Structural adjustment programmes and communicable disease burdens: causal evidence from 187 countries

Nosrati, E.; Dowd, J. B.; Marmot, M.; King, L. P.

International financial organisations like the International Monetary Fund (IMF) play a central role in shaping the developmental trajectories of low- and middle-income countries through their conditional lending schemes, known as "structural adjustment programmes". These programmes entail wide-ranging domestic policy reforms that influence local health and welfare systems. Using novel panel data from 187 countries and an instrumental variable technique, we find that IMF programmes cause over 400 excess deaths and over 4,100 excess disability-adjusted life years (DALYs) from communicable diseases per 100,000 population. IMF-mandated privatisation reforms cause over 570 excess deaths and over 6,700 excess DALYs per 100,000 population. Structural adjustment programmes, as currently designed and implemented, are harmful to population health and increase communicable disease burdens in developing contexts.