Edited by: Harshad Thakur, National Institute of Health and Family Welfare, India
Reviewed by: Wim Naudé, RWTH Aachen University, Germany; Torben Bager, University of Southern Denmark, Denmark
This article was submitted to Public Health Education and Promotion, a section of the journal Frontiers in Public Health
This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
This paper describes a framework used to understand public health entrepreneurship and intrapreneurship for the purpose of pedagogy and practice. To ground this framework in the academic literature, a scoping review of the literature was conducted with application of a snowball method to identify further articles from the bibliographies of the search results. Recurring themes were identified to characterize common patterns of public health entrepreneurship and intrapreneurship. These themes were design thinking, resource mobilization, financial viability, cross-disciplinary collaboration, and systems strengthening. Case examples are provided to illustrate key themes in both intrapreneurship and entrepreneurship. This framework is a starting point to further the discourse, teaching, and practice of entrepreneurship and intrapreneurship in public health. More research is needed to understand implications for power and privilege, capacity building, financing, scaling, and policy making related to entrepreneurship and intrapreneurship in public health.
Public health entrepreneurship is an emerging field, driven by the desire of public health students and practitioners to be more action oriented. In a recent study, public health students voiced that public health research must be accompanied by action; public health entrepreneurship provides a potential pathway for action; a unique skillset is required for public health entrepreneurship; and public health entrepreneurship provides an opportunity for inter-professional collaboration and cross-pollination of knowledge across disciplines (
Public health entrepreneurship has been defined as “the application of entrepreneurial skills to advance public health” (
The literature on PHEI is limited, yet indicates an appetite for greater understanding of and planning for this area of training and practice (
A literature review was conducted to identify papers with public health entrepreneurship and intrapreneurship as their primary focus, as indicated by the title. The search terms [“public health”] AND [“entrepreneurship” OR “intrapreneurship” OR “innovation”] were applied in a pub med title search. This identified 88 papers, which were screened based on the Jacobsen et al. definition of the application of entrepreneurial skills to advance public health (
Scoping literature search results and snowball method.
Five integral components of PHEI were identified through thematic analysis of the 96 resulting papers. These components are described below and illustrated with case examples (
Case examples from literature review illustrating key components of public health entrepreneurship and intrapreneurship.
Building Blocks Collaborative ( |
Launched by Alameda County Public Health Department, this multi-sector initiative engages community partners in improving economic and racial inequities in children's health by targeting neighborhood conditions in low income communities. Core elements contributing to BBC's success included strong leadership; dedicated staff; shared vision and ownership; flexible partnership structure; support for building partners' capacity; broad collective goals that build on partners' strengths and priorities; and funds to promote learning, sharing, creating, and launching projects. | |
Best Babies Zone ( |
National multi-year project aimed at reducing inequities in infant mortality rates, and enhancing overall population health and wellness. Results indicated that team diversity reflects new ways of thinking; immersion deepens empathy; reframing the challenge integrates insights into solutions; embracing ambiguity creates opportunities to explore new directions; prototyping enables fast and affordable learning. | |
Healthy Chicago ( |
Healthy Chicago is a comprehensive agenda housing multiple initiatives that use neighborhood level information and real time data to track, monitor, and protect the health of residents. | |
Health Leads ( |
Health Leads is an independent innovation hub that helps healthcare systems, community-based organizations, public health departments and other stakeholders to share resources, data, and health goals that remove systemic barriers keeping people from identifying, accessing and choosing essential resources needed for health; such as food, heat, transportation and housing, alongside medical care. |
A pre-requisite for PHEI is human centered design thinking. Design thinking is a problem-solving methodology that focuses on in-depth understanding, rapid idea generation, and prototyping to generate innovative solutions to complex challenges (
Approaches to defining public health innovation.
Farmer and Fizpatrick point to Drucker's use of the term entrepreneurship to describe entrepreneurs in the 1800s as those who shift resources into areas of greater yield. They apply this definition to health workers who identify opportunities, mobilize people and resources including funding; demonstrating persistence in serially initiating new initiatives by identifying gaps, injecting their vision, exciting others and securing resources (
Funding is an important component of resource mobilization and authors voiced a need within more traditional public health institutions for smaller grants that support prototype projects and allow creators to pursue ideas to failure or success (
Building a business model was cited as an important component of adopting a public health innovation approach; bridging direct health sector innovation with global and domestic public health problems, the former of which is often venture capital backed and profit oriented and the latter of which requires a non-profit approach (
PHEI teams are interdisciplinary in composition, including different sub-disciplines and skill areas within the field of public health, such as health management, policy, epidemiology, bioinformatics, social and behavioral sciences, nutrition and environmental sciences; alongside roles and professions from other fields such as engineering, information technology, education, urban planning, social media, design, management and finance (
Cross-disciplinary composition of PHEI.
Through this network approach, the products and services created through PHEI aim to strengthen existing systems, rather than creating parallel systems; through careful consideration, and integration of existing infrastructure and stakeholders (
The five components of the PHEI framework are summarized in
Components of the PHEI framework.
Design thinking | Adaptive, iterative, customer-centric innovation process requiring a cultural shift within public health to manage risk and failure |
Resource mobilization | Mobilizing people and resources to accelerate innovation, including blended finance to test and scale new ideas |
Financial viability | Generating revenue models or cost savings for financial sustainability |
Cross-disciplinary | Breaking silos within sub-disciplines of public health and with other disciplines; engaging private, government, non-profit sectors |
Systems strengthening | Incorporating existing systems into design and implementation of innovations rather than creating parallel systems |
This is the first paper to present a framework for characterizing entrepreneurship and intrapreneuership in public health. The scoping literature review conducted to inform this framework resulted in more examples of intrapreneurship within government than of entrepreneurship and new ventures. This result, combined with the intrinsic nature of public health systems, underscores the importance of developing frameworks for understanding and supporting public health entrepreneurship that include innovations within and across government systems.
This framework has been tested for pedagological purposes through a course launched at Yale University titled “Public Health Entrepreneurship and Intrapreneurship.” The course was structured around the components of the framework; and was cross-registered at Yale School of Management, School of Public Health, School of Environment, and Jackson Institute of Global Affairs. The PHEI framework was used to analyze case studies of PHEI identified through the author's work and through case study collections including Yale School of Management raw cases and Harvard Business School Publishing. Topics areas included primary health, maternal child health, social and environmental determinants of health; spanning global and domestic settings. Fifty five students registered for the course, giving it an overall rating of 4.3/5 in the course evaluation. A sample comment stated that students “appreciated the funding/management perspective of the course. Often as a public health student. we try to implement an educational campaign to bring awareness to solve issues. This course talked about funding models beyond donor support, and partnerships and stakeholder engagement.”
Feedback was also solicited at the American Public Health Association (APHA) annual meeting in Fall 2019, during a round table session held by the community-based public health caucus. During the 90-min session, a one-page overview of the framework was distributed and presented by the author to participants in four back-to-back round table discussions. Comments was elicited from fifteen participants through focus group discussion in conjunction with a written survey. A sample comment indicated that “while this is a valuable framework to understand entrepreneurship and intrapraneurship in the context of public health training, a more detailed framework is needed to inform investment decisions and capacity building for public health entrepreneurs.” Other comments included the importance of linking PHEI with public health policy.
Further input was elicited from twelve subject matter experts including authors of selected papers and public health entrepreneurs through telephone interviews. Participants commented that human centered design thinking can help ensure a constant feedback loop of community voice and public participation in the design and implementation of public health programs, mimicking the “product market fit” of the private sector; as opposed to traditional public health programs which are designed using a top-down rather than a bottom-up approach. While some emphasized the importance of the ideation process of human centered design thinking, others emphasized the importance of integrating existing ideas into existing systems rather than generating new ideas. The use of data was underscored to balance risk with evidence, and to develop adaptive revenue models which are responsive to the scientific models underlying public health products and services. Feedback was consistent on the importance of being risk prepared rather than risk averse; and on the role of managing failure as a part of the design and iteration process.
It was noted that the framework does not explicitly address power and privilege. Design thinking entails community engagement, but it is important to analyze cases with a critical lens to determine whether different voices were heard, whether the community participated in a meaningful rather than tokenizing way, and whether community capacity and leadership were built. Systems thinking also entails understanding whether root causes and inequities are being addressed, and whether the venture will result in a shift of power to address root causes and inequities. Just as PHEI requires a shift in culture to budget for and manage risks and failures, so too does it require a shift in culture to innovate
Finally, it is important to note that a limitation of this study is that it is a scoping review which does not attempt to capture the full literature on PHEI. While it may be too early in this emerging sub-discipline of public health for a systematic review, the results indicate a growing number of attempts to characterize PHEI in the literature, especially in government settings. The number of papers on entrepreneurship and new ventures in public health was limited, indicating an opportunity for partnership between academic researchers and entrepreneurs. The accelerated digital transformation in healthcare and public health catalyzed by Covid-19 presents a ripe opportunity for case studies to explore how themes of this paper were or were not applied (
In summary, this framework is a starting point to further the discourse, teaching, research and practice of PHEI. This is an emerging field within public health, and more data is needed to better understand and characterize its nuances, opportunities, and limitations. In keeping with the cross-disciplinary nature of PHEI, this data and understanding can only be achieved through cross-sectoral collaboration of entrepreneurs, intrapreneurs, researchers and academics, funders, communities, government, the technology and private sector, and other diverse stakeholders.
The original contributions presented in the study are included in the article/
TC conducted the scoping review, analyzed results, developed and tested framework, conducted focus groups and interviews, and wrote manuscript.
The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
The author gratefully acknowledges Martin Williams, Leslie Curry, Mark Schlesinger, Kate Nyhan, and Victoria Ellison for their input and support. The following authors and practitioners provided feedback on the PHEI framework: Ross Shegog, Elisabeth Becker, Cameron Lister, Peter Jacobson, Bina Shrimali, Howard Koh, Rebecca Onie, Trishan Panch, Rushika Fernandopulle, Mona Mowafi, Richard Siegrist, and Nalaka Gooneratne. Special thanks to Elisabeth Becker for help assimilating entrepreneurship literature and to Olav Sorenson for guidance on the literature.
The Supplementary Material for this article can be found online at: