Iskander Dalia, Picchioni Fiorella, Zanello Giacomo, Guermond Vincent, Brickell Katherine
Department of Anthropology, University College London, 14 Taviton St, London, WC1H 0BW, UK.
Food and Markets Department, Natural Resources Institute, University of Greenwich, Central Avenue, Chatham Maritime, Kent, ME4 4TB, UK.
Soc Sci Med. 2025 Feb;367:117678. doi: 10.1016/j.socscimed.2025.117678. Epub 2025 Jan 11.
This paper evidences how many rural poor Cambodians are sick of debt. Based on original, mixed-method data (2020-2022), exploring credit provisioning in this context, the aim of this paper is to illuminate some of the conditions leading to rural Cambodians taking on debt to bolster their health, and the effects this is having on borrowers' physical, psychological, emotional and social health. Specifically, we show how the health of our participants is constrained by a range of major illnesses that many suffer from and their poor food conditions, both exacerbated by the effects of climate change. Against this backdrop, many resort to debt-taking from multiple sources, including microfinance, as a coping strategy to pay for out-of-pocket health expenses and to cover food costs. While such loans offer a short-term means of sustaining health, we show that the extent of debt needed is leading to over-indebtedness which ultimately undermines health in the longer-term. Debtors are pushed to make further undue sacrifices to their food, treatment options and living conditions, specifically to service debt. We show how they are then rendered vulnerable to being exposed to, and experiencing, the negative effects of health and economic shocks, as well as to different forms of psychological, physical, emotional, social, and moral suffering to meet payments. Being sick of debt is especially acute for overindebted women who take on an increased double shift of productive and reproductive work to pay loans. While some of the adverse effects of over-indebtedness are made visible here, we warn that other forms of suffering potentially remain hidden, and will likely be expressed as longer-term population patterns of ill-health. In this context, over-indebtedness is hampering the government's aim of achieving universal health coverage and interventions are needed that reduce the debt crisis among the rural poor in order to improve health.
本文证明了柬埔寨农村有多少贫困人口因债务而困苦不堪。基于2020年至2022年的原始混合方法数据，探讨了这种背景下的信贷供应情况，本文旨在阐明一些导致柬埔寨农村居民举债以改善健康状况的条件，以及这对借款人的身体、心理、情感和社会健康所产生的影响。具体而言，我们展示了参与者的健康如何受到一系列他们中许多人所患的重大疾病以及恶劣饮食条件的限制，而气候变化的影响又加剧了这些问题。在此背景下，许多人诉诸从包括小额信贷在内的多种渠道举债，作为支付自付医疗费用和支付食品费用的应对策略。虽然此类贷款提供了维持健康的短期手段，但我们表明所需债务的规模正导致过度负债，这最终会在长期内损害健康。债务人被迫在食物、治疗选择和生活条件方面做出进一步不合理的牺牲，特别是为了偿还债务。我们展示了他们如何因此变得容易受到健康和经济冲击的负面影响，以及为了偿还债务而遭受不同形式的心理、身体、情感、社会和道德痛苦。对于过度负债的女性来说，因债务而困苦不堪的情况尤为严重，她们承担了更多的生产和生殖工作双重负担来偿还贷款。虽然这里揭示了过度负债的一些不利影响，但我们警告说，其他形式的痛苦可能仍然隐藏着，并且很可能会以长期的不健康人口模式表现出来。在这种情况下，过度负债正在阻碍政府实现全民健康覆盖的目标，因此需要采取干预措施来减少农村贫困人口中的债务危机，以改善健康状况。
