The Impact of Microfinance on Health: Experimental Evidence from India

描述（由申请人提供）：尽管小额信贷作为一项扶贫计划有了巨大的增长，但我们对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存在重大差距。现有的评估未能仔细衡量小额供资对健康结果的影响。例如，没有研究评估获得信贷如何影响重要的生物标志物和身体健康指标，如血压、身高和体重。此外，我们几乎不知道小额信贷是否——甚至是在什么方向上——会影响压力和心理健康。最后，关于健康结果的大多数现有证据依赖于主观健康指标，如自我报告的健康状况和饥饿状况。虽然其他一些研究已经探索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志物相结合，以评估小额信贷对健康的影响。越来越多的证据表明，儿童早期发育导致成年后的健康和老龄化。通过在印度进行一项大型社区一级随机试验，拟议的项目将提供关于小额信贷对成人和幼儿身心健康影响的因果证据。本研究利用了2010年至2012年间在印度南部农村的小额信贷机构（MFI）在80个随机选择的地点（160个样本）的扩张。小额信贷机构分配的随机化消除了选择偏差，其中村庄有机会获得小额信贷。该项目包括在分行开业前对6 200户家庭进行基线调查，并在两年后对这些家庭进行再调查，以评估健康结果。我们的调查包含了传统经济学领域的健康问题，以及经过验证和客观的健康措施，包括在这种性质的研究中很少使用的既有的和新的生物标志物。该项目的具体目标是评估小额信贷获取对以下方面的影响：(1)与营养和粮食安全相关的健康结果（包括BMI和贫血）；(2)压力生理指标（皮质醇水平）和痛苦心理指标；(3)卫生支出和卫生保健利用。第四个目标是寻求提供证据，证明获得小额信贷影响健康结果的潜在渠道（增加收入、平滑消费、在社会网络内分担风险或增强女性权能）。项目小组由在发展中国家具有丰富经验的经济学和流行病学领域的高级领导人组成。预期成果包括关于小额供资对可靠健康措施影响的因果证据，以及公开提供的关于6200户家庭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有关小额信贷和公共卫生的政策产生重要的积极影响。

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.