Olga Biosca

Where is the ‘Plus’ in ‘Credit-Plus’? The Case of Chiapas, Mexico

Abstract It has become common to try and increase the effectiveness of microfinance programmes by adding supplementary services to the financial product. However, the added value accruing from this ‘credit-plus’ approach has been little analysed. We hypothesise that the extent of added value from credit-plus depends on the ability of the credit supplier to cultivate trust, or social capital, amongst clients. Applying difference-in-difference estimation, we exploit a natural experiment of two ‘credit-plus’ programmes in Mexico. The findings suggest that credit-plus is not universally effective, but that it is at its most effective, especially with low-income groups, where ‘bonding’ (within-group) social capital exists.

Boosting health insurance coverage in developing countries: do conditional cash transfer programmes matter in Mexico?

BACKGROUND Achieving universal health insurance coverage is a goal for many developing countries. Even when universal health insurance programmes are in place, there are significant barriers to reaching the lowest socio-economic groups such as a lack of awareness of the programmes or knowledge of the benefits to participating in the insurance market. Conditional cash transfer (CCT) programmes can encourage participation through mandatory health education classes, increased contact with the health care system and cash payments to reduce costs of participating in the insurance market. OBJECTIVE To explore if participation in a CCT programme in Mexico, Oportunidades, is significantly associated with self-reported enrolment in a public health insurance programme. METHODS Cross-sectional data from 2007 collected on 29 595 Mexican households where the household head is aged between ages 15 and 60 were analysed. A logit model was used to estimate the association between Oportunidades participation and awareness of enrolment in a public health insurance programme. RESULTS Participation in the Oportunidades programme is associated with a 25% higher likelihood of being actively aware of enrolment in Seguro Popular, a public health insurance scheme for the lowest socio-economic groups. CONCLUSIONS Participation in the Oportunidades CCT programme is positively associated with awareness of enrolment in public health insurance. CCT programmes may be used to promote participation of the lowest socio-economic groups in universal public health insurance systems. This is crucial to achieving universal health insurance coverage in developing countries.

Exploring the relationship between time preference, body fatness, and educational attainment

Obesity is a global health concern. This is the first study to explore if the relationship between body fatness and time preference is consistent across different ways of objectively measuring body fatness. Our second aim is to explore if there are differential associations between educational attainment and being a saver to determine if education can be used to change saving behaviour and subsequently body fatness. This paper uses data on 15,591 individuals from 2010/2011 of the Understanding Society Survey (UK) to explore the relationship between time preference, measured as being a saver and three objective measures of body fatness: BMI, percent body fatness (PBF), and waist circumference (WC). Our findings show that there is a negative relationship between the three measures of body fatness and being a saver. The strongest relationship is found for WC and being a saver for both genders. Overall, a stronger association is found for women than men. Our results suggest that differential effects by educational attainment can be found in the relationship between being a saver and body fatness. Educational interventions to improve savings behaviour and subsequently obesity may be more effective for women with lower levels of education.

Pulling Together or Pulling Apart? Solidarity in the Post-Crisis UK

Solidarity in contemporary Britain has come under pressure not only as a result of the global financial crisis and the ensuing austerity measures but also against a backdrop of constitutional volatility from the Scottish independence referendum in 2014 and the vote to leave the EU in 2016. Using cross-sectional data from an original survey of 2083 UK-based individuals, this chapter uncovers how practices, attitudes, and behaviours of solidarity towards vulnerable groups are distributed in contemporary Britain. Our findings highlight specific challenges for maintaining solidarity in post-crisis Britain as we reveal both a variegated distribution of solidarity across the constituent nations of the UK and a hierarchy of solidarity towards different vulnerable groups.

RF23 Who knows best? perspectives of professional stakeholders and community participants on health in low-income communities

Background Health inequalities in the UK have proved to be stubborn, and health gaps between best and worst-off are widening. While we have an understanding of how the main causes of poor health are perceived among different stakeholders, similar insight is lacking regarding what solutions should be prioritised. Furthermore, we do not know the relationship between perceived causes and solutions to health inequalities, whether there is agreement between professional stakeholders and people living in low-income communities or agreement within these different societal groups. Methods Q methodology was used to identify and describe the shared perspectives (‘subjectivities’) that exist on i) why health is worse in low-income communities (’Causes’) and ii) the ways that health could be improved in these same communities (‘Solutions’). 53 purposively selected individuals from low-income communities (n=25) and professional stakeholder groups (n=28), for example, academics, policymakers, public health professionals, financial service practitioners, ranked ordered sets of 34 ‘Causes’ statements and 39 ‘Solutions’ statements onto quasi-normal shaped grids according to their point of view. These ‘Q’ sorts were followed by brief interviews. Factor analysis was used to identify shared points of view (patterns of similarity between individuals’ Q sorts). ‘Causes’ and ‘Solutions’ were analysed independently. Results Analysis produced three factor solutions for both the ‘Causes’ and ‘Solutions’. These rich, shared accounts can be broadly summarised as: ‘Causes’ i) ‘Unfair Society’, ii) ‘Individual Responsibility’, iii) ‘Hard Lives’ and for ‘Solutions’ i) ‘More than Money’, ii) ‘Guiding Choice’, iii) ‘Make Society Fair’. No professionals were among respondents who exemplified (had a significant association with) ‘Causes – Individual Responsibility’ or ‘Solutions – Guiding Choice’ and no community participants exemplified ‘Solutions – Make Society Fair’. There was an expected correlation between the ‘Causes’ and ‘Solutions’ factor solutions given the accounts identified. Conclusion While there was some disagreement among professional participants, there was more of a focus on material, social and environmental factors. Community participants recognised a range of causes of worse health but even among those identifying structural causes as the main problem, structural solutions were not recognised. Despite the plurality of views there was broad agreement across the accounts about issues relating to money. While no easy solutions exist, addressing basic needs and the unpredictability of finances are seen as important for good health.

From wealth to health: Evaluating microfinance as a complex intervention

Innovative interventions that address the social determinants of health are required to help reduce persistent health inequalities. We argue that microcredit can act in this way and develop a conceptual framework from which to examine this. In seeking to evaluate microcredit this way we then examine how randomized controlled trials, currently considered as the ‘gold standard’ in impact evaluations of microcredit, compare with developments in thinking about study design in public health. This leads us to challenge the notion of trials as the apparent gold standard for microcredit evaluations and contend that the pursuit of trial-based evidence alone may be hampering the production of relevant evidence on microcredit’s public health (and other wider) impacts. In doing so, we introduce new insights into the global debate on microfinance impact evaluation, related to ethical issues in staging randomized controlled trials, and propose innovations on complementary methods for use in the evaluation of complex interventions.

Financing Health in Latin America Volume 1: Household Spending and Impoverishment

In Latin America, health care is costly for the poor. More than half of the population is frequently excluded from salary-based health insurance schemes. The need to pay for health out-of-pocket continues to have a devastating and impoverishing effect on the more vulnerable. Equitable and efficient health financing is a major policy priority in most Latin-American countries.