The problem of health inequalities – the preventable and unfair differences in health status between social groups, populations and individuals (Whitehead, 1992; Whitehead et al., 2001) – has challenged public health... [ view full abstract ]
The problem of health inequalities – the preventable and unfair differences in health status between social groups, populations and individuals (Whitehead, 1992; Whitehead et al., 2001) – has challenged public health researchers since the relationship between income and health was first established. In the context of austerity measures, and faced with continuing, even growing, inequalities, more innovative, community-based solutions have gained prominence (Baum, 2008; O’Mara-Eves et al., 2013). While social enterprise could prove to be a potentially innovative and sustainable response (Roy et al., 2013), there is still a significant gap in knowledge of how, and to what extent, social enterprise-led activity impacts upon health and well-being. This paper builds upon the very first Systematic Review of the literature at the interface of the ‘social enterprise’ and ‘health’ fields (Roy et al., 2014) which provided evidence (albeit limited) 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.
However, this paper seeks to answer: how, and in what ways, do social enterprise practitioners – implicitly or explicitly – conceptualise their impact upon health and well-being?
As one of a range of post-positivist approaches that seek to plot a middle path between positivism and interpretivism, critical realism (Bhaskar 1975, 1987, 1989) simultaneously recognizes the existence of knowledge independent of humans, but also the socially embedded and fallible nature of scientific inquiry. Typical methods described by Sayer (2000) as ‘intensive’ and thus suitable for critical realist enquiry, include the study of individuals in their causal contexts, interviews and qualitative analysis. A purposive (Mason, 1996, 2002) maximum variation (Emmel, 2013) sample of social enterprise practitioners (n=14) in Glasgow was identified, and data was generated through employing qualitative, semi-structured interviews and a focus group. A critical realist analysis, employing causation coding (Saldaña, 2013) identified a range of explanatory mechanisms and potential pathways of causation between engagement in social enterprise-led activity to health and well-being. Employing ‘abductive’ inference (Kapitan, 1992; Peirce, 1932), systematically combining (Dubois and Gadde, 2002) theory, data and the insights generated in earlier stages of empirical enquiry, has allowed the construction of an empirically-informed conceptual model. The aim in future will be to build upon, refine, elaborate and/or revise the overall conceptual model and thus advance our empirical and theoretical understanding of the causal pathways at work, in what may be recognised as a particularly complex form of public health ‘intervention,’ and thus act as a platform for the development of a future research agenda in this area.
