New Bottle, Old Wine? Implications of the World Bank's Systematic Diagnostic Reports for the Rise of Noncommunicable Diseases in the Organization of Eastern Caribbean States

Since its foundation in 1944, the International Bank for Reconstruction and Development, soon renamed the World Bank (hereafter, “the Bank”), has shifted its initial goal of reconstructing post-World War II Europe to promoting economic development and alleviating poverty in Africa, Asia, Latin America, and the Caribbean. Bank assistance is provided through loans awarded to countries that agree to policy changes that the Bank deems necessary to achieve its stated goals. Bank policies—dubbed Structural Adjustment Programs (SAPs) and, over time, superseded by Poverty Reduction Strategy Papers—have been criticized for not only failing to ameliorate underdevelopment and poverty, but for exacerbating both. The most recent Bank approach to development and poverty alleviation, the Systematic Diagnostic Reports (SDR), attempts to address these criticisms. We appraise the SDR for six Organization of Eastern Caribbean States (OECS). All share daunting economic and social challenges, including an ongoing epidemic of noncommunicable diseases (NCDs). We argue that, contrary to the Bank's claims, these challenges will continue under, and may even be exacerbated by, the policies the Report demands, and we elaborate on their implications for NCDs in the OECS and for social and health equity in the region.