> [!NOTE] Learning outcomes > - Identify the roles of the IMF and WB in the global economy and their implications for global health > - Assess the strengths and weaknesses of their institutional and decision-making structures > - Evaluate the criticisms levelled at them from various perspectives ## 1. Introduction Along with [[World Trade Organization (WTO)]], [[World Bank (WB)]] and [[International Monetary Fund (IMF)]] are the most powerful multilateral economic institutions with clear implications for global health governance. The task of creating economic and monetary stability in the global economy falls principally to the IMF, which is able to offer short-term loans to countries experiencing financial difficulties, currency fluctuations and pressures or temporary disruptions in their domestic economies. The 2008 global financial crisis, and its aftermath, saw the IMF play a key role in assisting a number of higher income countries, most notably Greece, as well as those in low- and middle-income countries (LMIC) facing the prospect of financial instability. However, the policies and conditions associated with these loans were the subject of widespread criticism. The task of the [[World Bank (WB)]], meanwhile, is to provide funds (via loans) and policy advice designed to support longer term economic development, principally in LMICs. It is to this body which we now turn. ## 2. The [[World Bank (WB)]] > WB is not a bank in the conventional sense of the word but a development institution owned by its membership. Its role is to promote economic growth and development in the poorest countries in the world through its lending. ## 3. The [[International Monetary Fund (IMF)]] ## 4. Integrating activity Consider the strengths and weaknesses of the governance structures of the WB and the IMF. In your view how democratic are these institutions in their current forms? Are all states' voices heard? Does it matter and why? Do the WB and IMF need to be reformed? If so, what changes would you propose to their organisation and conduct? Post your comments/views to the Reflective Activity discussion forum on Moodle and comment on the responses of two other students. ## 5. Summary In summary, we have seen that the WB and IMF are important institutions with a significant impact on global health and development issues. The WB and the IMF are at the heart of the development system and the policies they promote have wide-ranging impacts on poverty in LMICs. In certain policy areas such as the fight against HIV/AIDS the WB has created a clear link between disease and development. All these institutions reflect the times and circumstances of their creation and often embody the power balances of that time rather than those of the 21st century. Criticisms levelled against them include suggestions that they are unjust and unfair and that they promote policies which impact negatively on LMICs. Many of the criticisms are disputed by those within the organisations and those who support them. Nevertheless, there is agreement that the challenge remains to reform and improve these institutions in the future so they are better able to serve the interests of LMICs. ## 6. References ### [[Essential readings]] Peet R (2009). [[Unholy Trinity - WB, IMF, WTO]]. London: Zed Books. Chapter 3: 56-110. [[@kentikelenisStructuralAdjustmentPublic2015]] Kentikelenis AE, Stubbs TH, King LP (2015). Structural adjustment and public spending on health: Evidence from IMF programs in low-income countries. Social Science & Medicine 126:169-176. [[@khaliqAlternativesIMFWorldBank2019]] https://www.opendemocracy.net/en/oureconomy/imf-and-world-bank-have-lost-all-legitimacy-we-need-new-alternatives/ ### [[Recommended reading]] Daoud A, Nosrati E, Reinsberg B, Kentikelenis AE, Stubbs TH, King LP (2017). Impact of International Monetary Fund programs on child health. Proceedings of the National Academy of Sciences, 114(25), 6492-6497. Available at: https://www.pnas.org/content/pnas/114/25/6492.full.pdf McKee M, Stuckler D (2015). Reflective Practice: How the World Bank Explored Its Own Biases? International Journal Health Policy Management 5, 79-82 Marshall K (2008). The World Bank: from reconstruction to development to equity. Chapter 6: 136-151 Mele M, Nicolai F (2019). The Role of the International Monetary Fund After the 2008 Crisis. Research in World Economy 10(1): 60-71. Available online. Tichenor M, Sridhar D (2017). Universal health coverage, health systems strengthening, and the World Bank. BMJ 358. Available at: https://www.bmj.com/content/bmj/358/bmj.j3347.full.pdf