Academic journal article Canadian Journal of Public Health

In the Wake of Structural Adjustment Programs: Exploring the Relationship between Domestic Policies and Health Outcomes in Argentina and Uruguay

Academic journal article Canadian Journal of Public Health

In the Wake of Structural Adjustment Programs: Exploring the Relationship between Domestic Policies and Health Outcomes in Argentina and Uruguay

Article excerpt

ABSTRACT

Background: The implementation of structural adjustment programs (SAPs) in developing countries has been followed by a marked reduction in their progress on economic growth, health outcomes, and social indicators. Comprehensive and contextualized explorations of the effects of SAPs are needed to assist health and social policy-makers in better determining responses to such programs that continue to dominate global trade, aid and debt cancellation negotiations.

Methods: A comparative case study of Argentina and Uruguay was developed exploring the effects of SAPs on health. Using a framework developed to analyze the relationship between globalization and health, changes in domestic policies resulting from SAPs and the corresponding economic, social and health outcomes of the countries were explored.

Results: In general, SAPs were implemented with greater severity and speed in Argentina than in Uruguay, with the greatest differences occurring over the 1980s. The more gradual and modest reforms implemented in Uruguay were associated with better economic, social and health outcomes.

Conclusions: Findings support those of previous studies demonstrating that countries that have maintained more dynamic public social and health programming while applying SAPs have been better able to protect the health of the most vulnerable sectors of society.

MeSH terms: Structural adjustment; economics; socioeconomic factors; politics; public sector; Argentina; Uruguay

Globalization has led to a number of important changes in population health-related economic policies.1-8 In the 1980s and 1990s, many developing countries underwent radical changes due to the implementation of structural adjustment programs (SAPs) that were introduced as conditions of their access to foreign credit.1-8 Many studies of SAPs have been limited to a simplistic analysis of their role in promoting economic growth, with insufficient attention to their effects on income inequality, the erosion of public health systems and social protection.1-5 In addition, few studies of SAPs have incorporated comprehensive methods that capture the complex interaction between the economic, political, environmental and social contexts on a global, national, and local level that collectively culminate in health outcomes.9-11

METHODS

Comparative case studies of Argentina and Uruguay have been developed incorporating a comprehensive framework designed to analyze the links between globalization and health (see Figure 1).9

The selection of the countries was made through a process of matching their pre-existing endowments from the globalization and health framework prior to the onset of SAPs.9 Pre-existing endowments included 1) economic development levels, 2) time period in which SAPs were implemented, 3) racial and ethnic composition and 4) economic and political progression. Matching allows for the differences being observed after SAPs were implemented to be credited to differences in the way SAPs were adopted by countries rather than being attributed to other unrelated factors.

In addition to the matched characteristics, key differences were used in the country selection. Key differences consisted of 1) historical development of domestic policies and social structures prior to the onset of SAPs and 2) progression of income inequality after the introduction of SAPs. Differences in the historical development of the countries' domestic policies and social structures before the introduction of SAPs was used as a good predictor of possible differences in the way the countries might implement SAPs. Along with the differing emphasis on social policies prior to the onset of SAPs, trends in the progression of income inequality in the countries after the implementation of SAPs was used as further evidence of potential variations in the countries' abilities to buffer the negative effects of SAPs.

Following the country selection, a comprehensive analysis of the SAP conditionalities implemented in the two countries, and their corresponding economic, social and health outcomes, was undertaken, covering a 20-year time period that spanned the initiation of SAPs in the early 1980s to the year 2000. …

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