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

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.

How can social enterprises impact health and well-being?

“…One type of intervention that may have the potential to influence health and wellbeing is that of social enterprise (Roy et al, 2017, Roy et al, 2014. While significant energy has been applied to the definition and meaning of social enterprise (Shaw and De Bruin, 2013), it remains a contested concept (Teasdale, 2011).…”

Understanding Motivations for Volunteering in Food Insecurity and Food Upcycling Projects

“…In recent years, several social enterprises have shifted towards addressing the marginalization of individuals who experience barriers to full social participation and are working to reduce stigma directed towards this demographic (Lysaght et al 2012). These social enterprises may aim to help by providing meaningful work, creating a safe and supportive environment, cultivating knowledge and skills, expanding social networks, and building trust and cooperation (Roy et al 2017). In addition, they may also act by increasing access to information and working to improve public awareness and understanding of social issues (Roy et al 2017).…”

“…The rescued food may be distributed for free, sold at a reduced fee at social marketplaces, or upcycled into new products Sedlmeier et al 2019). Current research in food insecurity is focused on the stability of these services and how to reduce stigma and improve the dignity for the clients which access these services (Bedore 2018;Booth et al 2018;Gordon et al 2018;McKay et al 2018;Roy et al 2017).…”

From wealth to health: Evaluating microfinance as a complex intervention

“…In this article, we argue that 'microcredit' has the potential to be considered as a non-obvious public health measure. By 'non-obvious', we mean that such initiatives possess characteristics that act on upstream determinants of health even if the initiatives do not recognize this in their stated objectives or missions (Roy et al, 2016).…”