The effect of International Monetary Fund programmes on population health

Background As one of the world’s most powerful international financial organisations, the International Monetary Fund (IMF) is uniquely positioned to shape global developmental trajectories by influencing domestic policy arrangements. However, its role in shaping population health is understudied. Methods We use previously unavailable cross-national time-series data and an instrumental-variables method to examine the causal impact of the IMF’s structural adjustment programmes on age-standardised all-cause mortality rates and disability-adjusted life years (DALYs) in 187 countries between 1990 and 2017. For this purpose, we specify two-way fixed-effects regression models. Findings According to our baseline models, IMF programmes cause 392 excess all-cause deaths (95% CI: 176–608; p = 0.0004) and 4,205 excess DALYs (95% CI: 2,429–5,981; p = 0.000004) per 100,000 population. This aggregate effect appears to be driven by IMF-mandated privatisation reforms, which lead to 562 excess all-cause deaths (95% CI: 267–857; p = 0.0002) and 5,285 excess DALYs (95% CI: 2,749–7,822; p = 0.00004) per 100,000 population. Interpretation Structural adjustment programmes play a significant role in perpetuating preventable disability and death in developing contexts. The IMF’s policy reforms, especially those pertaining to the privatisation of state-owned enterprises, increase excess mortality rates and disease burdens in the world’s most vulnerable regions. Funding None.