Globalization and health equity: The impact of structural adjustment programs on developing countries
Globalization and health equity: The impact of structural adjustment programs on developing countries
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DOI：
10.1016/j.socscimed.2019.112496
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发表时间：
2020-12-01
影响因子：
5.4
通讯作者：
King, Lawrence P.
中科院分区：
文献类型：
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作者：
Forster, Timon;Kentikelenis, Alexander E.;King, Lawrence P.
在健康不平等的众多驱动因素中，本文重点关注重要但尚未充分理解的国际层面的决定因素：经济全球化以及向发展中国家传播市场导向政策的组织。国际货币基金组织（IMF）就是这样的组织之一，它向陷入经济困境的国家提供财政援助，以换取政策改革。世界各国通过“结构调整计划”实现了经济自由化和放松管制。我们研究了结构调整计划中规定的政策改革如何解释国家之间健康公平性的差异——通过卫生系统的可及性和新生儿死亡率来近似。我们的实证分析使用了 1980 年至 2014 年间 IMF 授权政策改革的原始数据集，涵盖了多达 137 个发展中国家。我们采用回归分析来评估这些改革与健康公平之间的关系，同时考虑到 IMF 计划的非随机选择和设计。我们发现结构调整改革降低了卫生系统的可及性并增加了新生儿死亡率。其他分析表明，劳动力市场改革导致了这些有害影响。总体而言，我们的证据表明，结构调整计划危及发展中国家可持续发展目标的实现。
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.