Abstract
Public health researchers are increasingly shifting their attention away from merely documenting those factors that determine health–a solid evidence base on health determinants now exists–to improving our understanding of how various interventions influence population health. This paper argues for greater investigations of the potential unintended health benefits associated with participation in a poverty alleviation strategy (PAS) in low-income countries. We focus on microcredit, a PAS that has been spreading across the developing world. Microcredit aims to address the “credit gap” between the poor and the better off by offering an alternative for the poor to acquire loans: small groups are formed and loans are allocated to members based on group solidarity instead of formal collateral. We argue that microcredit corresponds with activities that will help build up health capital (e.g., greater access to resources) and describe the main pathways from microcredit participation to health. We advocate that microcredit and other potential pro-health PAS be included among the range of interventions considered by public health researchers in improving the health of the poor.
MeSH terms: Developing countries, poverty, women’s health
Résumé
Les facteurs déterminants de la santé des populations sont désormais de mieux en mieux connus. L’attention des chercheurs et des professionnels de la santé publique tend ainsi à se porter davantage sur les effets d’interventions à visée collective et les mécanismes par lesquels ces interventions contribuent à la santé des populations. Cet article défend l’idée selon laquelle il conviendrait d’explorer de manière plus soutenue et plus systématique les effets sur la santé de la participation, dans des pays à faible et moyen revenu, à des activités de lutte contre la pauvreté. Le microcrédit, dont la diffusion est désormais très large, constitue l’une de ces stratégies. Il cible des populations pauvres qui, faute de pouvoir présenter des garanties suffisantes, ne peuvent accéder au crédit, et contribue ainsi à réduire les inégalités sociales. Typiquement, les participants sont réunis au sein de « groupes de microcrédit » solidairement responsables des emprunts réalisés par les membres. Nous soutenons que la participation à des groupes de microcrédit peut, même si ce n’est pas là son intention initiale, contribuer de manière sensible au « capital de santé » des membres des groupes, et explorons les divers mécanismes par lesquels cette contribution peut s’opérer. Nous proposons d’incorporer le microcrédit et les stratégies de lutte contre la pauvreté dans la panoplie des interventions que les acteurs de la santé publique devraient considérer pour promouvoir la santé des populations pauvres.
Motsclés: pays en développement, pauvreté, santé des femmes
Footnotes
Acknowledgements: This paper is based on K.S. Mohindra’s doctoral dissertation, which was supported by doctoral grants: Analyse et évaluation des interventions en santé (AnÉIS), Fond de Recherche en Santé du Québec, RRSBD/FODQ, Faculté des études supérieurs (FES) and Centre Hospitalier (CHUM) of the Université de Montréal
References
- 1.Evans R, Stoddart G. Consuming research, producing policy? Am J Public Health. 2003;93:371–79. doi: 10.2105/AJPH.93.3.371. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Rychetnik L, Frommer M, Hawe P, Shiell A. Criteria for evaluating evidence on public health interventions. J Epidemiol Community Health. 2006;56:119–27. doi: 10.1136/jech.56.2.119. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Guhan S. Social security options for developing countries. Int Labour Rev. 1994;133(1):35–53. [Google Scholar]
- 4.Montgomery R. Disciplining or protecting the poor? Avoiding the social costs of peer pressures in micro-credit schemes. J Int Dev. 1996;8(2):289–305. doi: 10.1002/(SICI)1099-1328(199603)8:2<289::AID-JID368>3.0.CO;2-2. [DOI] [Google Scholar]
- 5.Mosley P, Hulme D. Microenterprise finance: Is there a conflict between growth and poverty alleviation? World Development. 1998;26(5):783–90. doi: 10.1016/S0305-750X(98)00021-7. [DOI] [Google Scholar]
- 6.Kabeer N. Conflicts over credit: Re-evaluating the empowerment potential of loans to women in rural Bangladesh. World Development. 2000;29(1):63–84. doi: 10.1016/S0305-750X(00)00081-4. [DOI] [Google Scholar]
- 7.Yunus M. Banker to the Poor. Micro-lending and the Battle Against World Poverty. New York, NY: Public Affairs; 1999. [Google Scholar]
- 8.Daley-Harris S. State of the Microcredit Summit Campaign Report 2005. Washington, DC: The Microcredit Summit Campaign; 2005. [Google Scholar]
- 9.Mohindra K, Haddad S. Women’s interlaced freedoms: A framework linking microcredit participation and health. J Human Development. 2005;6:353–74. doi: 10.1080/14649880500287662. [DOI] [Google Scholar]
- 10.Amin R, Li Y. NGO-promoted women’s credit program, immunization coverage, and child mortality in rural Bangladesh. Women Health. 1997;25:71–87. doi: 10.1300/J013v25n01_05. [DOI] [PubMed] [Google Scholar]
- 11.Amin R, Li Y, Ahmed A. Women’s credit programs and family planning in rural Bangladesh. Int Fam Plan Perspect. 1996;22:158–62. doi: 10.2307/2950813. [DOI] [Google Scholar]
- 12.Bhuiya A, Chowdhury M. Beneficial effects of a woman-focused development programme on child survival: Evidence from rural Bangladesh. Soc Sci Med. 2002;55:1553–60. doi: 10.1016/S0277-9536(01)00287-8. [DOI] [PubMed] [Google Scholar]
- 13.Hadi A. Promoting health knowledge through micro-credit programmes: Experience of BRAC in Bangladesh. Health Promot Int. 2001;16(3):219–27. doi: 10.1093/heapro/16.3.219. [DOI] [PubMed] [Google Scholar]
- 14.Schuler S, Hashemi S, Riley A. The influence of women’s changing roles and status in Bangladesh’s fertility transition: Evidence from a study of credit programs and contraceptive use. World Development. 1997;25(4):563–75. doi: 10.1016/S0305-750X(96)00119-2. [DOI] [Google Scholar]
- 15.Doocy S, Teferra S, Norell D, Burnham G. Credit program outcomes: Coping capacity and nutritional status in the food insecure context of Ethiopia. Soc Sci Med. 2005;60:2371–82. doi: 10.1016/j.socscimed.2004.10.025. [DOI] [PubMed] [Google Scholar]
- 16.Nanda P. Women’s participation in rural credit programmes in Bangladesh and their demand for formal health care: Is there a positive effect? Health Economics. 1999;8:415–28. doi: 10.1002/(SICI)1099-1050(199908)8:5<415::AID-HEC450>3.0.CO;2-L. [DOI] [PubMed] [Google Scholar]
- 17.Schuler S, Hashemi S, Riley A, Akhter S. Credit programs, patriarchy and men’s violence against women in rural Bangladesh. Soc Sci Med. 1996;43(12):1729–42. doi: 10.1016/S0277-9536(96)00068-8. [DOI] [PubMed] [Google Scholar]
- 18.Mohindra K. On poverty and health: An interventionist perspective. A study of women microcredit groups in Kerala, India [dissertation] Montréal, QC: Université de Montréal; 2007. [Google Scholar]
- 19.Amrith S. In search of a “Magic Bullet” for tuberculosis: South India and beyond, 1955–65. Soc Hist Med. 2004;17(1):113–30. doi: 10.1093/shm/17.1.113. [DOI] [Google Scholar]
- 20.Easterly W. The big push déja vu: A review of Jeffrey Sach’s The End of Poverty: Economic Possibilities of Our Time. J Econ Lit. 2006;44(1):96–105. doi: 10.1257/002205106776162663. [DOI] [Google Scholar]
- 21.Matin I, Hulme D, Rutherford S. Finance for the poor: From microcredit to microfinancial services. J Int Dev. 2002;14:273–94. doi: 10.1002/jid.874. [DOI] [Google Scholar]