June 22, 2026
Presented June 22, 2026 by Miledys Guzman, MD – National Network on Cuba
Distinguished Chair, Members of the United Nations Special Committee on Decolonization, and honored delegates:
I appear before you today as a physician to address the public health consequences of Puerto Rico’s continued colonial status.
As a medical doctor, I have an ethical responsibility to identify the conditions that place populations at risk of disease, disability, and preventable death. In Puerto Rico, many of those conditions are rooted in a colonial relationship that denies Puerto Ricans full sovereignty over the policies that govern their healthcare system, economy, infrastructure, and future.
Puerto Rico’s history includes profound bioethical violations. Puerto Ricans were subjected to unethical medical experimentation, such as the work of Dr. Cornelius Rhoads, mass sterilization, and testing of supra-therapeutic contraceptives often without informed consent.
Today, the consequences of colonial governance continue to shape public health. The federally imposed Fiscal Oversight and Management Board has overseen austerity measures that have weakened essential public services. The deterioration of water infrastructure, the privatization of electrical services, and cuts to public education have worsening social determinants of health. Inadequate healthcare reimbursement and chronic underinvestment have driven thousands of healthcare professionals from the archipelago, limiting access to care.
Puerto Rico remains vulnerable to public health emergencies. The devastation of Hurricane Maria exposed the deadly consequences of weakened infrastructure and political powerlessness. The lack of reliable access to clean potable water continues to increase risks associated with dengue, chikungunya, and zika in a tropical environment already burdened by climate-related challenges, such as the impending Project Essencia.
The municipality of Vieques remains a stark example of environmental injustice. After decades of military bombing, residents continue to experience disproportionate rates of cancer and chronic disease while lacking adequate access to a hospital. The closure of hospitals, dialysis centers, and HIV clinics across Puerto Rico has further deepened health disparities.
As physicians, we are taught to address the root causes of disease rather than merely treat its symptoms. Puerto Rico’s public health crisis cannot be separated from its colonial condition. Healthcare access, environmental health, disaster preparedness, and economic stability are all influenced by the archipelago’s inability to exercise full self-determination.
For this reason, Puerto Rican independence is not solely a political aspiration. It is a public health imperative. The right to health is inseparable from the right to self-determination. A sovereign Puerto Rico would possess the authority to design healthcare, environmental, and economic policies responsive to the needs of its people rather than the priorities of external political institutions. Sovereign nations, such as Cuba, received recognition from the World Health Organization for maintaining the elimination of vertical transmission of HIV and syphilis despite an illegal blockade.
I respectfully urge this Committee to recognize that decolonization through sovereign independence is not only a matter of political rights but also a matter of public health, human dignity, and bioethical justice to secure the conditions necessary for health, survival, and a just future.
Thank you.