Conceptualising the public health role of actors operating outside of formal health systems: the case of social enterprise

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Abstract

This paper focuses on the role of actors that operate outside formal health systems, but nevertheless have a vital, if often under-recognised, role in supporting public health. The specific example used is the ‘social enterprise’, an organisation that seeks, through trading, to maximise social returns, rather than the distribution of profits to shareholders or owners. In this paper we advance empirical and theoretical understanding of the causal pathways at work in social enterprises, by considering them as a particularly complex form of public health ‘intervention’. Data were generated through qualitative, in depth, semi-structured interviews and a focus group discussion, with a purposive, maximum variation sample of social enterprise practitioners (n = 13) in an urban setting in the west of Scotland. A method of analysis inspired by critical realism – Causation Coding – enabled the identification of a range of explanatory mechanisms and potential pathways of causation between engagement in social enterprise-led activity and various outcomes, which have been grouped into physical health, mental health and social determinants. The findings then informed the construction of an empirically-informed conceptual model to act as a platform upon which to develop a future research agenda. The results of this work are considered to not only encourage a broader and more imaginative consideration of what actually constitutes a public health intervention, but also reinforces arguments that actors within the Third Sector have an important role to play in addressing contemporary and future public health challenges.
Original languageEnglish
Pages (from-to)144-152
Number of pages9
JournalSocial Science and Medicine
Early online date9 Nov 2016
DOIs
Publication statusPublished - Jan 2017

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Public Health
public health
Health
health
Causality
distribution of profits
shareholder
Scotland
Focus Groups
realism
group discussion
coding
Mental Health
mental health
Interviews
determinants
Enterprise
interview
Pathway
Causation

Keywords

  • public health
  • social enterprise

Cite this

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abstract = "This paper focuses on the role of actors that operate outside formal health systems, but nevertheless have a vital, if often under-recognised, role in supporting public health. The specific example used is the ‘social enterprise’, an organisation that seeks, through trading, to maximise social returns, rather than the distribution of profits to shareholders or owners. In this paper we advance empirical and theoretical understanding of the causal pathways at work in social enterprises, by considering them as a particularly complex form of public health ‘intervention’. Data were generated through qualitative, in depth, semi-structured interviews and a focus group discussion, with a purposive, maximum variation sample of social enterprise practitioners (n = 13) in an urban setting in the west of Scotland. A method of analysis inspired by critical realism – Causation Coding – enabled the identification of a range of explanatory mechanisms and potential pathways of causation between engagement in social enterprise-led activity and various outcomes, which have been grouped into physical health, mental health and social determinants. The findings then informed the construction of an empirically-informed conceptual model to act as a platform upon which to develop a future research agenda. The results of this work are considered to not only encourage a broader and more imaginative consideration of what actually constitutes a public health intervention, but also reinforces arguments that actors within the Third Sector have an important role to play in addressing contemporary and future public health challenges.",
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note = "Accepted: 7 November 2016 Online pub: 9 November 2016 Gold OA Funding note: This study was supported with the financial assistance of the Medical Research Council and Economic and Social Research Council, ref: MR/L0032827/1 for a project entitled Developing Methods to evidence ‘social enterprise as a public health intervention’. Compliant with funder policy (in EuroPMC)",
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