The 2008 United Nations human development index, which measures social welfare indicators such as infant mortality, ranks Cuba 51st, on par with Mexico and surpassing Brazil and Panama. The United States ranks 12th.
Government statistics show that life expectancy in Cuba is 77.7 years, the same as in the United States. Latin Americans in general live until they are about 70.
Many Cuba-watchers stress that despite Cuba's economic woes, it still fares much better than places such as the Dominican Republic.
''The human tragedy and that so many families were torn apart is very unfortunate,'' said Professor John Kirk, a Cuba expert at Dalhousie University in Halifax, Nova Scotia. ``But if you look at education and healthcare, Cuba has made significant advancements.''
People leave in droves for Miami, he said, because of the mythical image of ``roads paved in gold.''
Arturo López-Levy, a former political analyst at Cuba's Ministry of the Interior, agrees with Kirk's assessment that the overall balance is still positive -- if only Cuba would quit putting politics over economics.
''The economic policies of the last 40 years made it difficult to keep those achievements,'' said López-Levy, who broke with the government and is now a lecturer at the University of Denver. ``Overall, if you look at social indicators, I think things are better than they were in 1959.''
Advancements held strong until the Soviet Union's collapse in 1991, when Cuba suddenly lost billions of dollars in subsidies. Castro had poured so much foreign money into social services that he never established a sound economic policy of Cuba's own. The U.S. trade embargo further limited the country's cash flow. Money to pay for everything from school supplies to aspirins vanished.
''In the beginning, they tried to do things in grand scale,'' said Julio César Alfonso, who heads Solidarity Without Borders, a Miami organization of Cuban doctors who have defected. ``They graduated 3,000 doctors a year, creating so many doctors that it was excessive and unnecessary. But now they don't have ambulances in Cuba. If someone falls in the street, they flag the first car that goes by. And if the first thing to go by is a bicycle, then they flag down the bicycle.''
Alfonso, 40, who lives in West Miami-Dade County, said he was a devout believer in the revolution until he was jailed in the early 1990s and charged with ''enemy propaganda'' for suggesting improvements to the state healthcare system.
''In the last 20 years, things have deteriorated in all levels,'' said Katrin Hansing, visiting associate director of FIU's Cuban Research Institute, who lived on the island for a decade. ``Today, if you need a checkup with a specialist, you need to bribe somebody -- No. 1, because there are not enough doctors, and No. 2, because doctors need to make ends meet, too.
'People used to say, `At least we have this.' Now, they don't have this. So, it's ''para que?' '' For what?
THE NEW LEADER
Raúl Castro formally took over the presidency last February when his brother Fidel, now 82, retired because of a prolonged illness. The new leader has publicly acknowledged the need to reform the educational sector and bring qualified teachers back to the classroom.
He also has received visits from the presidents of Russia and China. Raúl Castro, 77, leads a nation with a significant foreign-policy presence -- a nation that has succeeded in thumbing its nose at Uncle Sam for five decades.
Together, the Castros have outlasted 10 U.S. presidents so far.