Neoliberalism and the World Bank’s Changing Approach to Health
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This chapter places the focus more fully on the World Bank and examines its changing approach to health. I trace the World Bank’s discussions of health in its policy documents, starting in 1980 when the World Bank formally committed to direct involvement in health projects and loans. I discuss criticisms of and the Bank’s response to these critiques of structural adjustment approaches that promote economic growth and often mandate cutbacks in public safety nets. I discuss the seminal 1993 World Development Report on health and the 2004 World Development report on improving services for poor people. I catalog an increasing emphasis in the Bank on outcomes and systems. I trace both continuity and shifts in the World Bank’s work in health, a return to the lost focus on equity in the interest of poverty amelioration and economic growth via investments in human capital, an enduring concern with efficiency, and relatively stable financial commitments to health since the 1990s. This chapter concludes by discussing the Bank’s recent renewed discursive commitment to universalism in health, questioning how and whether it will play out in deed.
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