David Stuckler and Lawrence P. King of the University of Cambridge and Sanjay Basu of Yale find that 3 post-communist countries which participated in International Monetary Fund programs had higher rates of tuberculosis and mortality. The IMF seems like the causative agent of this outcome according to their analysis.
We performed multivariate regression of two decades of tuberculosis incidence, prevalence, and mortality data against variables potentially influencing tuberculosis program outcomes in 21 post-communist countries for which comparative data are available. After correcting for confounding variables, as well as potential detection, selection, and ecological biases, we observed that participating in an IMF program was associated with increased tuberculosis incidence, prevalence, and mortality rates by 13.9%, 13.2%, and 16.6%, respectively. Each additional year of participation in an IMF program was associated with increased tuberculosis mortality rates by 4.1%, and each 1% increase in IMF lending was associated with increased tuberculosis mortality rates by 0.9%. On the other hand, we estimated a decrease in tuberculosis mortality rates of 30.7% (95% confidence interval, 18.3% to 49.5%) associated with exiting the IMF programs. IMF lending did not appear to be a response to worsened health outcomes; rather, it appeared to be a precipitant of such outcomes (Granger- and Sims-causality tests), even after controlling for potential political, socioeconomic, demographic, and health-related confounders. In contrast, non-IMF lending programs were connected with decreased tuberculosis mortality rates (−7.6%, 95% confidence interval, −1.0% to −14.1%). The associations observed between tuberculosis mortality and IMF programs were similar to those observed when evaluating the impact of IMF programs on tuberculosis incidence and prevalence. While IMF programs were connected with large reductions in generalized government expenditures, tuberculosis program coverage, and the number of physicians per capita, non-IMF lending programs were not significantly associated with these variables.
Some conservatives might find this a reason to attack the IMF. But the correlation of IMF program participation and decreased government spending is inconvenient for this line of attack. My guess is that if these governments had selectively not cut back on public health spending while cutting back on other forms of spending then they could have prevented much of the increase in mortality and TB. But I'm speculating. Certainly, some public health spending delivers a net benefit in average health. But my problems with full socialized medicine include loss of freedom, waiting lists, and a big reduction in incentives for the development of new treatments. Pharma new drug development is overwhelmingly driven by profits in the US market.
|Share |||By Randall Parker at 2008 July 25 05:03 PM International Institutions|