Editor—In 1992 we participated in a study tour of Cuba’s health system. We witnessed a service that was the pride of the developing world and that, in the way it was organised, offered many examples for our own service. During our stay the then American president, George Bush, signed the Cuban Democracy Act. At a stroke Cuba was denied access to foodstuffs and medicines produced by any subsidiary of any American multinational company anywhere in the world (direct sales of anything from the United States to Cuba having been barred since 1961).

The impact on the health and nutrition of the Cuban people has now been well documented.^1–3 The report of the American Association for World Health states: “A humanitarian catastrophe has been averted only because the Cuban government has maintained a high level of budgetary support for a health care system designed to deliver primary and preventative health care to all its citizens.”³

We welcome the fact that a BMJ editorial⁴ has joined the Lancet,⁵ the Pope, and 143 countries in the United Nations General Assembly in criticising or condemning what has become the most severe and sustained economic blockade ever imposed on a country in peacetime. One of us belongs to the union UNISON, which has a record of voicing its opposition to that blockade in both national and international forums. The other, as a BMA member, looks forward to the day when the BMA is prepared to do the same.