to-population ratio of any country in the world, and Cuba’s doctors address medical and non-medical determinants of health in their delivery of care to the entire population of specific, geographically defined areas.163
