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Trevor Hancock: The new public-health entrepreneurs

There is a lot of money to be made from making us ill. The No. 1 example is the tobacco industry, whose products, if used as intended, are bound to make us ill.

There is a lot of money to be made from making us ill. The No. 1 example is the tobacco industry, whose products, if used as intended, are bound to make us ill.

But close behind it is the food industry, which for years has been selling us both too much food and the wrong sorts of food. Then there are the alcohol industry, the car industry, the firearms industry and many others; on top of that are all the businesses that reduce their costs by causing pollution or occupational injuries and illnesses — it’s a long list.

Our standard response — and it’s a valid one — is to educate people about the hazards they face and to regulate, tax or otherwise seek to control these industries. But a new approach is emerging, not to replace these approaches, but to complement them: Compete with these pathogenic businesses in the marketplace, and perhaps in the process induce them to change their ways.

To some extent that has been happening for decades; health-food stores, low-fat or low-sugar products, low alcohol or de-alcoholized drinks and so on.

In the past few years, however, this has been taken further with the advent of public-health entrepreneurs, as part of the wider interest in social entrepreneurship.

Social Enterprise Canada says social enterprises are businesses that “create community impacts and social values”; moreover, “they limit or don’t have distribution of profits and assets to individual shareholders.” As such, their bottom line is both financial and social — “the simultaneous achievement of both economic and social values.”

In Canada, the concept of social enterprise has recently caught the attention of the Institute of Population and Public Health, which is part of the Canadian Institutes of Health Research.

In early 2015, the IPPH held a workshop on “New pathways to health and well-being through social enterprise.” Its understanding of social enterprise is that it includes a focus on the common good and on addressing social vulnerability, with profits used for social or community benefit. The workshop participants identified many potential health benefits, noting that social enterprises could focus on broad social determinants of health such as food and housing, as well as benefits from local employment and improved community relationships.

This concept is beginning to go mainstream within public health. Several U.S. schools of public health offer courses or programs in social entrepreneurship, although many of them seem in practice to be focused on health care as much as on improving the health of the population. And here in B.C., Paola Ardiles, a lecturer in Simon Fraser University’s Faculty of Health Sciences, together with Shawn Smith from the Beedie School of Business, has been teaching a course called Health Change Lab, in which students create projects designed to affect health and well-being in the community.

In a 2014 article in Public Health Reports, the authors defined public-health entrepreneurs as social entrepreneurs “with a specific emphasis on achieving health impacts” and as “enterprises rooted in health promotion, disease prevention, health-care services and the social determinants of health.” They identified several industries that they thought were “ripe for public-health entrepreneurs.”

These included the design and development of healthy homes and healthy urban revitalization; sustainable approaches to water, waste, energy and food production; the creation of healthy food stores, food co-ops, and cooking and food preparation classes; and alternative/active transportation options. Other industries mentioned are education and social services, fitness and recreation, holistic health, information and communications, organizational support services and consulting, and product development.

Fresh Fare, one of the winners of an annual Innovation in Action competition at the University of Michigan School of Public Health that began in 2013, gives a sense of what is possible. It established links “between grocery retailers and a ride-share program to enable transportation-limited individuals to shop for healthy foods in well-stocked grocery stores.” This points to another approach that has also been tried in the U.S., the Healthy Corner Store, of which more in the coming weeks.

Clearly, there is much scope for health promoters both to work with and work within these and other business and non-profit sectors that, collectively, are working to create a healthier future.


Dr. Trevor Hancock is a professor and senior scholar at the University of Victoria’s school of public health and social policy.

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