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
Résumé
Contexte: La mise en oeuvre des programmes d’ajustement structurel (PAS) dans les pays en développement a eu pour effet de ralentir les progrès réalisés dans les domaines de la croissance économique, des résultats de santé et des indicateurs sociaux. Un examen exhaustif et conceptualisé des effets de ces politiques est nécessaire afin d’aider les responsables des politiques sociales et sanitaires à mieux déterminer comment réagir à ces politiques néolibérales qui continuent de dominer les négociations sur le commerce mondial, l’aide au développement et l’annulation de la dette.
Méthodologie: Une étude comparative de la situation en Argentine et en Uruguay a été menée afin d’examiner les effets des PAS sur la santé. À l’aide d’un cadre établi pour l’analyse des relations entre la mondialisation et la santé, nous avons exploré les changements des politiques intérieures résultant des PAS et les résultats économiques, sociaux et sanitaires correspondants dans les pays examinés.
Résultats: En général, les PAS ont été mis en oeuvre de manière plus rigoureuse et plus rapide en Argentine qu’en Uruguay, les plus grandes différences ayant été observées au cours des années 1980. Les réformes mises en oeuvre de façon plus graduelle et plus modeste en Uruguay ont été associées à de meilleurs résultats économiques, sociaux et sanitaires.
Conclusions: Les conclusions appuient les résultats des études antérieures démontrant que les pays ayant maintenu des programmes sociaux et de santé publique plus dynamiques tout en appliquant les PAS ont été mieux en mesure de protéger la santé des couches les plus vulnérables de la société.
Footnotes
Acknowledgements: Funding for this study was provided from the CPHR Training Program, Global Health Research Program and the CIHR-IPPH/CPHA Student Awards Program. Thesis Supervisor–Dr. Ronald Labonte, Institute of Population Health, University of Ottawa. Co-Supervisor–Dr. Jim Handy, Professor, Department of History, University of Saskatchewan. Chair–Dr. Nazeem Muhajarine, Associate Professor, Community Health and Epidemiology, University of Saskatchewan.
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