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

Brexit, division and individual solidarity: what future for Europe? Evidence from eight European countries

Solidarity among member states, one of the European Union’s (EU) fundamental values, has recently been put to the test by numerous and diverse challenges that have led to a “crisis of solidarity.” In the United Kingdom, the decision in June 2016 by the electorate to vote to leave the EU revealed the British dimension of this crisis. However, little is known about the perceptions of other European citizens on this decision, even though it has contributed to shaping the present and future of the EU. In this article, using a representative survey conducted in eight European countries, including the United Kingdom, we aim to explore and contrast cross-country evidence on individual perceptions on Brexit. We then aim to establish if an association exists between the opinions on Brexit and the individual solidaristic attitudes and concrete behaviors of the survey respondents. The complex relationship between opinions on this event and expressions of solidarity at different levels (local, national, European, and beyond) will be explored using multivariate regression techniques as well as the demographic and socioeconomic characteristics of the survey respondents

Intended and unintended effects of specialized regulation on microfinance institutions’ double‐bottom line management

Taking advantage of the passage of a microfinance law in Italy (2014), we explore the rationales for introducing microfinance-specific regulation in high-income welfare states and the potential effects that this process may have on MFIs’ social and financial performances (i.e. double bottom line). Our findings suggest that the institutional transformation of MFIs, in addition to product design and target group required by the new regulation, has unintendedly shifted their balance in favor of financial over social performance. This mainly applies to non-profit organizations and cooperatives. Microfinance-specific regulation in high-income welfare states may reflect the emerging trends of market-based rationality of public policy. When regulatory arrangements for MFIs are stipulated irrespectively of MFIs’ original mission the structural causes of financial exclusion may be reinforced. The underlying rationales for this trade-off should be considered to prevent and mitigate the unintended effects of microfinance-specific regulation

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

Regulating Fortress Britain: Migrants, Refugees and Asylum Applicants in the British Labour Market

The purpose of this chapter is to provide a detailed overview of the UK legal and institutional factors at the macro-level that can be regarded as decisive for explaining the effective capacity of the country to integrate migrants, refugees and asylum seekers into the labour market. By doing so, we aim to better understand the conditions within which integration policies for migrants, refugees and asylum applicants (MRA) may take place. We begin by providing an insight into the social and cultural context of migration in the UK, firstly by looking at the history of migration and the social and political instabilities of the country. Furthermore, we investigate how legislation concerning migration and asylum has developed within the UK context across the decades and analyse how legislation has been translated by UK policymakers in recent years. We then examine the current constitutional organisation of the British state, highlighting the importance of case law in developing MRA integration. Following this, we outline key legislation concerning the integration of MRA in the British labour market. The chapter then provides a critical overview of the integration strategies (or the lack thereof) promoted at the national level, outlining the institutional challenges that affect integration. We then conclude by highlighting the possible impact that Brexit will have on an already ‘hostile environment’ for migration

Microfinance trials on trial

Microfinance has attracted great attention, stimulated, initially, by its association with the award of the Nobel Prize for Peace, based on its transformative potential in addressing poverty. However, work based on randomised trials associated with the award of the Memorial Prize in Economic Sciences, put the brakes on. As health economists, and given their promotion as a ‘gold standard’ method borrowed from medicine, we take a particular perspective on the microfinance trials. We question whether full account had been taken of methodological developments in the health arena that were in place before the microfinance trials were embarked upon. This may help explain the outcomes of research, subsequent to the trials, casting doubt on their initial results, but also aid calls for even greater attention to be paid to developments in health evaluations–many drawing from social science more broadly–to better explain what works for whom in which circumstances.</p

The health impacts of place-based creative programmes on older adults’ health: a critical realist review

Place-based creative programmes can help alleviate the structural and place-related problems that affect older adults' health. However, it is unclear why these programmes achieve positive outcomes, and how these may vary across contexts. This critical realist review aimed to address these gaps. We were able to evidence why these programmes may work for older people's mental, social and physical health. Place-based creative programmes impact on health because they support social relatedness, motivation, self-continuity and self-efficacy. However, the circumstances under which and for whom these programmes work remain hidden since existing studies do not report sufficiently on context. We set out some of the general aspects of context that could form the basis of minimum standards for reporting