[The effect of structural adjustment on health conditions in Latin America and the Caribbean, 1980-2000].
OBJECTIVE
To assess the impact of structural adjustment on health indicators in Latin America and the Caribbean during 1980-2000.


METHODS
This was an ecological study. Public spending and per capita gross domestic product (pcGDP) figures were obtained from the World Bank, and life expectancy (LE) and infant mortality (IM) figures were obtained from the World Health Organization. Structural adjustment (government downsizing) was assessed by looking at the change in the amount of spending taken up by the government (or the reduction in public spending) in Latin American and Caribbean countries during 1980-1990. Changes in health indicators were measured in terms of the percentage variation in LE and IM. The variations found in Latin America and the Caribbean were compared to those seen in different groups of countries in other parts of the world during 1980-2000. Pearson's chi squared test was used to explore the associations between the decrease in public spending and health indicators. In order to estimate the health effects of such changes, a multivariate linear regression model was created, with adjustments for pcGDP.


RESULTS
A deceleration in the rise of LE and in the decline of IM in Latin America and the Caribbean was noted, especially over the period from 1980 through 1990. Significant associations were observed between health indicators and the change in public spending in all groups of countries included in the study. When adjustments were introduced into the multiple regression model, the only associations that remained were seen in Latin America and the Caribbean.


CONCLUSIONS
In the decade of 1980, adjustments in macroeconomic policies had a negative effect on social indicators, specifically those that had to do with health conditions in Latin America and the Caribbean. Such an effect lasted throughout the following decade.
Franco-Giraldo
Alvaro
A
Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia. alvarofrancogiraldo@hotmail.com
Palma
Marco
M
Alvarez-Dardet
Carlos
C
D017691:Caribbean Region / Q000453:epidemiology; D005102:Health Expenditures; D006293:Health Promotion; D006305:Health Status Indicators; D019456:Health Transition; D006801:Humans; D007843:Latin America / Q000453:epidemiology; D008017:Life Expectancy / Q000639:trends; D009026:Mortality / Q000639:trends; D011635:Public Health Administration / Q000191:economics*