Combining distributive ethics and causal Inference to make trade-offs between austerity and population health

The International Monetary Fund (IMF) provides financial assistance to its member-countries in economic turmoil, but requires at the same time that these countries reform their public policies. In several contexts, these reforms are at odds with population health. While researchers have empirically analyzed the consequences of these reforms on health, no analysis exist on identifying fair tradeoffs between consequences on population health and economic outcomes. Our article analyzes and identifies the principles governing these tradeoffs. First, this article reviews existing policy-evaluation studies, which show, on balance, that IMF policies frequently cause adverse effects on child health and material standards in the pursuit of macroeconmic improvement. Second, this article discusses four theories in distributive ethics (maximization, egalitarianianism, prioritarianiasm, and sufficientarianism) to identify which is the most compatible with the core mission of the IMF, that is, improved macroeconomics (Articles of Agreement) while at the same time balancing consequences on health. Using a distributive-ethics analyses of IMF polices, we argue that sufficientarianism is the most compatible theory. Third, this article offer a qualitative rearticulation of the Articles of Agreement, and formalize sufficientarian principles in the language of causal inference. We also offer a framework on how to empirically measure, from observational data, the extent that IMF policies trade off fairly between population health and economic outcomes. We conclude with policy recommendations and suggestions for future research.