Abstract
Among the many drivers of health inequities, this article focuses on important, yet insufficiently understood, international-level determinants: economic globalization and the organizations that spread market-oriented policies to the developing world. One such organization is the International Monetary Fund (IMF), which provides financial assistance to countries in economic trouble in exchange for policy reforms. Through its 'structural adjustment programs,' countries around the world have liberalized and deregulated their economies. We examine how policy reforms prescribed in structural adjustment programs explain variation in health equity between nations-approximated by health system access and neonatal mortality. Our empirical analysis uses an original dataset of IMF-mandated policy reforms for a panel of up to 137 developing countries between 1980 and 2014. We employ regression analysis to evaluate the relationship between these reforms and health equity, taking into account the non-random selection and design of IMF programs. We find that structural adjustment reforms lower health system access and increase neonatal mortality. Additional analyses show that labor market reforms drive these deleterious effects. Overall, our evidence suggests that structural adjustment programs endanger the attainment of Sustainable Development Goals in developing countries.
Highlights
The Sustainable Development Goals (SDGs) represent a policy agenda for enabling universal health coverage and improving population health
We focus on one controversial dimension of globalization: structural adjustment programs administered by the International Monetary Fund (IMF)
We examine two health equity measures that are available over time, enabling inferences based on cross-national panel data analysis: health system access, a key determinant of equitable health outcomes (Bishaia et al, 2003); and average neonatal mortality rates, as the neonatal period is highly responsive to interventions in health care access and quality (Nolte et al, 2000; UNICEF, 2014)
Summary
The Sustainable Development Goals (SDGs) represent a policy agenda for enabling universal health coverage and improving population health. Social Science & Medicine 267 (2020) 112496 international organizations, in explaining differences in health equity between countries (Beckfield and Krieger, 2009; Forster et al, 2018; Ruckert and Labonté, 2017; Schrecker and Bambra, 2015; Shandra et al, 2011) To examine these issues, we focus on one controversial dimension of globalization: structural adjustment programs administered by the International Monetary Fund (IMF). We examine two health equity measures that are available over time, enabling inferences based on cross-national panel data analysis: health system access, a key determinant of equitable health outcomes (Bishaia et al, 2003); and average neonatal mortality rates, as the neonatal period is highly responsive to interventions in health care access and quality (Nolte et al, 2000; UNICEF, 2014) Together, these indicators approximate health equity in the developing world, reflecting differential exposure and vulnerability to health risks (Diderichsen et al, 2001, p.14). These findings are a far cry from the purported commitment of the IMF—broadcast in high-level speeches and factsheets (IMF 2017)—to aiding developing countries’ progress towards achieving the SDGs
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