ABSTRACT
This conclusion presents some closing thoughts on the key concepts discussed in the preceding chapters of this book. The book contends that state decisions that are the product of a general democratic will face fewer competing forces and would therefore have a greater likelihood of sustainability and permanence, than coerced decisions. It argues that the resilience of the public system decreases where central authorities retain non-negotiable control over resources and decision-making power. The book discusses that political priorities have already shifted to some degree with increasing focus on Cuba's health image as a means for earning symbolic and economic capital from abroad. It examines the extent of negotiation with social groups in the process of arriving at national public health decisions. The book argues that "shadow" activity in the health system, while it serves to temporarily overcome unresolved problems in the formal system, ultimately perpetuates those problems and erodes the legitimacy of formal arrangements.
