ABSTRACT
Intergovernmental organizations (IGOs) were crucial in mitigating the effects of the global COVID-19 pandemic on health systems and development. Yet, IGOs have long-shaped country responses to socio-economic crises: exerting a profound influence on global health via policy prescriptions attached to structural adjustment lending programs, and through more subtle processes of policy norm diffusion. This chapter reviews how IGOs promote neoliberalism – that is, market-oriented solutions for a range of policy problems – and to what end. First, we discuss how IGOs foster the adoption of neoliberal policies by drawing on normative and coercive mechanisms. Second, we introduce a conceptual framework that distinguishes between three pathways through which neoliberalism affects health outcomes: (i) direct effects from policies targeting health systems, (ii) indirect effects that stem from macroeconomic and institutional policies that shape health systems, and (iii) indirect effects through the social determinants of health. Subsequently, we provide empirical evidence on these pathways from three especially powerful IGOs in the form of the World Health Organization (WHO), International Monetary Fund (IMF), and World Bank. We conclude by discussing the implications of this analysis for global health.
