The Continued Impact of Multilateral Debt on the Population Health Outcomes of Low- and Middle-Income Countries

Abstract

Background: The primary aim of this study is to examine the association of national economic indicators on national population health outcomes in low- and middle-income countries. We hypothesize that countries with higher shares of external debt to multilateral institutions will have worse population health outcomes when compared to countries with lower shares of external debt to these same institutions between 2000 and 2019. Methods: Population health data in the pre-COVID 21st century were collected for 103 low- and middle- income countries. These dependent variables were infant mortality rate (IMR), under 5 mortality rate (U5MR), maternal mortality ratio (MMR), and life expectancy (LE). A multivariable regression panel analysis assuming random effects was conducted on these countries. The independent variables were gross national income per capita purchasing power parity (GNI), share of Multilateral and IMF debt out of Total External debt (MITE), debt service as a percentage of GDP (DSGDP), the level of export commodity concentration (EPC), the number of IMF conditionalities in effect, and the share of wealth in a country concentrated in the top 1% of the population. Results: The multivariable panel regressions for each dependent variable were found to have significant negative associations between the population health outcomes and GNI, MITE, EPC, IMF conditionality and DSGDP. The concentration of wealth in the top 1% of the country was found to be significantly negatively associated with all population health outcomes apart from MMR. Conclusion: This study provides evidence that MITE is a novel variable of significance that could be utilized when conditionality data are difficult to extract on a large scale to examine the impact of debt in other settings and in combination with other variables. Debt, including that owed to multilateral lending institutions, continues to have negative associations with population health outcomes in the 21st century.