Has the IMF helped to spread tuberculosis?

Do health policies do anything? Do they have effects on health outcomes, good and bad? And if they do, is it possible to isolate precisely what effects certain policies have, independent of other, related factors?

These are some of the questions raised by a study recently published in PLoS Medicine, which suggests that International Monetary Fund (IMF) policies are associated with significantly worsened tuberculosis incidence, prevalence, and mortality rates in post-communist Eastern European and former Soviet countries. It has been asserted before that IMF policies, because they often involve reductions in health care spending to control inflation, must have a detrimental effect on health. This seems intuitively plausible. But until now, no serious study has been conducted to test whether the intuition holds water. There are a host of methodological challenges to such studies, as the Editors of PLoS medicine point out. And representatives of the IMF are bound to hammer on such methodological shortcomings in order to question the study results and dodge possible responsibility for harm. But even if this study has limitations, the authors have drawn attention to an interesting research domain -- the health effects of policy decisions -- that ought to be of interest to bioethics workers worldwide.