Structural adjustment programmes are the largest single cause of increased poverty, inequality and hunger in developing countries. The World Bank and the IMF have compelled country after country to adopt a “one size fits all” economic strategy, so exposing the world’s weakest economies to the full force of the global market place. This is a comprehensive, real-life assessment of the impacts of the liberalization, deregulation, privatization and austerity that constitute structural adjustment. It is the result of a unique five year collaboration among citizens’ groups, developing country governments, and the World Bank itself. Its authors, the members of the Structural Adjustment Participatory Review International Network (SAPRIN), reveal the practical consequences for manufacturing, small enterprise, wages and conditions, social services, health, education, food security, poverty and inequality. The stark conclusion emerges: if there is to be any hope for meaningful development, structural adjustment and neoliberal economics must be jettisoned.