千刀万剐： 紧缩时代的社会保护》，牛津大学出版社，2023

千刀万剐： 紧缩时代的社会保护》，牛津大学出版社，2023 年，269 页，25.99 英镑，ISBN 978-0-

19-063773-6

安德鲁-芒罗

接受： 2024 年 10 月 3 日

作者 2024

关键词 社会政策 国际组织

社会保护

国际货币基金组织

社会权利

国际货币基金组织（IMF）自 1944 年成立以来一直是国际经济秩序的重要组成部分。 国际货币基金组织最初的任务是管理国际收支问题，但在 20 世纪 70 年代和 80 年代，其作用显著扩大。 这一转变与战后福利国家秩序的瓦解及其被新自由主义资本主义所取代是一致的。 在第三世界陷入债务危机后，国际货币基金组织将其大部分活动转向了第三世界。 国际货币基金组织向债务国提供流动资金以防止违约，但这种资助是有条件的；资金的提供以实施结构调整方案为条件，包括紧缩、私有化、贸易自由化和其他亲市场改革。 这些都是新自由主义改革，旨在增强资本主义阶级力量。 这使得国际货币基金组织对全球社会和经济政策产生了巨大的、超乎寻常的影响。

关于结构调整方案在社会政策方面的 "成功"，一直存在着广泛的争论。 国际货币基金组织本身认为，这些计划为经济增长创造了条件，从而加强了社会保护。 另一种说法也（主要）来自国际货币基金组织，即国际货币基金组织已经纠正了其先前的失误，放弃了结构调整，转而实施减贫和增长方案。 第三种说法认为，在结构调整方案中作为条件强加的政策产生了灾难性的社会后果，而且这种后果仍在继续。 Alexandros Kentikelenis 和 Thomas Stubbs 在《A Thousand Cuts： 通过对有关条件性的新数据进行细致分析，他们在《千切：紧缩时代的社会保护》一书中对这些说法进行了评估。 他们使用了一种方法论，认为这种方法通过将贷款条件分解为不同的政策领域，使他们能够超越推断国际货币基金组织的条件性与社会政策之间的相关性。 这意味着他们不仅能推断出国际货币基金组织的干预与借款国社会结果之间的因果关系，还能分离出产生这些影响的条件类型。 作者认为，这将使他们能够证明国际货币基金组织的条件继续对社会保护和社会成果产生不利影响，从而验证国际货币基金组织的批评。 他们认为，国际货币基金组织在社会政策方面的做法所做的任何改变都是表面文章；国际货币基金组织的言论与实践之间存在着巨大差距。

本书第一部分由两章组成。 第 2 章追踪了国际货币基金组织附加条件的演变。 曾经，IMF 的条件纯粹是 "量化 "的，即强制各国达到宏观经济目标以释放更多资金，而在 20 世纪 80 年代，IMF 开始施加 "结构性条件"，这些条件不仅涉及政策的目的，还涉及政策的手段。 毫不奇怪，选择的手段大多是亲市场的改革。 作者还将条件分为八个政策领域：外债、金融/货币、财政、贸易、私有化、劳工、机构改革和减贫。 第 3 章介绍了他们的研究方法。 作者使用了 1980-2019 年所有条件的数据，以 "国家-年 "作为分析单位。 他们认为，这种识别特定类型条件影响的能力使他们能够超越现有研究。 他们使用医疗支出、收入平等和健康结果（"相关结果"）作为社会保护/社会结果的替代物。 第 3 章的讨论（正如作者所承认的）可能会让非专业人士难以理解，但作者似乎令人信服地证明了其方法论的合理性。 第二部分将他们的统计模型应用于医疗支出、不平等和医疗 "结果"，旨在检验国际货币基金组织的条件是否对社会状况产生了不利影响。 第 4、5 和 6 章采用了一致的格式。 首先，他们广泛讨论了国际货币基金组织附加条件影响特定相关结果的各种 "途径"。 其次，它们报告了条件数量与相关结果之间的关系。 在所有三章中，更多的条件被证明会使社会保护恶化。 他们还试图控制一些事先存在的特定国家变量，如工作年龄人口的比例，这些变量可能会改变附加条件的影响。 第三，他们将模型应用于条件的类型（结构或数量）及其对相关结果的影响。

他们只相信数量条件对医疗支出和不平等的（负面）影响，以及结构条件对医疗结果的（负面）影响。 第四，他们试图分离出对相关结果产生不利影响的政策条件领域。 这一步骤的结果并不完整；在大多数情况下，尽管他们的研究普遍表明，在八个政策领域中，条件要么有不利影响，要么没有影响，但在大多数情况下，他们无法就一个以上的政策领域有把握地宣布这些结论。 例如，在不平等问题上，他们只能肯定地说 "外部条件对不平等产生了不利影响"。 尽管令人失望，但他们的数据为今后的研究奠定了基础，任何含糊不清之处似乎主要源于谨慎，这是作者的巨大功劳。

最后，第二部分的每一章都以更详细的案例研究结束。 关于医疗支出的第 4 章最后分析了国际货币基金组织的条件与西非医疗支出之间的联系。 关于收入不平等的第 5 章研究了将人口分为十分位数时，国际货币基金组织的条件对收入不平等的影响，得出了一个有趣的结论：财政整顿提高了第 10 个（最高）十分位数人口的收入，降低了最低 7 个十分位数人口的收入。 最后，在第 6 章中，他们衡量了附加条件对 23 项健康指标的影响，同样发现了不利影响。 这些全面的研究为他们的研究成果增添了更多的实质内容。 第三部分还有两章。 第 7 章对 Covid-19 大流行导致国际货币基金组织改变做法的说法表示怀疑。 他们的研究结果表明，国际货币基金组织一如既往地坚持紧缩政策和结构调整。 第八章提出了一些改革国际货币基金组织贷款和附加条件做法的建议，涉及社会保护和适应气候变化。

千刀万剐》中有许多值得推荐的内容。 如前所述，本书是对国际货币基金组织批评者的一次结论性平反。 他们对减贫相关条件的研究结果就是一个很好的例子。 国际货币基金组织将减贫作为对早期做法的纠正，而这些条件已变得越来越普遍。 然而，作者发现，减贫条件对社会结果要么没有影响，要么有不利影响。 因此，他们认为减贫是 "扩大基本医疗服务覆盖面的最差政策领域"。 这让人对国际货币基金组织承认过去错误的言论产生怀疑。 作者以引人入胜的方式展示了他们的数据，并对研究结果进行了深思熟虑和细致入微的讨论。 作者不厌其烦地指出了他们的数据可能存在的偏差和局限性；例如，他们意识到使用 "国家-年 "作为分析单位只能捕捉到条件的短期影响，这可能是他们无法就影响社会结果的政策领域得出更多结论性结论的原因。 他们承认，他们的一些分类数据可能存在 "噪音"。 然而，他们的分析是严谨的，他们的研究与早期的项目有很好的区别。

有几个（轻微的）缺点。 在他们的数据分析中使用的控制变量包括 "民主水平"；试图使用民主的定量衡量标准似乎值得商榷。 在衡量附加条件对医疗支出和医疗结果的影响时，这两种结果都是通过两种衡量标准来评估的：医疗支出是指单位资本支出和占国内生产总值的比例，医疗结果是指获得基本医疗服务的机会和新生儿死亡率。 然而，对不平等的评估仅采用基尼系数。 或许可以使用另一种衡量标准，如劳动收入份额（已提及）。 可以更多地认识到不同类型条件之间的相互作用，特别是在讨论部分。 例如，在关于不平等的章节中，关于货币政策的讨论没有提到货币政策对劳动条件的影响，即较高的利率通常被用来对抗通货膨胀，以达到增加失业的目的。

本书最大的局限性或许在于它的天真。 有几章在结尾处提出了国际货币基金组织的改革建议；关于医疗支出的第 4 章建议国际货币基金组织利用其研究成果进行 "重新校准"。 书中提到，IMF 人主导的改革 "考虑不周"，IMF 的成功经验 "喜忧参半"，因此作者提出改革能否让 IMF 实现其 "潜力"。 然而，自（新自由主义）转变以来，国际货币基金组织取得了惊人的成功。 当时，它承担的重要职责是确保第三世界跟随西方转向新自由主义资本主义，而不是推进国际经济新秩序。 这一点尤其令人沮丧，因为作者偶尔会表现出这种认识。 例如，他们提到国际货币基金组织的计划在推行以市场为基础的政策时 "有意 "增加了不平等。 他们提到了 "潜在的资本主义进程"，但他们的研究并没有捕捉到这些进程。 他们承认，IMF 是 "西方政治主子及其资本主义阶级的产物"。

尽管如此，《千刀万剐》对国际货币基金组织的条件限制和结构调整对社会政策、社会成果和社会保护的影响进行了严谨、详细和细致的研究。 在向国际货币基金组织施加政治压力以及在国内和全球范围内反对紧缩政策方面，该书可能会被证明是一个非常有价值的工具。 最重要的是，如前所述，它为今后研究国际货币基金组织的活动和基于市场的政策处方奠定了基础。

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A Thousand Cuts: Social Protection in the Age of Austerity, Oxford University Press, 2023, 269 pp, £25.99, ISBN 978-0-

19-063773-6

Andrew Munro¹

Accepted: 3 October 2024

The Author(s) 2024

Keywords Social policy International organisations

Social protection.

International monetary fund

Social rights

The International Monetary Fund (IMF) has been a fundamental part of the interna-tional economic order since its foundation in 1944. Originally tasked with managing balance of payment issues, the IMF's role expanded significantly in the 1970s and 80s. This shift was in accordance with the breakdown of the post-war order of the welfare state and its replacement with neoliberal capitalism. After the Third World entered a debt crisis, the IMF shifted the majority of its activities to the Third World. The IMF offered liquidity to indebted nations to prevent default, but this funding was premised upon conditionality; funds were conditional upon implementing struc-tural adjustment programmes, consisting of austerity, privatisation, trade liberalisa-tion, and other pro-market reforms. These are neoliberal reforms, aimed at enhancing capitalist class power. This has given the IMF substantial and outsized - influence on global social and economic policy.

There has been widespread debate on the 'success' of structural adjustment pro-grammes in terms of social policy. The IMF itself has argued that they create the con-ditions for economic growth that enhances social protection. Another narrative, also emerging (mostly) from the IMF, is that the IMF has rectified its earlier failings, hav-ing discarded structural adjustment for poverty reduction and growth programmes. A third narrative argues both that policies imposed as conditions in structural adjust-ment programmes had disastrous social consequences and that they continue to do so. Alexandros Kentikelenis and Thomas Stubbs assess these narratives in A Thousand Cuts: Social Protection in the Age of Austerity through meticulous analysis of new data on conditionality. They use a methodological approach that, they argue, allows them to go beyond inferring a correlation between IMF conditionality and social policy by disaggregating conditions on lending into separate policy areas. This means that they are not only able to infer a causal relationship between IMF intervention and social outcomes in borrowing countries, but to isolate the type of condition that drives these effects. The authors argue that this will allow them to demonstrate that IMF conditionality continues to adversely affect social protection and social out-comes, thus validating the IMF critics. Any changes made to IMF practices regarding social policy, they suggest, is cosmetic; a significant gap exists between IMF rhetoric and practice.

Part I of the book consists of two chapters. Chapter 2 tracks the evolution of IMF conditionality. Whilst once conditions were purely 'quantitative', imposing macroeconomic targets that countries were forced to meet to unlock further funds, the IMF began to impose 'structural conditions in the 1980s, those concerned not merely with the ends but also the means of policy. Unsurprisingly, the means cho-sen were mostly pro-market reforms. The authors also divide conditions into eight policy areas: external debt, financial/monetary, fiscal, trade, privatisation, labour, institutional reforms, and poverty reduction. Chapter 3 explains their methodological approach. The authors use data on all conditions from 1980-2019, using 'country-years' as the unit of analysis. Their ability to identify the effects of a particular type of condition, they argue, allows them to go beyond existing research. They use health expenditure, income equality, and health outcomes (the 'outcomes of interest') as proxies for social protection/social outcomes. The discussion in Chapter 3 (as the authors acknowledge) may be inaccessible to non-experts, but the authors appear to convincingly justify their methodological approach. Part II applies their statistical model to health spending, inequality, and health 'outcomes', aiming to test whether IMF conditionality had adversely affected social conditions. Chapters 4, 5, and 6 follow a consistent format. First, they engage in a broad discussion of the various pathways' through which IMF conditionality affects the given outcome of interest. Second, they report the relationship between number of of conditions and the outcome of interest. In all three chapters, more conditions are shown to worsen social protection. They also attempt to control for several pre-existing country-specific variables, such as proportion of working-age population,that may alter the effect of conditionality. Third, they apply their model to the type(structural or quantitative) of condition and their effects upon the outcome of interest.

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They are only confident in the (negative) effects of quantitative conditions on health spending and inequality and structural conditions on health outcomes. Fourth, they attempt to isolate the policy area of conditions that drives the adverse effects upon the outcome of interest. The results of this step are incomplete; in most cases, although their research generally points towards either adverse effects or no effect of conditions in each of the eight policy areas, in most cases they are not able to declare these findings with confidence for more than one policy area. For example, on inequality,they can only say for certain that 'external sector conditions adversely affect inequality. Whilst disappointing, their data provides a foundation for future research, and any ambiguity seems to stem mostly from caution, which is to the immense credit of the authors.

Finally, each chapter in Part II ends with a more detailed case study. Chapter 4 on health spending ends with an analysis of the link between IMF conditions and health spending in West Africa. Chapter 5 on income inequality examines the effect of IMF conditionality on income inequality when the population is separated into deciles, leading to the interesting conclusion that fiscal consolidation boosts the income of those in the 10th (highest) decile, and reduces the income of those in the lowest seven deciles. Finally, in Chapter 6, they measure the effects of conditionality on 23 health indicators, again finding a detrimental effect. These comprehensive studies add fur-ther substance to their findings of their research. Two further chapters make up Part III. Chapter 7 casts doubt upon the suggestion that the Covid-19 pandemic has led to changes in IMF practice. Their findings indicate that the IMF is as committed to austerity and structural adjustment as ever. The eighth chapter makes some sugges-tions for reform of IMF lending and conditionality practices with reference to social protection and climate change adaptation.

There is much to recommend in A Thousand Cuts. As mentioned, this book is a conclusive vindication of IMF critics. Their findings on poverty reduction-related conditions are a case in point. The IMF poses poverty reduction as a corrective to ear-lier practices, and these conditions have become increasingly prevalent. The authors find, however, that poverty reduction conditions either have no effect or an adverse effect on social outcomes. This leads them to declare poverty reduction to be 'the worst policy area for expanding coverage of essential health services. This casts doubt upon IMF rhetoric about its recognition of past errors. The authors present their data in an engaging manner and the discussion that accompanies their findings is considered and nuanced. The authors are constantly at pains to point out the potential biases and limitations of their data; for example, they are aware that using 'country-years' as their unit of analysis only captures the short-term effects of conditions, which may explain their inability to make more conclusive findings on the policy areas that affect social outcomes. They acknowledge that some of their disaggregated data may be 'noisy'. However, their analysis is rigorous, and their research is care-fully distinguished from earlier projects.

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There are several (slight) drawbacks. Among the control variables used in their data analysis is 'level of democracy'; attempting to use a quantitative measure of democracy seems questionable. When measuring the effects of conditionality on health spending and health outcomes, both outcomes are assessed by two measures: spending per capital and as a proportion of GDP for health spending and access to essential health services and neonatal mortality rate for health outcomes. However, inequality is only assessed according to the Gini coefficient. Perhaps another mea-sure, such as the labour share of income (which is mentioned), could have been used. There could have been more recognition of the interaction between distinct types of conditions, especially in discussion sections. For example, in the chapter on inequal-ity, the discussion of monetary policy does not refer to the effects of monetary policy upon labour conditions, that higher interest rates are often used against inflation for the purpose of increasing unemployment.

Perhaps the book's most significant limitation is its naivety. Several chapters end with recommendations for IMF reform; Chapter 4 on health spending suggests that the IMF could use their findings to 'recalibrate'. There are references to IMF-man-dated reforms being 'ill-conceived' and to the IMF having a 'mixed track-record' of success, leading the authors to ask whether reform can allow the IMF to realise its 'potential'. However, the IMF has, since its (neoliberal) shift, been startlingly suc-cessful. At that time, it took on the important role of ensuring that the Third World followed the West in its turn to neoliberal capitalism rather than advance a New International Economic Order. This is especially frustrating as the authors occasion-ally display such recognition. They refer, for example, to IMF programmes increas-ing inequality 'by design' in its imposition of market-based policy. They reference 'underlying capitalist processes' not captured by their research. They recognise that the IMF is a 'creature of its political masters in the West and their capitalist classes.

Despite this, A Thousand Cuts is a rigorous, detailed, and nuanced look at the effects of IMF conditionality and structural adjustment upon social policy, social out-comes, and social protection. It may prove an invaluable tool in putting political pressure upon the IMF and opposing austerity both domestically and globally. Most importantly, as mentioned, it lays the groundwork for future research on IMF activi-ties and market-based policy prescriptions.

Declarations

Competing interests The author reports no financial or non-financial interests that are directly or indi-rectly related to the work submitted for publication.

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