[OPE] IMF loans 'lead to TB deaths'

From: Gerald Levy (Gerald_A_Levy@msn.com)
Date: Thu Jul 24 2008 - 18:04:12 EDT

via Globolist.

2 articles, one from New Scientist, the other from the Financial 

IMF loans 'lead to TB deaths'

22 July 2008
NewScientist.com news service
Debora MacKenzie

The International Monetary Fund could be bad for your health. The 
organisation loans money to countries with financial problems, and in 
return requires governments to undertake "structural adjustment" 
policies aimed at improving their financial management.

These usually cut government spending to control inflation. Critics 
have long charged that this reduces spending on healthcare, so much 
so that some have called for the organisation to be renamed 
the "Infant Mortality Fund".

David Stuckler and colleagues at the University of Cambridge have now 
tested this by analyzing TB data in 21 countries in central and 
eastern Europe that were involved with the IMF for different amounts 
of time after 1989 and borrowed different amounts of money.

They found these were associated with 13% more TB cases, and 16% more 

The countries started with TB death rates averaging six per 100,000 
of the population. This rose to 12 per 100,000 by 2003 in countries 
with IMF loans, but sank in countries without them. In a detailed 
statistical analysis of the timing of the loans, the team found that 
this was not because countries with worsening TB simply attracted 
more IMF attention.
Care cuts

"We found TB rates were falling or steady before the IMF programmes 
began, and rose during the IMF programs," then fell again afterwards 
to almost the rate they had been before the IMF, says Stuckler.

The team also found that death rates rose almost 1% for each percent 
increase in the size of the loan, and by another 4% for each year of 
IMF involvement.

The effect was not associated with other lenders, such as the 
European Bank for Reconstruction and Development, which invests in 
Eastern Europe. Nor did it vary in step with other factors such as 
HIV, conflict, or the rate at which people were put in prison, where 
much TB transmission takes place the region.

The team found that IMF programmes were associated with less 
government spending, fewer doctors per person, and a cut of nearly 
half in the number of people with TB that received Directly Observed 
Therapy, or DOTS.

DOTS is the World Health Organisation's recommended method of 
managing TB, in which health personnel directly ensure that TB 
outpatients always take their medicine. The technique requires 
investment in public health staff.

'Aggressive policies'

"TB takes time [to cause death], so the increase in mortality rates 
must be linked to something that happened much earlier," objects IMF 
spokesman William Murray.

TB actually kills quickly when patients do not get drugs and medical 
supervision, says Stuckler, so death rates are likely an indicator of 
rapidly declining care, not of events years previously.

Murray also says that the increase in TB was related to the fall of 
the Soviet Union. But, if that was so, says Stuckler, the effect 
should have had similar timing and magnitude across the old Soviet 
block, instead of being linked closely to IMF involvement. In 
Slovenia, which got no IMF loan, he points out, TB didn't worsen at 

Murray says the IMF advises countries to spend on healthcare. "No-one 
wants to say that health spending is not a priority," says 
Stuckler, "but, in practice, the IMF's aggressive anti-inflation 
policies cut government spending."

Journal reference: PLoS Medicine (DOI: 10.1371/journal.pmed.0050143)


TB's rise blamed on austerity cuts
By Michael Kahn
Financial Times: July 23 2008

Austerity measures attached to International Monetary Fund loans may 
have contributed to a resurgence in tuberculosis in eastern Europe 
and the former Soviet Union, British researchers said yesterday.

Their study, published in the Public Library of science journal PLoS 
Medicine, said governments might be reducing funding for health 
services such as hospitals and clinics to meet strict IMF targets.

Countries participating in IMF programmes had seen tuberculosis death 
rates increase by at least 17 per cent between 1991 and 2000 - 
equivalent to more than 100,000 additional deaths.

Nations receiving money from institutions with less restrictive 
conditions had seen a near 8 per cent drop in death rates.


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