The Impact of Microfinance on Health: Experimental Evidence from India

小额信贷对健康的影响：来自印度的实验证据

• 批准号: 8245974
• 负责人: Rohini Pande
• 金额: $ 53.94万
• 依托单位: HARVARD SCHOOL OF PUBLIC HEALTH
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-20 至 2017-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8245974
• 关键词: Address; Adult; Aging; Anemia; Baseline Surveys; Biological Markers; Blood Pressure; Body mass index; Characteristics; Child; Childhood; Communities; Consumption; Data; Data Set; Developing Countries; Development; Distress; Economics; Epidemiology; Evaluation; Fathers; Female; Generations; Growth; Hair; Health; Health Expenditures; Health Policy; Health Services; Health Status; Height; Heterogeneity; Household; Hunger; Hydrocortisone; Income; India; Individual; Institution; Intervention; Investments; Knowledge; Learning; Link; Measures; Mental Health; Methods; Nature; Outcome; Pathway interactions; Patient Self-Report; Personal Satisfaction; Physiological; Policies; Poverty; Program Development; Psychological Stress; Public Health; Randomized; Research Design; Resource Allocation; Role; Rural; Sampling; Savings; Selection Bias; Services; Shock; Site; Social Network; Stress; Survey Methodology; Surveys; Underweight; Weight; Woman; aged; base; beneficiary; conditioning; design; early childhood; empowerment; experience; food security; health care service utilization; improved; innovation; novel; nutrition; physical conditioning; poverty alleviation; programs; psychologic; randomized trial; research study; response; risk sharing; symposium; wasting; young adult

DESCRIPTION (provided by applicant): Despite the immense growth of microfinance as a poverty alleviation program, there is a significant gap in our understanding of whether and how access to financial services improves health and aging outcomes of the poor. Existing evaluations fail to carefully measure the impact of microfinance on health outcomes. For instance, no studies have assessed how access to credit influences important biomarkers and indicators of physical health such as blood pressure, height and weight. Furthermore, we have almost no knowledge of whether - and even in what direction - microfinance influences stress and psychological wellbeing. Finally, most existing evidence on health outcomes relies on subjective health measures such as self-reported health and hunger. While a handful of other studies have explored how microfinance may impact health, ours will be the first to combine an experimental research design with rigorous biomarkers to evaluate health effects of microfinance. Increasing evidence reveals that early childhood development leads to successful health and aging in adulthood Through conducting a large community-level randomized trial in India, the proposed project will provide causal evidence on the physical and mental health impacts of microfinance on adults and young children. This study exploits the expansion of a microfinance institution (MFI) in rural South India into 80 randomly selected sites (of a sample of 160) between 2010 and 2012. Randomization in MFI assignment eliminates selection bias among which villages have access to microfinance. The project includes a baseline survey of 6,200 households just before branch opening and a resurvey of these households two years later to assess health outcomes. Our surveys contain questions about health traditional in economics fieldwork as well as validated and objective health measures including both established and novel biomarkers rarely employed in studies of this nature. The specific aims of this project are to assess the impact of microfinance access on (1) health outcomes related to nutrition and food security (including BMI and anemia), (2) physiological indicators of stress (cortisol levels) and psychological indicators of distress and (3) health expenditures and health care utilization. The fourth aim is to seek to provide evidence on the potential channels through which microfinance access influences health outcomes (increased income, smoothed consumption, risk sharing within social networks, or greater female empowerment). The project team is comprised of senior leaders in both economics and epidemiology with substantial experience in developing countries. Expected outcomes include causal evidence on the impact of microfinance on reliable measures of health and a ground-breaking longitudinal data set on health and aging outcomes for 6200 households made publicly available. We anticipate that the results will have an important positive impact on policy surrounding microfinance and public health in developing countries. PUBLIC HEALTH RELEVANCE: With more than 130-190 million microfinance borrowers and more than $43 billion dollars of loans outstanding worldwide, it is critical that we accurately value microfinance programs and design them to most effectively improve public health. However, the evidence on the health and aging impacts of this fast-growing development program remains limited. Our project will address this critical gap in understanding by using a rigorous experimental method to measure the impact of microfinance on health and aging, providing valuable information to policymakers for use in allocation of resources among development programs as well as in the design of health policy interventions.

描述（由申请人提供）：尽管小额信贷作为一项扶贫计划取得了巨大的发展，但我们对获得金融服务是否以及如何改善穷人的健康和老龄化结果的理解还存在很大差距。现有的评估未能仔细衡量小额信贷对健康结果的影响。例如，没有研究评估获得信贷的机会如何影响血压、身高和体重等重要的生物标志物和身体健康指标。此外，我们几乎不知道小额信贷是否会影响压力和心理健康，甚至不知道会影响什么方向。最后，大多数关于健康结果的现有证据依赖于主观健康指标，例如自我报告的健康和饥饿。虽然其他一些研究已经探讨了小额信贷如何影响健康，但我们的研究将是第一个将实验研究设计与严格的生物标记相结合来评估小额信贷对健康影响的研究。越来越多的证据表明，儿童早期发展有助于成年后的健康和老龄化。通过在印度进行一项大型社区级随机试验，拟议项目将提供小额信贷对成人和幼儿身心健康影响的因果证据。本研究利用 2010 年至 2012 年间印度南部农村小额信贷机构 (MFI) 的扩张，随机选择 80 个地点（样本为 160 个）。小额信贷机构分配的随机化消除了村庄获得小额信贷的选择偏差。该项目包括在分支机构开业前对 6,200 个家庭进行基线调查，并在两年后对这些家庭进行重新调查，以评估健康状况。我们的调查包含有关经济学实地考察中传统健康的问题，以及经过验证和客观的健康衡量标准，包括在此类性质的研究中很少使用的已建立的和新颖的生物标志物。该项目的具体目标是评估小额信贷对以下方面的影响：(1) 与营养和粮食安全相关的健康结果（包括体重指数和贫血）；(2) 压力生理指标（皮质醇水平）和痛苦心理指标；(3) 健康支出和医疗保健利用。第四个目标是寻求提供小额信贷影响健康结果的潜在渠道的证据（增加收入、平滑消费、社交网络内的风险分担或更大的女性赋权）。项目团队由在发展中国家拥有丰富经验的经济学和流行病学领域的高级领导人组成。预期成果包括小额信贷对可靠的健康衡量标准影响的因果证据，以及公开的 6200 个家庭的健康和老龄化结果的开创性纵向数据集。我们预计研究结果将对发展中国家的小额信贷和公共卫生政策产生重要的积极影响。 公共卫生相关性：全球有超过 130-1.9 亿小额信贷借款人和超过 430 亿美元的未偿还贷款，因此我们准确评估小额信贷计划并设计它们以最有效地改善公共卫生至关重要。然而，有关这一快速增长的发展计划对健康和老龄化影响的证据仍然有限。我们的项目将通过使用严格的实验方法来衡量小额信贷对健康和老龄化的影响，为政策制定者提供有价值的信息，用于在发展计划之间分配资源以及设计卫生政策干预措施，从而解决这一认识上的重大差距。