In the wake of structural adjustment programs : exploring the relationship between domestic policies and health in Argentina and Uruguay

Abstract

Background: The implementation of structural adjustment programs (SAPs) in low to middle income (LMICs) has been followed by a marked reduction in their progress on economic growth, social indicators and health outcomes. 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. Drawing from a population health perspective and using a framework developed to analyze the relationship between globalization and health, changes in domestic policies resulting from SAPs and the corresponding population 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 over the 1980s were associated with better population health outcomes. As Uruguay’s reforms began to accelerate and more closely resemble Argentina’s over the 1990s, differences in population health of the countries were diminished.Conclusions: Findings support those of previous studies demonstrating that countries that have maintained more protectionist policies have been better able to protect the health of the most vulnerable sectors of society.