In 1983, Muhammad Yunus founded the Grameen Bank to provide credit and banking services to the rural poor in Bangladesh; in 2006, Yunus and the bank won the Nobel Peace Prize.1 The success of the Grameen Bank was based on the idea that lack of financial capital prevents poor people from achieving greater financial success and that by giving poor people just a small amount of startup capital (less than $100), they can start small businesses that benefit their families and communities. In this way, the Grameen Bank has been very successful in helping people get out of poverty. Despite not having legal contracts between the bank and the borrowers, loan repayment rates are reportedly very high, on the order of 98%.
Weight Watchers is an international organization that helps people lose weight. Obviously, the key to success in any weight loss program is burning more energy through exercise and other activity than one eats. Weight Watchers encourages the development of helpful habits, smarter diet and exercise using a system of “counting points.” Participation in Weight Watchers is said to lead to three-fold greater weight loss than non-participation.
The lending programs of Grameen Bank and the weight loss programs of Weight Watchers are very different, yet in both cases, success is based on changing people’s behaviors. Do these programs have anything in common? Perhaps it is not obvious from the usual descriptions of these programs, but an essential, probably the essential factor that makes these programs successful is incorporation of a supportive social group that provides caring and accountability.
It’s true that microlending involves giving poor people, typically women, a small amount of money (perhaps as little as $25), but with the money comes required participation in a solidarity program. Borrowers must be organized into groups of five borrowers. The group meets weekly to discuss the progress of the borrowers’ businesses, what was done to promote sales that week, what was done with the money that was received. These weekly meetings promote accountability. Similarly, a key component of the Weight Watchers program is participation in weekly meetings that give members support and accountability.
I’m not convinced that the money lent by Grameen Bank or the points system used by Weight Watchers contributes much to people’s success in these programs. More likely, the social incentives inherent in group participation provide accountability and a sense of caring that drives people toward better adherence to the program. These interpersonal interactions are powerful motivators for adherence that can and should be used to promote patients’ adherence to medical treatments.
1. To Catch a Dollar. http://www.tocatchadollar.com/about-grameen/. Accessed June 9, 2013.