High Tuberculosis Rates Linked to IMF Loan Programs

Loans to European and Asian countries from the International Monetary Fund (IMF) are associated with significantly higher tuberculosis rates and mortality, according to a study published in PLoS Medicine and co–authored by a doctoral student at the Yale School of Public Health.

The researchers examined 21 post–communist countries in Europe and the former Soviet Union and found that IMF loan programs were associated with a 16.6 percent increase in TB mortality. Strict conditions placed on IMF loans in those countries resulted in cuts to health and education budgets when countries have to repay the loans, according to Sanjay Basu, M.D, a PhD candidate at Yale, and his co–authors David Stuckler and Lawrence King of Cambridge University in England.

The findings are particularly troubling because drug–resistant forms of tuberculosis are spreading and more treatment is needed, the authors said.

“There were significant declines in the number of doctors available to treat tuberculosis,” in countries receiving IMF loans, Basu said. “Soon after the countries entered the IMF programs, there was a significant rise in tuberculosis cases and deaths. The rates were stable or improving beforehand. When countries left the IMF programs, their rates of tuberculosis significantly improved.”

The team examined over two decades of data and determined that loans from the IMF—intended to help revive countries with stagnant economies—have had the unintended consequence of increasing the incidence, prevalence and mortality rates from the respiratory illness, Basu said .

IMF loans were significantly associated with large reductions in government health expenditures, tuberculosis program coverage, and the number of physicians per capita. Loans or aid packages from non–IMF institutions were not associated with these reductions, or with higher tuberculosis rates. Previous studies by other researchers also have suggested that IMF loan programs have an influence on health care in the recipient country.

To make the study comprehensive, they checked that the association between the IMF programs and tuberculosis rates was not “confounded” by other factors, such as changes to the political structures, economic situations, or other variables that might affect tuberculosis rates. The study also revealed that IMF programs were associated with reduced reporting of tuberculosis cases, making their results conservative.