2008 July 25 Friday
International Monetary Fund Increases Mortality Rates?

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

Bob Badour said at July 26, 2008 9:41 AM:

The problem is the indiscriminate reduction in spending. Some forms of public spending are a public good.

Vaccination and hauling away garbage reduce my neighbours' likelihood to harm me just as hauling away the criminally inclined does.

Public spending to reduce the spread of an infectious agent is spending for the public good. If the IMF are too stupid to realize that, they have no business mucking about in anybody's finances.

Using the state's monopoly on violence to stop the spread of a deadly infection is a far cry from using the state's monopoly on violence to control who gets what access to medical treatment.

irish savant said at July 27, 2008 1:43 PM:

If you campare the performances of the US privatised health system and those of say France and the Scandinavian countries, the 'soclialised' systems were far more effective. At least until these countries were overrun by African and Arab immigrants. This lead to increased demand with no commensurate increase in funding, as most of these immigrants had large families and were heavily welfare-dependent. Compounding the problem, existing taxpayers, as happens everywhere, don't want to pick up the tab for immigrant welfare, hence the European health systems are now under chronic stress everywhere.

This shows that welfare and high immigration cannot coexist - not that for-profit health systems are superior.

Bob Badour said at July 27, 2008 7:03 PM:

irish savant,

Please define "effective". Are you saying these systems were more effective for advancing the state of the art of medicine? Were they at the forefront of heart transplants and limb re-attachments, for example?

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