Structural adjustment and health: A conceptual framework and evidence on pathways

Area of Science:

• Public Health
• Health Economics
• International Development

Background:

• Structural adjustment programs (SAPs) by the International Monetary Fund (IMF) and World Bank have shaped global economic policy for decades.
• Countries often implement SAPs, involving reduced public spending and deregulation, to access financial support during economic crises.
• These reforms have significant, yet complex, implications for national health systems and population health outcomes.

Purpose of the Study:

• To identify the components of structural adjustment.
• To present a conceptual framework linking SAPs to health systems and outcomes.
• To analyze the health consequences of SAPs across different socioeconomic contexts.

Main Methods:

• Comprehensive review of the academic literature on structural adjustment and health.
• Development of a conceptual framework detailing pathways of impact.
• Case study analysis of Greece's recent experience with SAPs, using IMF reports and secondary literature.

Main Results:

• Identified three primary pathways through which SAPs affect health: direct health system policies, indirect health system impacts, and effects on social determinants of health.
• The proposed framework effectively links SAP components to health system performance and population health.
• The Greek case study illustrated the framework's applicability in analyzing real-world SAP implementation and health consequences.

Conclusions:

• Structural adjustment programs exert multifaceted influences on health systems and outcomes.
• The developed framework provides a valuable tool for understanding and assessing the health impacts of SAPs.
• The framework can be utilized for ex ante health impact assessments of future economic reform policies.