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s a junior majoring in economics at Harvard in 2004, Heather Schofield was searching for a senior thesis topic when a confluence of coursework and real life gave her direction. Within weeks of enrolling in Harvard's first-ever global health course for undergraduates, "Introduction to Global Health and Population," Schofield learned that her father, a Save the Children volunteer, had come back from Ethiopia with drug-resistant malaria. Soon afterward, Schofield, then 21, found a lump in her breast. By the end of that semester, both health crises had subsided--dad's fever fell; daughter's tumor proved benign--and Schofield was thinking deeply about the link between her economics studies and the public's health. With her professor, the Harvard School of Public Health's David Bloom, as her mentor, and with a bit of inspiration from her dad, a semi-retired financial advisor with a DBA from Harvard Business School, she decided to explore the impact of small loans ("microlending") on the health of impoverished families in Indonesia.

Schofield's research turned up a finding that sounds intuitive, but had never been spotted before: Micro-loans as small as $100 seem likely to make families healthier in the long term. "Heather's the first to look systematically at microfinance and health," says Bloom, who is the Clarence James Gamble Professor of Economics and Demography and chair of the Department of Population and International Health at HSPH. "She's produced something of bona fide academic value. In evaluating whether microfinance is a good thing, we need to know the full set of benefits"--health included. With Bloom's encouragement, Schofield enrolled in a master's degree program at HSPH last September.

INVESTING IN FAMILIES
Coined in the late 1970s, "microfinance" is an umbrella term for all kinds of financial services, from loans to savings accounts to insurance, for people traditionally seen as ineligible for these vehicles, including the roughly 2.8 billion who live on less than $2 U.S. a day. The first micro-bank, the Grameen Bank, opened 30 years ago in Bangladesh, when a local economist asked the government for help in providing credit to the rural poor. Today Grameen Bank, like others around the world, helps families overcome poverty by freeing them from a cycle of borrowing from moneylenders, whose usurious practices can make economic progress impossible.

Roughly 80 percent of the world's 70 million microfinance users are women, targeted by lenders to give them control over assets. Women are more likely than men to repay their loans, and they tend to spend their earnings on their families. With as little as $100, a woman can perhaps buy a cart she needs to sell her wares, pay off the loan within months, and generate more income--which she can then spend on food, clothing, education, and health care, and even reinvest. The United Nations named 2005 the Year of Microcredit in an effort to raise this strategy's profile.
Most microfinance research has focused on how it empowers women, or lifts people above the poverty line. "There wasn't any broad study of what happens to people's health," says Schofield. So she analyzed data from nationwide surveys in Indonesia done over half a dozen years ending in 2001, taking a look at people's health and borrowing histories. Schofield focused on two categories of health outcomes: direct, as in days of work a person missed due to illness; and indirect, as in their knowledge of where the closest health facilities are and child immunization. She then compared changes in these categories against microfinance use.

LIFE-ENHANCING LOANS
Schofield showed that microfinance users have improved health prospects, owing to increases in income, improved knowledge of health, augmented decision-making power for women, and consequent changes in household behavior. For example, households that participate in micro-credit programs are likely to spend more on food and more on clean cooking fuels, and have better knowledge about contraception.

"Heather's work is extraordinary," says Bloom, citing, in addition to her path-breaking results, the complexity of the dataset whose use she mastered and analyzed using advanced statistical methods.

Schofield is one of many Harvard undergraduates who were inspired by Bloom's course to write senior theses on public health issues. (The Class of 2005 voted Bloom one of their top 20 professors.) Members of this group formed a new senior thesis research seminar run by Bloom's colleague, David Canning, professor of economics and international health. A third undergraduate public health offering, "Global Health Challenges," is taught by Christopher Murray, director of the Harvard Initiative for Global Health and HSPH's Richard Saltonstall Professor of Population Policy.

While at HSPH, Schofield hopes to publish her thesis findings. She wants to take as many classes as she can before deciding on a career track (and, once again, a thesis--and perhaps also a doctorate). Having traveled a good deal as a child, she plans to continue to do that, training her eyes on the ways health and economic development intersect. "I love the fact that public health has so many disciplines coming into play," she says. "There are so many ways to look at each problem."

Illustration, Polly Becker; photograph, Kent Dayton/HSPH

Katharine Dunn writes about science, technology, and medicine for the Boston Globe, Science and Spirit, and Technology Review.


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