Elias Nosrati

Educational mobility is considered a key driver of population health. While prior studies suggest that intergenerational equality of opportunity may be linked to mortality, most evidence comes from high-income countries. Little is known about whether these associations apply globally. This study assesses the relationship between intergenerational educational mobility and all-cause mortality across a global sample of countries. We combine country-level data from the WHO Mortality Database and the World Bank's Global Database on Intergenerational Mobility, covering five birth cohorts across 148 countries. Using multilevel random effects models, we estimate associations between four dimensions of educational mobility (upward, downward, stagnant, and correlation-based) and age- and sex-adjusted all-cause mortality, controlling for national indicators of education, income, inequality, health spending, unemployment, and political freedoms. Higher upward educational mobility and lower stagnant mobility are significantly associated with reduced all-cause mortality. In fully adjusted models, a one standard deviation greater measure of upward mobility is associated with a reduction of 29.1 deaths per 100,000 population, while a one standard deviation lower stagnation measure is associated with a reduction of 27.3 deaths per 100,000 population. These patterns are consistent across high- and low-income countries. Our findings suggest that promoting educational equality of opportunity may reduce mortality and improve public health worldwide. Strengthening social mobility, especially in settings with persistent educational inequality, can be an effective policy lever for reducing health disparities and supporting healthier populations.

International financial organisations like the International Monetary Fund (IMF) play a central role in shaping the developmental trajectories of fiscally distressed countries through their conditional lending schemes, known as ‘structural adjustment programmes’. These programmes entail wide-ranging domestic policy reforms that influence local health and welfare systems. Using novel panel data from 187 countries between 1990 and 2017 and an instrumental variable technique, we find that IMF programmes lead to over 70 excess deaths from respiratory diseases and tuberculosis per 100,000 population and that IMF-mandated privatisation reforms lead to over 90 excess deaths per 100,000 population. Thus structural adjustment programmes, as currently designed and implemented, are harmful to population health and increase global infectious disease burdens.

Geographical inequalities in life and death are among the world's most pronounced in the United States. However, the driving forces behind this macroscopic variation in population health outcomes remain surprisingly understudied, both empirically and theoretically. The present article steps into this breach by assessing a number of theoretically informed hypotheses surrounding the underlying causes of such spatial heterogeneity. Above and beyond a range of usual suspects, such as poverty, unemployment, and ethno-racial disparities, we find that a hitherto neglected explanans is prison incarceration. In particular, through the use of previously unavailable county-level panel data and a compound instrumentation technique suited to isolating exogenous treatment variation, high imprisonment rates are shown to substantially increase the population-wide risk of premature death. Our findings contribute to the political economy of population health by relating the rise of the carceral state to the amplification of geographically anchored unequal life chances.

Background: As one of the world’s most powerful international financial organisations, the International Monetary Fund (IMF) is uniquely positioned to shape global developmental trajectories by influencing domestic policy arrangements. However, its role in shaping population health is understudied. Methods: We use previously unavailable cross-national time-series data and an instrumental-variables method to examine the causal impact of the IMF’s structural adjustment programmes on age-standardised all-cause mortality rates and disability-adjusted life years (DALYs) in 187 countries between 1990 and 2017. For this purpose, we specify two-way fixed-effects regression models. Findings: According to our baseline models, IMF programmes cause 392 excess all-cause deaths (95% CI: 176–608; p = 0.0004) and 4,205 excess DALYs (95% CI: 2,429–5,981; p = 0.000004) per 100,000 population. This aggregate effect appears to be driven by IMF-mandated privatisation reforms, which lead to 562 excess all-cause deaths (95% CI: 267–857; p = 0.0002) and 5,285 excess DALYs (95% CI: 2,749–7,822; p = 0.00004) per 100,000 population. Interpretation: Structural adjustment programmes play a significant role in perpetuating preventable disability and death in developing contexts. The IMF’s policy reforms, especially those pertaining to the privatisation of state-owned enterprises, increase excess mortality rates and disease burdens in the world’s most vulnerable regions. Funding: None.

International financial organisations like the International Monetary Fund (IMF) play a central role in shaping the developmental trajectories of low- and middle-income countries through their conditional lending schemes, known as “structural adjustment programmes”. These programmes entail wide-ranging domestic policy reforms that influence local health and welfare systems. Using novel panel data from 187 countries and an instrumental variable technique, we find that IMF programmes cause over 400 excess deaths and over 4,100 excess disability-adjusted life years (DALYs) from communicable diseases per 100,000 population. IMF-mandated privatisation reforms cause over 570 excess deaths and over 6,700 excess DALYs per 100,000 population. Structural adjustment programmes, as currently designed and implemented, are harmful to population health and increase communicable disease burdens in developing contexts. One Sentence Summary Policy interventions by the International Monetary Fund in developing countries increase communicable disease burdens.