Iskander, Dalia; Picchioni, Fiorella; Zanello, Giacomo; Guermond, Vincent; Brickell, Katherine; (2025) Sick of Debt: How over-indebtedness is hampering health in rural Cambodia. Social Science & Medicine , Article 117678. 10.1016/j.socscimed.2025.117678. (In press).

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Abstract

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.

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