Health Inequalities in Europe: Setting the Stage for Progressive Policy Action

While the health of Europeans has improved over recent years, differences by gender, birthplace, and/or socioeconomic background persist. This report maps the extent of such health inequalities, its determinants, and costs to society. The findings indicate that differences in health between and within countries are attributable not only to social and health policies, but also depend on economic policy and the social determinants of health. Thus, holistic policy interventions are required to tackle health inequalities

Health inequalities after austerity in Greece.

Since the beginning of economic crisis, Greece has been experiencing unprecedented levels of unemployment and profound cuts to public budgets. Health and welfare sectors were subject to severe austerity measures, which have endangered provision of as well as access to services, potentially widening health inequality gap. European Union Statistics on Income and Living Conditions data show that the proportion of individuals on low incomes reporting unmet medical need due to cost doubled from 7 % in 2008 to 13.9 % in 2013, while the relative gap in access to care between the richest and poorest population groups increased almost ten-fold. In addition, austerity cuts have affected other vulnerable groups, such as undocumented migrants and injecting drug users. Steps have been taken in attempt to mitigate the impact of the austerity, however addressing the growing health inequality gap will require persistent effort of the country's leadership for years to come

Social Protection and the International Monetary Fund:Promise versus Performance

Background: Countries in the Global South are currently facing momentous economic and social challenges, including major debt service problems. As in previous periods of global financial instability, a growing number of countries have turned to the International Monetary Fund (IMF) for financial assistance. The organization has a long track-record of advocating for extensive fiscal consolidation—commonly known as ‘austerity’—for its borrowers. However, in recent years, the IMF has announced major initiatives for ensuring that its loans support social spending, thus aiding countries in meeting their development targets and the Sustainable Development Goals. To assess this track record, we collected spending data on 21 loans signed in the 2020–2022 period, including from all their periodic reviews up to August 2023. Results: We find that austerity measures remain a core part of the organization’s mandated policies for its borrowers: 15 of the 21 countries studied here experience a decrease in fiscal space over the course of their IMF programs. Against this fiscal backdrop, social spending floors have failed to live up to their promise. There is no streamlined definition of these floors, thus rendering their application haphazard and inconsistent. But even on their own terms, these floors lack ambition: they often do not foresee trajectories of meaningful social spending increases over time, and, when they do, many of these gains are eaten up by soaring inflation. In addition, a third of social spending floors are not implemented—a much lower implementation rate from that for austerity conditions, which the IMF prioritizes. In several instances, where floors are implemented, they are not meaningfully exceeded, thus—in practice—acting as social spending ceilings. Conclusions: The IMF’s lending programs are still heavily focused on austerity, and its strategy on social spending has not represented the sea-change that the organization advertised. At best, social spending floors act as damage control for the painful budget cuts: they are instruments of social amelioration, underpinned by principles of targeted assistance for highly disadvantaged groups. Alternative approaches rooted in principles of universalism can be employed to build up durable and resilient social protection systems

International financial institutions and human rights: implications for public health.

Serving as lender of last resort to countries experiencing unsustainable levels of public debt, international financial institutions have attracted intense controversy over the past decades, exemplified most recently by the popular discontent expressed in Eurozone countries following several rounds of austerity measures. In exchange for access to financial assistance, borrowing countries must settle on a list of often painful policy reforms that are aimed at balancing the budget. This practice has afforded international financial institutions substantial policy influence on governments throughout the world and in a wide array of policy areas of direct bearing on human rights. This article reviews the consequences of policy reforms mandated by international financial institutions on the enjoyment of human rights, focusing on the International Monetary Fund and World Bank. It finds that these reforms undermine the enjoyment of health rights, labour rights, and civil and political rights, all of which have deleterious implications for public health. The evidence suggests that for human rights commitments to be met, a fundamental reorientation of international financial institutions' activities will be necessary

Taxing the People, Not Trade: the International Monetary Fund and the Structure of Taxation in Developing Countries

Abstract: Strengthening fiscal capacity in low- and middle-income countries is essential for achieving sustainable development. The International Monetary Fund—the world’s premier agent of fiscal policy reform—has taken a front-stage role in this process, promoting a model of tax policy that favors broad-based consumption taxes and discourages trade taxes. This article investigates the links between IMF-mandated tax reforms and the evolution of tax revenues. Using novel measures of tax-related conditionality and disaggregated data on revenues, our analysis shows that IMF interventions are significantly related to changes in tax structure. In particular, IMF programs increase revenues derived from goods and services taxes, but decrease revenues collected from trade taxes. Results for personal and corporate income taxes are inconclusive. These findings have important implications for debates on the role of the IMF in developing countries

Formal governance matters: when, how, and why states act on the IMF Executive Board

International financial institutions (IFIs) are central actors shaping global development. Scholarship on these institutions’ governance has primarily explored unequal voting rights and informal channels of decision-making. Much less is known about the actual decision-making processes that transpire in the IFIs’ formal governance structures, where votes are rarely taken. This article redirects academic scrutiny to these structures to reveal hitherto unobserved state behavior. Empirically, we examine decision-making at the International Monetary Fund (IMF), a key actor in the diffusion of market-oriented reforms. We introduce a novel dataset systematizing all comments of IMF Executive Board members over 3,111 developing-country-specific discussions between 1995 and 2015. First, regression analysis reveals that the interventions by the IMF’s most powerful member-states—the United States, Germany, Japan, France, and the United Kingdom—correlate with their bilateral trade and aid interests. Second, these countries frequently reference each other in debates, demonstrating how coalitions work in practice. Third, we find that the preferences they express for market liberalization vis-à-vis countries in the Global South are associated with an increase in market-liberalizing conditions in subsequent lending programs. Taken together, this article reveals the usefulness of examining formal deliberations in IFIs, contributing to a fuller understanding of decision-making processes in the international political economy

How to evaluate the effects of IMF conditionality: an extension of quantitative approaches and an empirical application to public education spending

Following calls for a more disaggregated approach to studying the consequences of IMF programs, scholars have developed new datasets of IMF-mandated policy reforms, or ‘conditionality.’ Initial studies have explored how conditions have, inter alia, affected tax revenues, public sector wages, and health systems. Notwithstanding the important contributions of these studies, a methodological quandary arises as to how to quantitatively examine the effects of conditionality, as distinct from other aspects of IMF operations (e.g., credit, technical support, or aid and investment catalysis). In this article, we review and advance these methodological debates by developing an identification strategy for addressing the multiple endogenous components of IMF programs. We begin by surveying the main strategies for studying the effects of IMF programs: matching methods, instrumental variable approaches, system GMM estimation, and variants of Heckman estimators. We then adapt these methods for studying the effects of conditionality per se. Specifically, we utilize a compound instrumental variable design over a system of three equations to address sources of endogeneity related to, first, the IMF participation decision and, second, the conditions included within the program. In Monte Carlo simulations, we demonstrate that our approach is unbiased and performs better than alternatives on standard diagnostics across a range of scenarios. Finally, we apply these methods to investigate how IMF programs impact government education spending as a share of GDP on a sample of 132 developing countries for the period 1990 to 2014, finding exposure to an additional condition results in a 0.05 percentage point decline

Pump up the volume: from covert to overt politics in global governance

Recent commentary on the state of multilateralism begins from an alarming premise: a popular backlash against globalization is underway. The prospects for multilateralism depend, by this account, on shielding global governance from the forces of mass politics. We challenge this conventional account to develop a novel conceptual framework for the mass politics of global governance and the role of contestation in resolving, rather than inciting, the present crisis of multilateralism. We distinguish between two modes of mass politics—covert and overt—and examine variation in (i) mass preferences, (ii) party strategies, and (iii) international organization between them. Building on this framework, we make the case for a shift from the current covert mode to a more overt politics of global governance that could make the multilateral system more effective, accountable, and legitimate. Concrete steps in this direction will accommodate broader political forces while defanging challenges from opportunistic political leaders. We conclude with an outline of pragmatic reforms to reinvigorate multilateralism for the post-pandemic era

Global Health Expertise in the Shadow of Hegemony

This work is funded by the European Commission Research and Innovation Action, Horizon 2020 Framework Program, 2023-2027 –‘NAVIGATOR: The EU Navigating Multilateral Cooperation’ (#101094394).publishedVersio

Poverty, inequality, and the International Monetary Fund:How austerity hurts the poor and widens inequality

Among the drivers of socio-economic development, this article focuses on an important yet insufficiently understood international-level determinant: the spread of austerity policies to the developing world by the International Monetary Fund (IMF). In offering loans to developing countries in exchange for policy reforms, the IMF typically sets the fiscal parameters within which development occurs. Using an original dataset of IMF-mandated austerity targets, we examine how policy reforms prescribed in IMF programs affect inequality and poverty. Our empirical analyses span a panel of up to 79 countries for the period 2002-2018. Using instrumentation techniques, we control for the possibility that these relationships are driven by the IMF imposing harsher austerity measures precisely in countries with more problematic economies. Our findings show that stricter austerity is associated with greater income inequality for up to two years, and that this effect is driven by concentrating income to the top 10% of earners while all other deciles lose out. We also find that stricter austerity is associated with higher poverty headcounts and poverty gaps. Taken together, our findings suggest that the IMF neglects the multiple ways its own policy advice contributed to social inequity in the developing world