International financial institutions and human rights: implications for public health

Do Higher Education and Financial Institutions Improve Health in China? A New Perspective

The importance of human wellbeing is documented in the literature of development economics because of its intensifying impacts on economic growth and productivity of labor in the long-run. To the best of the authors' knowledge, no empirical study has examined the symmetric association between China's financial institutional development, education, and health outcomes. Thus, our study aims to fill this vacuum by employing an autoregressive distributed lag (ARDL) approach to explore the impact of financial institutional development and education on life expectancy and infant mortality rate from 1990 to 2020. The empirical analysis reveals that financial institutional development and education report a significant increase in life expectancy and meaningful reduction in mortality rate in the long-run. Based on these findings, the study may deliver intuitive policy implications regarding improvement in health conditions that are imperative for promoting economic growth in the long-run.

It’s a Hard-Knock Life: Child Labor Practices and Compliance with IMF Agreements

How does IMF lending impact child labor? We argue that, as compliance with IMF reforms increases, child labor increases. IMF loans can help governments avoid bankruptcy, prevent debt defaults, and credibly signal a commitment to pro-market reforms which should generate trade and investment. However, IMF policies associated with revenue and social policies can have negative impacts on child labor. Education reforms undermine the quality of schooling, making child labor more likely. Healthcare reforms undermine the quality of healthcare; when parents are ill or injured, their children are more likely to enter the workforce to make up for lost income. Similarly, social safety net reforms reduce the ability of families to access a safety net during times of hardship and make it more likely that children are pushed into the labor market to keep families afloat. To test our argument, we use a control function selection model on a sample of 70 IMF borrowers between 2002 and 2016. Using new datasets on IMF compliance and child labor, we find that increased compliance with IMF reforms worsens child labor practices. Revenue and social policy compliance in particular are associated with an increase in child labor.

Structural competency and global health education

Structural competency is a new curricular framework for training health professionals to recognise and respond to disease and its unequal distribution as the outcome of social structures, such as economic and legal systems, healthcare and taxation policies, and international institutions. While extensive global health research has linked social structures to the disproportionate burden of disease in the Global South, formal attempts to incorporate the structural competency framework into US-based global health education have not been described in the literature. This paper fills this gap by articulating five sub-competencies for structurally competent global health instruction. Authors drew on their experiences developing global health and structural competency curricula-and consulted relevant structural competency, global health, social science, social theory, and social determinants of health literatures. The five sub-competencies include: (1) Describe the role of social structures in producing and maintaining health inequities globally, (2) Identify the ways that structural inequalities are naturalised within the field of global health, (3) Discuss the impact of structures on the practice of global health, (4) Recognise structural interventions for addressing global health inequities, and (5) Apply the concept of structural humility in the context of global health.

Understanding the impacts of NPM and proposed solutions to the healthcare system reforms in Indonesia: the case of BPJS

This study critically evaluates the adoption of a universal healthcare system recently introduced by the Indonesian government in 2014. Our study is driven by the lack of critical analysis of social and political factors and unintended consequences of New Public Management, which is evident in the healthcare sector reforms in emerging economies. This study not only examines the impact of economic and political forces surrounding the introduction of a universal health insurance programme in the country but also offers insights into the critical challenges and undesirable outcomes of a fundamental reform of the healthcare sector in Indonesia. Through a systematic and detailed review of prior studies, legal sources and reports from government and media organizations about the implementation and progress of an UHC health insurance programme in Indonesia, the authors find that a more democratic political system that emerged in 1998 created the opportunity for politicians and international financial aid agencies to introduce a universal social security administration agency called Badan Penyelenggara Jaminan Sosial (BPJS). Despite the introduction of BPJS to expand the health services' coverage, this effort faces critical challenges and unintended outcomes including: (1) increased financial deficits, (2) resistance from medical professionals and (3) politicians' tendency to blame BPJS's management for failing to pay healthcare services costs. We argue that the adoption of the insurance system was primarily motivated by politicians' own interests and those of international agencies at the expense of a sustainable national healthcare system. This study contributes to the healthcare industry policy literature by showing that a poorly designed UHC system could and will undermine the core values of healthcare services. It will also threaten the sustainability of the medical profession in Indonesia. The authors offer several suggestions for devising better policies in this sector in the developing nations.

Responding to the COVID-19 Pandemic in Developing Countries: Lessons from Selected Countries of the Global South

Reviewing selected policy responses in Asia and South America, this paper draws pragmatic lessons for developing countries to better address the COVID-19 pandemic. It argues that not acting quickly and adequately incurs much higher costs. So-called ‘best practices’, while useful, may be inappropriate, especially if not complemented by effective and suitable socio-economic measures. Public understanding, support and cooperation, not harsh and selective enforcement of draconian measures, are critical for successful implementation of containment strategies. This requires inclusive and transparent policy-making, and well-coordinated and accountable government actions that build and maintain trust between citizens and government. In short, addressing the pandemic crisis needs ‘all of government’ and ‘whole of society’ approaches under credible leadership.

Globalization and health equity: The impact of structural adjustment programs on developing countries

Among the many drivers of health inequities, this article focuses on important, yet insufficiently understood, international-level determinants: economic globalization and the organizations that spread market-oriented policies to the developing world. One such organization is the International Monetary Fund (IMF), which provides financial assistance to countries in economic trouble in exchange for policy reforms. Through its 'structural adjustment programs,' countries around the world have liberalized and deregulated their economies. We examine how policy reforms prescribed in structural adjustment programs explain variation in health equity between nations-approximated by health system access and neonatal mortality. Our empirical analysis uses an original dataset of IMF-mandated policy reforms for a panel of up to 137 developing countries between 1980 and 2014. We employ regression analysis to evaluate the relationship between these reforms and health equity, taking into account the non-random selection and design of IMF programs. We find that structural adjustment reforms lower health system access and increase neonatal mortality. Additional analyses show that labor market reforms drive these deleterious effects. Overall, our evidence suggests that structural adjustment programs endanger the attainment of Sustainable Development Goals in developing countries.

Correlation between human rights promotion and health protection: a cross country analysis

Purpose

The purpose of this paper is to explore the correlation among health outcomes, and civil and political rights (CPR) and also economic, social and cultural rights.

Design/methodology/approach

The study uses cross-sectional data from 161 countries. The authors use health outcomes and human rights variables in the model. In order to combine dimensions of human rights, this paper uses factor analysis and obtains proxy variables that measure economic, social and cultural rights and CPR. The two proxy variables are used as independent variables to explain variations in health in a regression model. The paper then classifies countries by cluster analysis and explores the patterns of different components of human rights and health outcomes across country clusters.

Findings

The regression model demonstrates that the economic, social and cultural rights variables explain variations in all health outcomes. The relationship between CPR and health is weaker than that of the economic, social and cultural rights. Cluster analysis further reveals that despite the country’s commitment to CPR, those that highly respect economic, social and cultural rights lead to superior health outcomes. The more respect a country has for economic, social and cultural rights, the better the health outcomes for the citizens of that country.

Practical implications

National policies should consider equal emphasis on all dimensions of human rights for further improvements in health.

Originality/value

The sole promotion of CPR such as democracy and empowerment, absence of adequate support of economic, social and cultural rights such as rights to housing, education, food and work can only contribute partially to health.