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

A Contingent Valuation Study for Use in Valuing Public Goods with Health Externalities: The Case of Street Pianos

BACKGROUND

Clinical healthcare is not the only way to improve an individual's health. Community-based interventions can have health and wellbeing impacts as well; however, the nature of these interventions, which have public good characteristics, poses challenges for the typical ways in which we value outcomes for use in (health) economic evaluations. The approaches to valuation of these type of interventions should allow for the incorporation of all types of values including option value, externalities and individual use-value.

OBJECTIVE

This is a feasibility study with the objective to re-consider the importance of health externalities when valuing public health interventions that are treated as public goods from an economic perspective.

METHODS

A contingent valuation (CV) survey was designed to elicit individual willingness to pay (WTP) for the public piano programme (PPP). Five different scenarios were designed; three scenarios focussed on individual use-value, while the other two (scenarios 4 and 5) covered option values and externalities. An online survey was conducted with a sample of 105 people.

RESULTS

Preferences differed across the different scenarios. The mean WTP for scenario 1 was £0.81, for scenario 2 £3.65, for scenario 3 £3.07, for scenario 4 £7.26 and for scenario 5 £6.02. The WTP results for each scenario are presented and discussed regarding the nature of the good, user and non-user perspectives, payment vehicles and individual characteristics.

CONCLUSION

This study provides evidence that all types of use are necessary for inclusion in an economic evaluation, especially when the good in question is a public good where its benefits can be obtained from all community members.

Public health and social entrepreneurs as activators of equitable health ecosystems

OBJECTIVES

To describe approaches that public health and social entrepreneurs take to address health equity, and identify strategies for equitable collaborations with these entrepreneurs.

METHODS

We leveraged data from semi-structured interviews, conducted August to October 2022, with 20 public health and social entrepreneurs who focus on drivers of health and health equity. Two researchers employed content analysis, guided by a prior framework.

RESULTS

To support health equity, public health and social entrepreneurs: center equity, critique biases, innovate for inclusion, engage translational expertise, catalyze capacity, and activate equitable systems. Equitable collaborations are supported by re-examining roles, de-conflicting organizational barriers, prioritizing representation, mitigating bias in generating evidence, and employing equitable capital.

CONCLUSIONS

Public health and social entrepreneurs can uplift equity across health service design and delivery. More equitable collaborations can advance this work.

Common health assets protocol: a mixed-methods, realist evaluation and economic appraisal of how community-led organisations (CLOs) impact on the health and well-being of people living in deprived areas

INTRODUCTION

This research investigates how community-led organisations' (CLOs') use of assets-based approaches improves health and well-being, and how that might be different in different contexts. Assets-based approaches involve 'doing with' rather than 'doing to' and bring people in communities together to achieve positive change using their own knowledge, skills and experience. Some studies have shown that such approaches can have a positive effect on health and well-being. However, research is limited, and we know little about which approaches lead to which outcomes and how different contexts might affect success.

METHODS AND ANALYSIS

Using a realist approach, we will work with 15 CLOs based in disadvantaged communities in England, Scotland and Northern Ireland. A realist synthesis of review papers, and a policy analysis in different contexts, precedes qualitative interviews and workshops with stakeholders, to find out how CLOs' programmes work and identify existing data. We will explore participants' experiences through: a Q methodology study; participatory photography workshops; qualitative interviews and measure outcomes using a longitudinal survey, with 225 CLO participants, to assess impact for people who connect with the CLOs. An economic analysis will estimate costs and benefits to participants, for different contexts and mechanisms. A 'Lived Experience Panel' of people connected with our CLOs as participants or volunteers, will ensure the appropriateness of the research, interpretation and reporting of findings.

ETHICS AND DISSEMINATION

This project, research tools and consent processes have been approved by the Glasgow Caledonian University School of Health and Life Sciences Ethics Committee, and affirmed by Ethics Committees at Bournemouth University, Queen's University Belfast and the University of East London. Common Health Assets does not involve any National Health Service sites, staff or patients.Findings will be presented through social media, project website, blogs, policy briefings, journal articles, conferences and visually in short digital stories, and photographic exhibitions.

The health impacts of place-based creative programmes on older adults' health: A critical realist review

Place-based creative programmes can help alleviate the structural and place-related problems that affect older adults' health. However, it is unclear why these programmes achieve positive outcomes, and how these may vary across contexts. This critical realist review aimed to address these gaps. We were able to evidence why these programmes may work for older people's mental, social and physical health. Place-based creative programmes impact on health because they support social relatedness, motivation, self-continuity and self-efficacy. However, the circumstances under which and for whom these programmes work remain hidden since existing studies do not report sufficiently on context. We set out some of the general aspects of context that could form the basis of minimum standards for reporting.

Men's Sheds in Scotland: the potential for improving the health of men

Recent policy focus is on the 'non-obvious' role of community-based organisations in tackling causes of poor health, such as social exclusion. Men's Sheds are a type of community-based organisation offering health and wellbeing benefits to men, despite this not being the explicit reason they exist. A qualitative study was conducted in Scotland to identify sustainability challenges that impact on the ability of Sheds to become a formal healthcare service. Findings showed that a reliance on ageing and retired volunteers to undertake operational tasks and generate income to fund activities affected the ability of Sheds to sustain and develop. Further, members preferred their Sheds to remain informal and flexible to fit their specific needs. Although Sheds are recognised for their health and wellbeing benefits to men, policymakers must recognise that formalising their activities might detract from the Shed's primary aims. This paper summarises specific policy implications and recommendations, taking into consideration tensions between the expectations placed on Sheds to expand into formal healthcare delivery, and the needs of Shed users. HIGHLIGHTS: Men's Shed are known for their ability to contribute to men's health and wellbeing. The potential of Shed to take on a formal healthcare role is questionable because of a reliance on ageing and retired volunteers and a preference to remain informal. Policymakers must recognise that although Sheds might be well placed to offer formal health care this may detract from their primary aims.

The health and well-being impacts of a work integration social enterprise from a systems perspective

Recent research has drawn upon the social determinants of health (SDH) framework to attempt to systematize the relationship between social enterprise and health. In this article, we adopt a realist evaluation approach to conceptualize social enterprises, and work integration social enterprises in particular, as 'complex interventions' that necessarily produce differential health outcomes for their beneficiaries, communities and staff. Drawing upon the findings from four social enterprises involving a range of methods including 93 semi-structured interviews with employees, managers and enterprise partners, together with participant observation, we demonstrate that these health outcomes are influenced by a limitless mix of complex and dynamic interactions between systems, settings, spaces, relationships and organizational and personal factors that cannot be distilled by questions of causality and attribution found in controlled trial designs. Given the increased policy focus on the potential of social enterprises to affect the SDH, this article seeks to respond to evidence gaps about the mechanisms and contexts through which social enterprises promote or constrain health outcomes, and thereby provide greater clarity about how research evidence can be used to support the social enterprise sector and policy development more broadly.

Microcredit as a public health initiative? Exploring mechanisms and pathways to health and wellbeing

The widening health gap between the best and worst-off in the UK requires innovative solutions that act upon the social, economic and environmental causes of ill-health. Initiatives such as microcredit have been conceptualised as having the potential to act on the social determinants of health. However, pathways that lead to this impact have yet to be empirically explored. People living on low incomes, who are financially-excluded, require access to credit to cope with everyday financial needs. While research shows the connections between debt and health, this link is often focused on over-indebtedness and negative health outcomes. In this paper, we investigate the impact of responsibly-delivered credit on the health and wellbeing of borrowers. In 2016-17, in-depth, semi-structured interviews were undertaken with fourteen borrowers from two microcredit providers offering personal and business microloans, operating in Glasgow, United Kingdom. Findings are presented, using social determinants of health as an analytic lens, and illustrated in a conceptual model explaining the loan mechanisms and pathways connecting microcredit to health and wellbeing. Microcredit, and the mechanisms through which it is delivered, were perceived by participants as positively impacting on their health and wellbeing. Access to flexible, responsibly-delivered, microloans enabled participants to plan and feel secure when faced with (un)expected financial events, reducing the associated stress, sustaining social relationships and empowering borrowers to take greater control over their lives. For some, receiving microcredit was stressful, as it is still a debt that needs to be repaid. Such stress can also be exacerbated by particular aspects of the lending model; for example, group lending. Our results contribute to growing evidence on the impact of financial inclusion approaches on health and wellbeing, highlighting the potential role of microcredit as a public health initiative and the need to support 'alternative' economic spaces in the UK to serve the financially-excluded.

Working Conditions in Social Firms and Health Promotion Interventions in Relation to Employees' Health and Work-Related Outcomes-A Scoping Review

Background: Social firms—a type of social enterprise—offer people with severe disabilities the possibility of employment and integration into the labor market. Since 01 January 2018, social firms in Germany are obligated to provide health promotion interventions for their employees. Therefore, the study aims to provide an overview of the current state of research on working conditions, coping strategies, work- and health-related outcomes, and health promotion interventions in social firms to derive recommendations for action. Methods: The databases PubMed, MEDLINE, PsycINFO, PSYNDEX, CINAHL, and Web of Science were searched. The study selection was based on predefined inclusion and exclusion criteria in the time period between 2000 and 2019. The quality of the studies was critically appraised in a standardized way using the Mixed-Methods Appraisal Tool. Results: A total of 25 studies were included. The current state of research indicated that employees with disabilities were provided with several environmental resources like social support, flexibility, structured work tasks or options for training. A mix of environmental and personal resources impacted several work- and health-related outcomes like well-being, job satisfaction, productivity, work engagement, the motivation to work, or job tenure. Conclusions: There is a need for further (longitudinal) research concerning the work and health situation of employees working in social firms and the development of health promotion interventions.

Understanding Motivations for Volunteering in Food Insecurity and Food Upcycling Projects

For non-profit organizations relying on volunteers to operate, investigations into the motivations of volunteerism are critical to attract new volunteers and to support the current ones. This study looked at volunteerism in the not-for-profit project The SEED in Ontario, Canada, which is looking to address food insecurity through a new social enterprise project that will create value-added “upcycled” products from second-grade produce while offering training opportunities for youth facing barriers to employment. The aims of this paper were to explore why volunteers chose to offer their time to this project and to gauge the current volunteers’ interest in volunteering with the organization’s new “Upcycle Kitchen”. Thirty-seven volunteers responded to a self-administered survey. They reported altruism, self-development, and social life improvement as their main motivations for volunteering. The volunteers expressed enthusiasm toward the Upcycle Kitchen initiative, which seems to be attributable to the multidimensional, creative, and educational aspects of the project. Tackling food insecurity and reducing the environmental impact of food waste are values which would most likely influence the respondents’ willingness to volunteer in food upcycling activities. We believe that this study is a good model to learn about the many facets of volunteerism for social enterprises developing upcycling-based food projects.

Understanding the low cost business model in healthcare service provision: A comparative case study in Italy

The cost of medical treatments may undermine timely and effective access to healthcare. We believe it is useful to examine innovative business models recently introduced in European countries, borrowing from less developed economies. This paper aims to analyze new business models of healthcare service provision that have recently been introduced in Italy, and its social component. In particular, we analyze the low cost business model in Italian healthcare. We carried out a comparative case study of three Italian low-cost organizations. The cases were selected using four social criteria: start-up capital; social value proposition; social value equation; and social profit equation. From the comparative case study, six main themes emerged: 1. Social relationships; 2. recruiting and engagement of medical and nursing personnel; 3. economies of scale; 4. cross subsidization; 5. management of financial surpluses; 6. patient involvement and participation. The cases reveal new ways of healthcare service provision and unravel innovative organizational dimensions falling into the low cost business model. The organizations both maximize profit and respond to the social need for healthcare at relatively low costs. The low cost business model is therefore able to respond to the demand for affordable healthcare, while providing social innovation.

Conceptualizing the health and well-being impacts of social enterprise: a UK-based study

Social enterprises-businesses that work for social benefit rather than for the maximization of financial returns to shareholders or owners-could potentially prove to be an innovative and sustainable way of tackling 'upstream' social determinants of health. However, empirical work focusing upon how, and to what extent, social enterprise-led activity may impact upon health and well-being is still relatively scarce. This study examines how social enterprises portray their impact, and how such impacts may be considered in health and well-being terms. Through analysing evaluative reports of the work of social enterprises in Scotland (n = 17) utilizing a 'process coding' method, we investigate both the self-reported impacts of the work of social enterprises and the mechanisms by which these are said to be derived. Revisiting previous conceptualizations in the extant literature, this work allows us to present an 'empirically-informed' conceptual model of the health and well-being impacts of social enterprise-led activity, and thus presents a significant advance on previous hypothetical, theoretically-based conceptualizations. It is considered that these findings further improve our overall knowledge of ways in which social enterprise and other parts of the third sector could be considered as potentially valuable 'non-obvious' public health actors.

Differentiating the effect of social enterprise activities on health

An emerging stream of literature has focused on the ways in which social enterprises might act on the social determinants of health. However, this previous work has not taken a sufficiently broad account of the wide range of stakeholders involved in social enterprises and has also tended to reduce and simplify a complex and heterogeneous set of organisations to a relatively homogenous social enterprise concept. In an attempt to address these gaps, we conducted an empirical investigation between August 2014 and October 2015 consisting of qualitative case studies involving in-depth semi-structured interviews and a focus group with a wide variety of stakeholders from three social enterprises in different regions of Scotland. We found that different forms of social enterprise impact on different dimensions of health in different ways, including through: engendering a feeling of ownership and control; improving environmental conditions (both physical and social); and providing or facilitating meaningful employment. In conclusion, we highlight areas for future research.