PIP: The dynamics of health care in Cuba during a period of severe crisis was explored within an economic, social, and political context. Cuban achievements in health care since 1959 were a consequence of the full commitment to health care by the state, the planned economy, and mass participation. In 1959 the infant mortality rate was 60/1000 live births and life expectancy was 65.1 years. By the period of 1983-88 Cuba had attained an infant mortality rate of 15/1000 and female life expectancy of 76 years compared to the figures of 27/1000 and 73 years, respectively, in South Korea. In response to problems that arose in the 1960s an improved health care model stressing the involvement of health care workers in the community was proposed in 1974. In the early 1980s 20,000 family physicians were trained to provide primary care services in the communities. Two external factors, the US economic embargo and the Council of Mutual Economic Cooperation (CMEA), shaped the Cuban society and economy, including its health care system. The U.S. embargo forced Cuba to pay higher transportation costs to import medical supplies from Soviet-bloc countries. Once the Soviet bloc collapsed, Washington further tightened the embargo through the Torricelli Bill of 1992, which bars U.S. subsidiaries in other countries from trading with Cuba and forbids US portage for 6 months to any ship that has docked in Cuba. As a result, in 1993 Cuba's imports for public health cost an extra $45 million. The CMEA was an important source for economic growth; however, the adoption of the Soviet model of economic development contributed to two internal factors that have undermined health care: low productivity of labor and the growth of bureaucracy. Social expenditures declined from 70% of the GNP in 1970 to 36% in 1995. Meanwhile, administrative personnel grew from 90,000 persons in 1973 to 240,000 persons in 1984. In 1995 some 50,000 physicians were serving a population of 11 million. Since 1986 a total of 1042 individuals have been found to be HIV positive. The policy of forced isolation of HIV-positive persons and AIDS patients was relaxed recently. While the health care system and its structure is sound, the economic crisis undermines its material and moral foundations and threatens its achievements.