Christ Church, Oxford University, United Kingdom.
Int J Health Serv. 2010;40(2):327-32. doi: 10.2190/HS.40.2.m.
The International Monetary Fund's recent claims concerning its impact on public health are evaluated against available data. First, the IMF claims that health spending either does not change or increases with IMF-supported programs, but there is substantial evidence to the contrary. Second, the IMF claims to have relaxed strict spending requirements in response to the 2008-9 financial crisis, but there is no evidence supporting this claim, and some limited evidence from the Center for Economic Policy Research contradicting it. Third, the IMF states that wage ceilings on public health are no longer part of its explicit conditionalities to poor countries, as governments can choose how to achieve public spending targets; but in practice, ministers are left with few viable alternatives than to reduce health budgets to achieve specific IMF-mandated targets, so the result effectively preserves former policy. Fourth, the IMF's claim that it has increased aid to poor countries also seems to be contradicted by its policies of diverting aid to reserves, as well as evidence that a very small fraction of the Fund's new lending in response to the financial crisis has reached poor countries. Finally, the IMF's claim that it follows public health standards in tobacco control contrasts with its existing policies, which fail to follow the guidelines recommended by the World Bank and World Health Organization. The authors recommend that the IMF (1) become more transparent in its policies, practices, and data to allow improved independent evaluations of its impact on public health (including Health Impact Assessment) and (2) review considerable public health evidence indicating a negative association between its current policies and public health outcomes.
国际货币基金组织（IMF）最近声称其对公共卫生的影响，本文根据现有数据对此进行评估。首先，IMF 声称卫生支出要么不变，要么随着 IMF 支持的项目而增加，但有大量证据与之相悖。其次，IMF 声称放宽了严格的支出要求，以应对 2008-2009 年金融危机，但没有证据支持这一说法，而来自经济政策研究中心的一些有限证据则与之相矛盾。第三，IMF 表示，对公共卫生部门的工资上限不再是其向穷国提出的明确附加条件的一部分，因为各国政府可以选择如何实现公共支出目标；但在实践中，部长们几乎没有可行的选择，只能削减卫生预算来实现具体的国际货币基金组织规定的目标，因此这一结果实际上保留了以前的政策。第四，IMF 声称增加了对穷国的援助，这似乎也与其将援助转移到储备金的政策相矛盾，而且有证据表明，基金组织为应对金融危机而新增贷款的极小一部分已到达穷国。最后，IMF 声称其在烟草控制方面遵循公共卫生标准，这与其现有政策形成鲜明对比，后者未能遵循世界银行和世界卫生组织建议的准则。作者建议 IMF（1）在政策、实践和数据方面更加透明，以便对其对公共卫生的影响（包括健康影响评估）进行独立的改进评估；（2）审查大量公共卫生证据，这些证据表明其当前政策与公共卫生结果之间存在负面关联。
