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Abstract

This study examines the impact of International Monetary Fund (IMF) Structural Adjustment Programs (SAPs) on health outcomes in a selection of Latin American countries between 1989 and 2014. The methodology for this study builds upon Stubbs et al.'s (2018) framework, employing maximum likelihood estimation over a system of three equations, and instrumenting and fitting independent variables, to evaluate the relationship between IMF participation and loan conditions and various health indicators. Results point to a multifaceted relationship between IMF intervention and health outcomes in the region. Most significantly, program participation is associated with a 6.31-year decrease in life expectancy, while each additional loan condition correlates with a 0.27-year increase. Similar opposing directional effects were observed for under-5 mortality and certain vaccination rates. The decrease in government expenditure associated with IMF conditionality (0.58% reduction in government spending as percentage of GDP per additional condition) offers a potential causal mechanism for these results. Reverse causality was determined to be insignificant in most models, except for conditionality on life expectancy. This study contributes to existing literature by focusing specifically on Latin America, a region with a unique degree of economic volatility and reliance on foreign debt. The findings suggest that while IMF interventions may address immediate balance of payment issues, they potentially create adverse consequences for public health outcomes, though reverse causality is present to a degree. These results underscore the need for policymakers to consider the downstream health impacts when implementing macroeconomic adjustment programs and highlight the importance of safeguarding essential health services during periods of fiscal austerity.

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