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. </jats:p

Social impact bonds: a wolf in sheep’s clothing?

This article provides a rounded critique of social impact bonds (SIBs): a newly developed and innovative financial investment model, developed in the UK and starting to spread internationally that could transform the provision of social services. Although SIBs have the potential to influence delivery by all providers, this article raises three concerns about their possible effects – in relation to their potential outcomes, unintended consequences for the UK third sector, and governance – and then reflects on SIBs as the latest manifestation of the ideological shift which the UK third sector is undergoing.</jats:p

The new merger: combining third sector and market-based approaches to tackling inequalities

In this paper we discuss the challenge posed by growing inequalities, specifically health inequalities, which have grown increasingly wider in recent decades. Rather than arguing for a wholesale return to state intervention to curb the worst excesses of the market, we put forward a less obvious potential solution, arguing for a greater role - and greater recognition - for the 'social economy': the part of the third or non-profit sector concerned with trading in the market rather than relying upon public funds or charitable donations to stay in business. We present three examples of such organisations, drawn from the UK, and discuss how doing business in such a way presents obvious benefits for, but challenges to, existing thinking, particularly in relation to how 'success' should be measured

Public perspectives on health improvement within a remote-rural island community

Abstract Background Rural health outcomes are often worse than their urban counterparts. While rural health theory recognizes the importance of the social determinants of health, there is a lack of insight into public perspectives for improving rural health beyond the provision of health‐care services. Gaining insight into perceived solutions, that include and go beyond health‐ care, can help to inform resource allocation decisions to improve rural health. Objective To identify and describe shared perspectives within a remote‐rural community on how to improve rural health. Method Using Q methodology, a set of 40 statements were developed representing different perceptions of how to improve rural health. Residents of one remote‐rural island community ranked this statement set according to their level of agreement. Card‐sorts were analysed using factor analysis to identify shared points of view and interpreted alongside post‐sort qualitative interviews. Results Sixty‐two respondents participated in the study. Four shared perspectives were identified, labelled: Local economic activity; Protect and care for the community; Redistribution of resources; and Investing in people. Factors converged on the need to relieve poverty and ensure access to amenities and services. Discussion and conclusions Factors represent different elements of a multifaceted theory of rural health, indicating that ‘lay’ respondents are capable of comprehending various approaches to health improvement and perspectives are not homogenous within rural communities. Respondents diverged on the role of individuals, the public sector and ‘empowered’ community‐based organizations in delivering these solutions, with implications for policy and practice. Public Contribution Members of the public were involved in the development and piloting of the statement set