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

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  • Kentikelenis, Alexander E.

Abstract

Economic reform programs designed by the International Monetary Fund and the World Bank—so-called ‘structural adjustment programs’—have formed one of the most influential policy agendas of the past four decades. To gain access to financial support from these organizations, countries—often in economic crisis—have reduced public spending, limited the role of the state, and deregulated economic activity. This article identifies the multiple components of structural adjustment, and presents a conceptual framework linking them to health systems and outcomes. Based on a comprehensive review of the academic literature, the article identifies three main pathways through which structural adjustment affects health: policies directly targeting health systems; policies indirectly impacting health systems; and policies affecting the social determinants of health. The cogency of the framework is illustrated by revisiting Greece's recent experience with structural adjustment, drawing on original IMF reports and secondary literature. Overall, the framework offers a lens through which to analyze the health consequences of structural adjustment across time, space and levels of socioeconomic development, and can be utilized in ex ante health impact assessments of these policies.

Suggested Citation

  • Kentikelenis, Alexander E., 2017. "Structural adjustment and health: A conceptual framework and evidence on pathways," Social Science & Medicine, Elsevier, vol. 187(C), pages 296-305.
    • Handle: RePEc:eee:socmed:v:187:y:2017:i:c:p:296-305
    DOI: 10.1016/j.socscimed.2017.02.021
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    4. Baba Aye, 2020. "Health Workers on the Frontline Struggle for Health as a Social Common," Development, Palgrave Macmillan;Society for International Deveopment, vol. 63(2), pages 244-248, December.
    5. Scheiring, Gábor & Azarova, Aytalina & Irdam, Darja & Doniec, Katarzyna Julia & McKee, Martin & Stuckler, David & King, Lawrence, 2021. "Deindustrialization and the Postsocialist Mortality Crisis," SocArXiv jpbct, Center for Open Science.
    6. Bernhard Reinsberg & Alexander Kentikelenis & Thomas Stubbs & Lawrence King & Centre for Business Research, 2018. "The World System & the Hollowing-out of State Capacity: How Structural Adjustment Programs Impact Bureaucratic Quality in Developing Countries," Working Papers wp503, Centre for Business Research, University of Cambridge.
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    8. Barlow, Pepita, 2018. "Does trade liberalization reduce child mortality in low- and middle-income countries? A synthetic control analysis of 36 policy experiments, 1963-2005," LSE Research Online Documents on Economics 102664, London School of Economics and Political Science, LSE Library.
    9. Juan Antonio Córdoba-Doña & Antonio Escolar-Pujolar & Miguel San Sebastián & Per E Gustafsson, 2018. "Withstanding austerity: Equity in health services utilisation in the first stage of the economic recession in Southern Spain," PLOS ONE, Public Library of Science, vol. 13(3), pages 1-21, March.
    10. Nosrati, Elias, 2021. "International financial organisations and global child mortality rates," SocArXiv bu4hm, Center for Open Science.
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    13. Forster, Timon & Kentikelenis, Alexander E. & Stubbs, Thomas H. & King, Lawrence P., 2020. "Globalization and health equity: The impact of structural adjustment programs on developing countries," Social Science & Medicine, Elsevier, vol. 267(C).
    14. Antunes, Ana & Frasquilho, Diana & Zózimo, Joana R. & Silva, Manuela & Cardoso, Graça & Ferrão, João & Caldas-de-Almeida, José Miguel, 2019. "Solutions to tackle the mental health consequences of the economic recession: A qualitative study integrating primary health care users and professionals’ perspectives," Health Policy, Elsevier, vol. 123(12), pages 1267-1274.
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