The Impact of Microfinance on Health: Experimental Evidence from India

描述(申请人提供)：尽管小额信贷作为一种扶贫项目有了巨大的增长，但在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上存在着巨大的差距。现有的评价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记物和身体健康指标，如血压、身高和体重。此外，我们几乎不知道小额信贷是否--甚至是以什么方向--影响压力和心理健康。最后，大多数现有的关于健康结果的证据依赖于主观的健康衡量标准，如自我报告的健康状况和饥饿。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记物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，通过在印度进行一项大型社区随机试验，儿童早期发展导致成年后健康和老龄化的成功，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。这项研究利用了2010至2012年间南印度农村的一家小额信贷机构(MFI)扩展到80个随机选择的地点(160个样本)的情况。小额金融机构分配中的随机化消除了村庄之间可以获得小额信贷的选择偏见。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重新调查，以评估健康结果。我们的调查包含了经济学领域中传统的健康问题，以及经过验证的和客观的健康指标，包括在这种性质的研究中很少使用的已建立的和新的生物标记物。该项目的具体目标是评估小额供资对以下方面的影响：(1)与营养和粮食安全(包括体重指数和贫血)有关的健康结果；(2)压力的生理指标(皮质醇水平)和痛苦的心理指标；以及(3)保健支出和保健利用情况。第四个目标是寻求提供证据，说明获得小额金融服务影响健康结果的潜在渠道(增加收入、平稳消费、在社会网络中分担风险或增强妇女权能)。该项目小组由经济学和流行病学领域的高级领导人组成，他们在发展中国家拥有丰富的经验。预期结果包括关于小额信贷对可靠的健康衡量标准影响的因果证据，以及关于6200个家庭健康和老龄化结果的开创性纵向数据集。我们预计，这一结果将对发展中国家的小额融资和公共卫生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.