Reply to "IMF Programs and Tuberculosis Outcomes in Post-Communist Countries"

July 24, 2008

July 23, 2008

This study finds that IMF programs are positively associated with the TB mortality rate for a sample of 21 transition countries from 1992 to 2002. However, severe methodological shortcomings limit the scope of these results and prevent any causal interpretation. The fundamental problem is that this study does not take properly into account that countries implement IMF-supported reforms in times of economic distress.

The main concerns with this study are the following:

• The authors do not take into account that the economic and social instability following the collapse of Soviet Union may have had a direct impact on TB incidence in the 21 transition economies considered in the study. Any analysis that seeks to estimate the impact of IMF-supported programs on economic or social outcomes should take into account the economic and political conditions that first led the country to agree to an IMF-supported program. By not including these conditions, this study confuses the reasons for asking IMF assistance with the consequences of this assistance.

• The study speculates that IMF-supported programs are associated with lower public health expenditure, leading to higher TB incidence. However, this conjecture is not corroborated by data. The average increase in health spending as a share of GDP is larger for countries with Fund-supported programs than in countries without such programs (http://www.imf.org/external/np/vc/2007/062907.htm and IMF's WP/05/100).

• The study has a number of dubious results, which cast doubt on the methodology used by the authors. The study does not take into account many other factors that should have a direct impact on TB incidence, including health expenditure, poverty, initial mortality, and migration. Other results of the study, including that TB-incidence increases with income growth and decreases with urbanization, contradict previous studies that find that TB incidence increases with poverty and increases with urbanization. Finally, the authors' finding that the only consistent factor impacting TB incidence is the presence of IMF-supported programs is in contrast with previous epidemiological studies on the incidence of TB.

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