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      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.

          Highlights

          • Considers the health role of actors outside of formal health systems.

          • Focuses upon the example of social enterprise.

          • Presents empirically-informed conceptual model of causal pathways.

          • Encourages a more imaginative consideration of what we think of as an ‘intervention’.

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          Most cited references 41

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          Proximal, distal, and the politics of causation: what's level got to do with it?

           Nancy Krieger (2008)
          Causal thinking in public health, and especially in the growing literature on social determinants of health, routinely employs the terminology of proximal (or downstream) and distal (or upstream). I argue that the use of these terms is problematic and adversely affects public health research, practice, and causal accountability. At issue are distortions created by conflating measures of space, time, level, and causal strength. To make this case, I draw on an ecosocial perspective to show how public health got caught in the middle of the problematic proximal-distal divide--surprisingly embraced by both biomedical and social determinist frameworks--and propose replacing the terms proximal and distal with explicit language about levels, pathways, and power.
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            Establishing rigour in qualitative research: the decision trail. 1993.

             Karel Koch (2005)
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              What’s in a Name? Making Sense of Social Enterprise Discourses

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                Author and article information

                Contributors
                Journal
                Soc Sci Med
                Soc Sci Med
                Social Science & Medicine (1982)
                Pergamon
                0277-9536
                1873-5347
                1 January 2017
                January 2017
                : 172
                : 144-152
                Affiliations
                [a ]Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
                [b ]School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
                [c ]Glasgow School for Business and Society, Glasgow Caledonian University, Glasgow, UK
                Author notes
                []Corresponding author. Cowcaddens Road, Glasgow, G4 0BA, UK.Cowcaddens RoadGlasgowG4 0BAUK michael.roy@ 123456gcu.ac.uk
                Article
                S0277-9536(16)30618-9
                10.1016/j.socscimed.2016.11.009
                5223783
                27842999
                © 2016 The Author(s)

                This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

                Categories
                Article

                Health & Social care

                uk, social enterprise, public health, conceptual modelling, logic models

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