The concept of moral economy can be applied to all types of economies as they all involve conceptions of the ‘common good’ that determine who gets what, why and how, and who is responsible for this distribution, eg state or private actors. In this paper, we use the concept of moral economy to demonstrate how particular morals and logics shape public health governance in Cuba, comparing these with market liberal contexts. The paper draws from ethnographic and interview data from Cuba to evaluate the benefits and drawbacks of Cuban agri-food governance, against the backdrop of market liberal approaches. While Cuban interviewees justified their activities in terms of Cuba’s moral economy of collective need, there were also instances when the socialist moral economy conflicted with individual needs and aspirations. We conclude that, despite its faults, Cuba’s holistic approach to food and agriculture illustrates how ecological approaches to public health might work in practice.