Michael J. Roy

The potential of social enterprise to enhance health and well-being: A model and systematic review

In recent years civil society organisations, associations, institutions and groups have become increasingly involved at various levels in the governance of healthcare systems around the world. In the UK, particularly in the context of recent reform of the National Health Service in England, social enterprise - that part of the third sector engaged in trading - has come to the fore as a potential model of state-sponsored healthcare delivery. However, to date, there has been no review of evidence on the outcomes of social enterprise involvement in healthcare, nor in the ability of social enterprise to address health inequalities more widely through action on the social determinants of health. Following the development of an initial conceptual model, this systematic review identifies and synthesises evidence from published empirical research on the impact of social enterprise activity on health outcomes and their social determinants. Ten health and social science databases were searched with no date delimiters set. Inclusion and exclusion criteria were applied prior to data extraction and quality appraisal. Heterogeneity in the outcomes assessed precluded meta-analysis/meta-synthesis and so the results are therefore presented in narrative form. Five studies met the inclusion criteria. The included studies provide limited evidence that social enterprise activity can impact positively on mental health, self-reliance/esteem and health behaviours, reduce stigmatization and build social capital, all of which can contribute to overall health and well-being. No empirical research was identified that examined social enterprise as an alternative mode of healthcare delivery. Due to the limited evidence available, we discuss the relationship between the evidence found and other literature not included in the review. There is a clear need for research to better understand and evidence causal mechanisms and to explore the impact of social enterprise activity, and wider civil society actors, upon a range of intermediate and long-term public health outcomes.

Social enterprise: New pathways to health and well-being?

In this article we attempt to make sense of recent policy directions and controversies relating to the ‘social enterprise’ and ‘health’ interface. In doing so, we outline the unrecognised potential of social enterprise for generating health and well-being improvement, and the subsequent challenges for government, the sector itself, and for the research community. Although we focus primarily upon the UK policy landscape, the key message – that social enterprise could represent an innovative and sustainable public health intervention – is a useful contribution to the ongoing international debate on how best to address the challenge of persistent and widening health inequalities.

Social enterprise and wellbeing in community life

Purpose This paper aims to explore the well-being impacts of social enterprise, beyond a social enterprise per se, in everyday community life. Design/methodology/approach An exploratory case study was used. The study’s underpinning theory is from relational geography, including Spaces of Wellbeing Theory and therapeutic assemblage. These theories underpin data collection methods. Nine social enterprise participants were engaged in mental mapping and walking interviews. Four other informants with “boundary-spanning” roles involving knowledge of the social enterprise and the community were interviewed. Data were managed using NVivo, and analysed thematically. Findings Well-being realised from “being inside” a social enterprise organisation was further developed for participants, in the community, through positive interactions with people, material objects, stories and performances of well-being that occurred in everyday community life. Boundary spanning community members had roles in referring participants to social enterprise, mediating between participants and structures of community life and normalising social enterprise in the community. They also gained benefit from social enterprise involvement. Originality/value This paper uses relational geography and aligned methods to reveal the intricate connections between social enterprise and well-being realisation in community life. There is potential to pursue this research on a larger scale to provide needed evidence about how well-being is realised in social enterprises and then extends into communities.

The role of institutional and stakeholder networks in shaping social enterprise ecosystems in Europe

Purpose This paper draws upon prior research that built a theoretical framework for the emergence of social enterprise ecosystems based upon the biological evolutionary theory. This paper aims to extend this previous research by practically applying the said theory to the development of stakeholder and institutional networks across Europe. Design/methodology/approach Data from in-depth semi-structured interviews and focus groups were analysed using Constant Comparison Method. Data were generated from discussions with 258 key stakeholders in ten countries across Europe, exploring the historical, political, social, legal and economic factors that influence the patterns of a social enterprise seen in each country. Findings The results identify the emergence of four social enterprise ecosystem types (Statist-macro, Statist-micro, Private-macro and Private-micro). These are used to explain the differences found in each of the ten country’s social enterprise ecosystems. The results are discussed in relation to the evolutionary theory in social entrepreneurship and how “genetic” and “epigenetic” factors lead to the divergence of social enterprise ecosystems, and the impact that this has on the stakeholders and institutions that are present within them. Originality/value A typology of ecosystems is presented, which can be used by policymakers across Europe to understand how best to support their local social economies.

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

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.

Re-imagining social enterprise

Purpose This intentionally polemical paper will aim to re-examine what is meant by social enterprise and try to assert its role within the current economic system. It is well over a decade since John Pearce’s Social Enterprise in Anytown was first published. Since then the term “social enterprise” has been used in multiple ways by politicians, practitioners and academics – very often for their own ideological ends. Design/methodology/approach This paper will outline the context and challenges currently facing social enterprise both from outside and from inside the social enterprise movement. Findings This paper re-affirms a paradigm for social enterprises through re-imagining how social enterprise should and could contribute to the creation of a fairer and more just society. Originality/value Finally, this paper will conclude with a reflection on what Pearce argued and how the social enterprise movement has to position itself as a viable alternative way of creating goods and services based on socially responsible values.

Polanyi's 'substantive approach' to the economy in action? Conceptualising social enterprise as a public health 'intervention'

Abstract For several decades now, critical public health researchers have highlighted the deleterious effects that pursuing neoliberal policies can have on the ‘causes of the causes’ of poor health and upon growing health inequalities. This paper argues that the conceptual tools of Karl Polanyi can help lend particular insight into this issue. The specific example that this paper focuses upon is the ‘social enterprise’: a form of organisation that combines both social and business objectives. The paper explores, conceptually, whether social enterprises may have the potential to act as one component of a neo-Polanyian countermovement: helping to re-embed the economy back into society, and offering greater recognition for a more comprehensive and socially imbued concept of health. Importantly, this potential is critically examined in the context of neoliberal hegemony, where challenges to the status quo have regularly been met with assimilation, co-option and/or repression.

The assets-based approach: furthering a neoliberal agenda or rediscovering the old public health? A critical examination of practitioner discourses

Abstract The ‘assets-based approach’ to health and well-being has, on the one hand, been presented as a potentially empowering means to address the social determinants of health while, on the other, been criticised for obscuring structural drivers of inequality and encouraging individualisation and marketisation; in essence, for being a tool of neoliberalism. This study looks at how this apparent contestation plays out in practice through a critical realist-inspired examination of practitioner discourses, specifically of those working within communities to address social vulnerabilities that we know impact upon health. The study finds that practitioners interact with the assets-based policy discourse in interesting ways. Rather than unwitting tools of neoliberalism, they considered their work to be about mitigating the worst effects of poverty and social vulnerability in ways that enhance collectivism and solidarity, concepts that neoliberalism arguably seeks to disrupt. Furthermore, rather than a different, innovative, way of working, they consider the assets-based approach to simply be a re-labelling of what they have been doing anyway, for as long as they can remember. So, for practitioners, rather than a ‘new’ approach to public health, the assets-based public health movement seems to be a return to recognising and appreciating the role of community within public health policy and practice; ideals that predate neoliberalism by quite some considerable time.

A comparative overview of social enterprise ‘ecosystems’ in Scotland and England: an evolutionary perspective

ABSTRACT Social enterprise has been identified as a culturally and socially constructed phenomenon; over recent years there has been increasing focus on how social enterprise ‘ecosystems’ differ across countries. There has been less focus on the differences in social enterprise ecosystems within countries, where regional differences in the cultural, political and social environment can lead to variations in the environment for support. Recent devolution within the United Kingdom has led to all four countries developing fairly diverse political and policy environments. This paper explores these differences through the lens of evolutionary theory which posits that within an ecosystem all organisms are a product of the evolution of that ecosystem and that socio-political and regulatory differences can lead to the rapid divergence of social enterprise ecosystems.

Social Innovation: Worklessness, Welfare and Well-being

The UK Government has recently implemented large-scale public-sector funding cuts and substantial welfare reform. Groups within civil society are being encouraged to fill gaps in service provision, and ‘social innovation’ has been championed as a means of addressing social exclusion, such as that caused by worklessness, a major impediment to citizens being able to access money, power and resources, which are key social determinants of health. The aim of this article is to make the case for innovative ‘upstream’ approaches to addressing health inequalities, and we discuss three prominent social innovations gaining traction: microcredit for enterprise; social enterprise in the form of Work Integration Social Enterprises (WISEs); and Self Reliant Groups (SRGs). We find that while certain social innovations may have the potential to address health inequalities, large-scale research programmes that will yield the quality and range of empirical evidence to demonstrate impact, and, in particular, an understanding of the causal pathways and mechanisms of action, simply do not yet exist.