This dissertation examined whether or not microcredit, the provision of small loans to people usually excluded from mainstream financial institutions, demonstrably improved health for typical borrowers in Indonesia. The underlying idea behind microcredit is that loans will increase borrowers’ income and lead to positive changes in their lives, including their health. However, microcredit may actually be harmful to borrowers’ health because of stress associated with repayment obligations, extra working hours needed to start a business and tensions caused by shifting power dynamics in the household. Moreover, for some borrowers, a loan may facilitate increased spending on so-called temptation goods that are damaging to health, such as tobacco and processed foods. Previous research has not adequately explored these competing positive and negative pathways linking microcredit and health. The project consisted of three parts: a systematic review and two empirical papers. The systematic review synthesized the scientific literature related to individual microcredit loans, health-related temptation spending, psychological stress and self-reported health outcomes in adults. The empirical papers estimated the causal effect of microcredit on household expenditures on tobacco and processed foods, and individual psychological distress and self-rated health. Both empirical papers used data from the Indonesia Family Life Survey, a longitudinal study that followed more than 7,000 households over 21 years. After adjusting for confounding, people living in borrowing households had levels of psychological distress and self-rated health that were similar to people living in non-borrowing households. These predominantly null findings were relatively robust across multiple models. Microcredit households did spend substantially more money on tobacco than non-borrowers. This difference was driven by households with male borrowers. Still, tobacco spending ultimately did not affect health outcomes. Based on empirical evidence from this dissertation along with findings from other studies, policymakers and practitioners should recalibrate their high expectations of microcredit as a socially transformative intervention. At the same time, fears about the unintended health consequences of microcredit may have been exaggerated. Reliance on longitudinal data generated insights into microcredit and health that could not be established from randomized controlled trials.

Economics has become a dominant framework for analysing problems in public health and health care and for proposing policy solutions. A separate subdiscipline of health economics has grown out of the welfare economics tradition to develop specific methods for economic inquiry into health care issues. The encroachment of economics into health care and public health has not occurred without consternation from within the health field. Part of the reason for this concern arises from a mismatch between the worldview of public health and that of mainstream economics. However, this mismatch is largely unexamined, and there has been limited attempt to address the mismatch and to propose alternative approaches to economic questions in public health. This thesis examines the project of public health in some detail, making reference to the consensus documents of the World Health Organization that set out the values base of public health and define its approach and some of its activities. Public health is a collective activity, mostly undertaken outside of markets and is primarily concerned with impacts on populations. It is inherently political and focuses on populations as its unit of analysis. This contrasts to the approach of mainstream economics, which presumes that economic decisions are primarily private decisions and focuses on individuals as its unit of analysis. The differing worldviews constitute an impasse between mainstream economics and this view of public health. The solutions of neo-classical economics are often at odds with the public health approach. An alternative view of economics, from the heterodox Institutional School may provide an alternative approach to economic questions in public health. In contrast to neoclassical economics, it claims to be holistic and not to engage in methodological individualism and to be explicitly concerned with questions of power. The case studies of role of government and ageing as a public health issue provide a lens through which the neoclassical approach can be examined and contrasted to the public health approach. These case studies are based on reports written for Australian governments by neoclassical economists. The two case studies are then inspected from an institutional perspective to examine whether this approach does indeed generate explanations and solutions that are more compatible with a public health approach. Other insights into the reports that can be gained from an institutional perspective are also discussed. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1287041 / Thesis (Ph.D.) -- School of Population Health and Clinical Practice, 2007.

In the first chapter of this dissertation, I ask what role bank presence plays in improving health of households. To explore this question, I use a policy of the Reserve Bank of India from 2005 that incentivizes banks to set up new branches in underbanked districts, defined as having a population-to-branch ratio larger than the national average. In a regression discontinuity design, I compare households in districts just above and just below the national average. Six years after the policy introduction, households in treatment districts are a third less likely to be affected by an illness in a month. They miss fewer days of work or school due to an illness and have lower medical expenses. Ten years after the policy was introduced, I observe persistently lower morbidity rates, higher vaccination rates, and lower risks associated with pregnancies. I provide evidence that two previously understudied aspects of banking contribute to the effect: households gain access to health insurance and health care providers gain access to credit. In equilibrium, I observe an increase in healthcare demand and supply. In the second chapter of this dissertation, co-authored with Naz Koont, we provide first empirical evidence that consumer peer effects matter for banks’ deposit demand. Using a novel measure that depicts for each county how exposed peers are to a specific bank in a given year, we tightly identify the causal effect of peer exposure on deposit demand through a fixed effects identification strategy. We address key empirical challenges such as time-invariant homophily. We find that a one percent increase in a bank’s peer exposure leads to a 0.05 percent increase in deposit market share. This effect has become stronger over time with the rise of the internet and social media, which facilitate cross-county communication. Peer exposure is especially relevant for smaller banks and customers that have access to the internet.

Over the past decade, chronic illnesses have increased significantly in developing regions around the world, with implications for health service provision. Research shows that morbidity follows a social gradient in many countries around the world. Though various studies highlight the importance of socioeconomic status as a predictor of a person’s morbidity and mortality experience, there is a dearth of data and literature in the South African context. This study aimed to address this gap by examining the association between socioeconomic status and diabetes and hypertension among participants aged 35 years and older. This was achieved by undertaking the analysis of secondary data from the National Income Dynamic Study. The findings of the study reveal that there is a significant relationship between socioeconomic factors and chronic health outcomes of individuals. People with lower levels of education were more likely to have a chronic illness than those with higher levels of education. However, interestingly the lowest rates of prevalence were found in the unemployed category in South Africa. This draws attention to the need for further research on employment and chronic disease prevalence. An important finding of the study was the relatively higher prevalence of chronic conditions in rural areas and among the Black/African population. This data suggests that changes in lifestyle and behavior in the context of globalization and urbanization may be contributing to changes in the health profile of these communities. Policy makers need to acknowledge that chronic diseases are no longer the preserve of the wealthy with diseases such as diabetes and hypertension evident across all sectors of South African society. By addressing the causes of chronic conditions policies and programs can aim to prevent the emergence of future epidemics. In the long-term, sustainable progress will only be achieved with greater attention directed towards the socioeconomic factors underlying the health profile of the country. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2011.

Thesis submitted in partial fulfilment of the requirements for the degree Master of Technology in Environmental Management In the Faculty of Applied Sciences Department of Environmental and Occupational Studies At the Cape Peninsula University of Technology / Rivers, lakes and streams are the only way people encounter water sources in urban areas. Human endeavours have consequently deteriorated the environmental quality provided by river systems thus rivers are supporting a fraction of their original biodiversity and abundance. Urban streams are highly valuable and sensitive systems which, can be assessed by means of impacts of urban catchment and pathway influences. Many of the problems associated with environmental quality and management of urban watercourses are as a result of poor public perception. Advances in river assessment and management has come about through the recognition that water resource problems involve biological, physical and chemical components and more recently the addition of social and economic aspects. Social public participation is therefore achieved by studying and acting on people’s values, behaviours and perceptions of environmental quality. The main aim of this research was to identify whether a difference in socio-economic status is an influential factor in people’s perception of environmental quality. The objectives of the research were to determine whether the Elsieskraal River has a perceived low environmental relevance and quality (health and aesthetics), to determine what sensitizes people about issues relating to the natural environment and to identify people’s uses and perceptions of the Elsieskraal River corridor and its importance to the enjoyment as a recreational space. The study used a qualitative approach to obtain the data using the focus group technique. The purposive sample of participants from Pinelands and Thornton were the population that this study sought to investigate. Two focus group discussions; one in each study area was conducted. The results of this study found both similarities and differences in people’s perceptions of the Elsieskraal River between the two different socioeconomic urban communities. The perceived observation that the Elsieskraal River was a canal and not a river set the foundation for the envisaged low environmental quality the river so acquired. The majority overall environmental quality scores for the attributes of aquatic life, vegetation and water quality were found to be lower than they were scientifically found to be. Two clear avenues concerning environmental information sourcing and sensitization to the public was found. Politicians and government officials were unreliable to relay environmental information of a trustworthy nature. Community newspapers were a useful tool to present theevidence of information concerning the status of the natural environment especially at a local level. Three themes namely safety, maintenance and facilities and community attachment emerged on the importance of the Elsieskraal River as a recreational space. It is recommended that further studies should examine the perceptions of other similar rivers in the urban environment, both natural and canalised within Cape Town and the greater South Africa. The findings can assist environmental managers, planners and educators identify the gaps between the scientific environmental conditions and what people’s perceived awareness and knowledge about environmental quality are (factual versus perceived). It is also recommended that emphasis and support from local authorities must be given to non-governmental organisations (NGO’s) and adjacent property owners to aid in mobilising people into “ownership of rivers” within their communities to enhance their value and utilisation.

Abstracts in English and Zulu / Immunisation is a cost-effective public health intervention that contributes to the attainment of the Sustainable Development Goals (SDGs). About 40% of children under the age of five years die from vaccine-preventable diseases in Nigeria. Routine immunisation has been quite low in Nigeria, where national coverage is estimated to be 33%, according to a 2016–2017 survey. This empirical research was aimed at determining the key socio-economic and gender determinants of immunisation in the Federal Capital Territory (FCT), identifying gaps and proffering solutions. Mixed methods of data collection and analysis were used. Data were gathered from several secondary sources and from 11 key informants using semi-structured interviews and 501 household and 26 health-facility surveys using questionnaires mounted on Open Data Kit. Lot quality assurance sampling and probability to population size methodology were used to size the samples and identify survey locations. Odds ratio analysis and logistic regression analysis were conducted to gauge the statistical association between the determinants and the coverage of immunisation. The main finding that was reached on the basis of the documents reviewed and the feedback received from the key informants was that they were gender blind at worst and gender neural at best. Most of the current strategies give little attention to socio-economic and gender barriers. Over 40 immunisation variables were identified. The analysis, particularly using the 2x2 odds ratio, yielded mixed results. The majority of the variables exhibited a close statistical association as far as immunisation indices were concerned. These variables included urban residency, married couples, literacy, birth at a health facility, antenatal care experience, vaccination card possession, immunisation knowledge, child health information, non-farming earnings, socio-economic status and tolerance of spouse beating. On the other hand, variables that were found to have no statistical significance included sex, marital status, marriage type, age, religion, tetanus toxoid (TT) vaccination and adequacy of income. Immunisation and gender are intertwined, particularly because of mothers’ biological and social attachment to their children. At the same time, conducting vaccination avails the opportunity to access almost all households. Moreover, it is important to recognise that socio-economic and gender determinants are not totally in control of one ministry. Single agenda interventions will not produce the desired result. A paradigm shift and the concerted effort of various sectors and partners are required. Therefore, the Nigerian government should galvanise the relevant stakeholders to bring gender and socio-economic variables into the mainstream throughout the immunisation ecosystem and to implement integrated development initiatives by prioritising vulnerable communities. / Ugonyo yindlela engcono yokungenela kwezempilo yabantu engathela esivivaneni ekufinyeleleni izinhloso zentuthuko eqhubekela phambili ezaziwa ngelokuthi yi- Sustainable Development Goals (SDGs). Cishe izingane ezifinyelela ku 40% ezingaphansi kweminyaka emihlanu zibulawa yizifo ezivimbelekayo ngomgcabo emitholampilo eNigeria. Ukugonya njalo kusezingeni eliphansi eNigeria, laphokhona ukwengamela kuzwelonke kulinganiselwa ku 33%, ngokuya kocwaningo olwenziwe phakathi kuka 2016-2017. Ucwaningo lokuthola ubufakazi lwalunenhloso yokubona imithelela yezesimo sabantu nomnotho (socio-economic) kanye nobulili ngokugonya kwi-Federal Capital Territory (FCT) ukubona amagebe kanye nokutholakala kwezixazululo. Amamethodi axubene okuqokelela ulwazi kanye nohlaziyo kwasetshenziswa. Ulwazi lwaqokelelwa ngokufunda imithombo yemibhalo (secondary sources) kanye nakubantu ababalulekile abanolwazi (key informants) abangu 11 ngokusebenzisa ama-semi-structured interview kanye nemizi engu 501 kanye namasurvey amafasilithi ezempilo angu 26 ngokusebenzisa uhla lwemibuzo yamaquestionnaire ebifakelwe kwi-Open Data Kit. Kwasetshenziswa nemethodi ye-Lot quality assurance sampling ne-probability, ngemethodoloji yobuningi babantu, ukwenza usayizi wamasampuli kanye nokubona izindawo okumele kwenziwe kuzo ama-survey. Kwenziwa nohlaziyo lwe-Odds ratio analysis kanye ne-logisic regression analysis ukubona ukuhambelana kwamastatistiki phakathi kwezinto eziwumthelela kanye nokunaba kongamelo lokwenziwa kogonyo. Okukhulu okutholakele ngokulandela amadokhumende okufundwe kuwo, kanye nezimpendulo ezivela kulabo abanolwazi ababalulekile (key informants) kube wukuthi bekungaboneleli ubulili (gender blind) kanti futhi bekungachemile ngokulandela ubulili (gender neutral) ngezinga elibi nangokungcono kakhulu. Amasu amaningi amanje awanakekeli kakhulu izihibe ezimayelana nabantu nezomnotho kanye nezobulili. Kwaphawulwa cishe izinto ezehlukene zama-variable ezingu 40 mayelana nogonyo. Uhlaziyo, ikakhulukazi ngokusebenzisa i 2x2 odds ratio, lwaveza imiphumela exubene. Ezinto zama-variable ehlukene eziningi zikhombise ukuhlobana phakathi kwamastatistiki mayelana namaindices ogonyo. Lama variable, abandakanye ukuhlala emadolobheni, abantu abashadile, ikhono lokubhala nokufunda, ukuzalwa kwezingane kumafasilithi ezempilo, izipiliyoni zonakekelo lwengane ngaphambi kokuzalwa, ukuba nekhadi lomgcabo ix wasemitholampilo, ulwazi ngogonyo, ulwazi ngempilo yengane, ukuthola imali ngemisebenzi engeyona eyokulima, isimo sabantu mayelana nezomnotho, kanye nokuqinisela ukuhlukunyezwa ngokushaywa kwabesimame. Kanti ngakolunye uhlangothi, ama-variable atholakale engenakho ukubaluleka ngokwamastatistiki, abandakanya ubulili, isimo ngokomendo, inhlobo yomendo, iminyaka yobudala, inkolo, umgcabo we-tetanus toxoid (TT), kanye nokwenela kwengeniso lemali. Ugonyo kanye nobulili kuyangenelana nokuhambelana, ikakhulukazi ngenxa yokusondelana komama kanye nezingane zabo. Ngaso leso sikhathi, ukwenziwa kogonyo kuhlinzeka ngethuba lokufinyelela cishe kuwo yonke imizi eminingi. Nangaphezu kwalokho, kubalulekile ukwamukela ukuthi isimo sabantu mayelana nezomnotho kanye nobulili kuyizinto ezinomthelela, azinalo ulawulo oluphelele kumnyango kangqongqoshe owodwa. Ungenelo ngento eyodwa ngeke kwaveza imiphumela efiswayo. Ukugudluka ngokomqondo (paradigm shift), kanye nemizamo eqhubekela phambili yemikhakha ehlukene kanye nabasebenzisani kuyadingeka. Ngakho-ke uhulumeni waseNigeria, kumele agqugquzele ababambiqhaza abafanele ukuhlanganisa nokufaka emkhakheni ofanele izinto ezimayelana nabantu nomnotho kanye nobulili, kuyo yonke inqubo yokusebenzisana kwemikhakha okumele isebenzisane nehlangene ukusebenza ngokulandela inqubo yentuthuko ehlangane ngokubonelela imiphakathi ekwizimo ezibucayi / Development Studies / D. Phil. (Development Studies)