Public Health Entrepreneurs: Training the Next Generation of Public Health Innovators

“Funny how I just spent two years learning public health and now I'm throwing myself into the business entrepreneurship world. I have an idea for a technology start-up with aims to revolutionize the way cancer survivors, patients, and their loved ones connect with each other online and offline. It ties in with the ability to self-organize into neighborhood support groups around common interests or activities and not just diagnosis. In the meantime, I'm looking for work that can pay my living expenses while I form this idea, start testing the concept, and look for funding from big, scary venture capitalists. :) There's no reason why public health can only be a government, academic, or nonprofit thing (though they make excellent partners). For my idea, a great amount of flexibility, creativity, and room for innovation is key.”

— e-mail from Jaclyn Clenney, a recent MPH graduate from the Columbia University Mailman School of Public Health

How are we preparing the likes of Jaclyn in the field of public health? The short answer is: we are not. Public health is an increasingly attractive field of study in schools in the United States and beyond.¹ Training includes a cross-disciplinary curriculum that emphasizes epidemiology, environmental health, biostatistics, health policy, health-care management, and social and behavioral science approaches to health. Upon completion of coursework, future public health practitioners and leaders possess knowledge in areas ranging from the molecular level in environmental studies to chronic disease epidemics in the developing world. Having mastered the foundations of a distinctively interdisciplinary and applied field, those trained in public health are then charged with meaningfully contributing to the public health workforce.² Earning a living while addressing health and social issues is at the core of what many public health students seek to achieve from their education. Given their diverse interests and the breadth of their training, public health students are uniquely positioned to act as practitioners, problem solvers, and, potentially, public health entrepreneurs. This article advances a proposal for new training opportunities that better prepare students to take on a novel career path as public health entrepreneurs.

Public health entrepreneurship represents a timely opportunity for public health to grow as a field. Its relevance is evidenced not only by the expansion of the entrepreneurial sector, but also by the simultaneous decline of public sector and nonprofit funding sources, as well as mounting debt and challenging labor market circumstances that recent graduates encounter.^3–6 To meet current market demands, students require differentiated competencies including tangible skills that can be marketed to prospective employers, but can also encourage self-employment when feasible. Providing such exposure and training will engender a new approach to workforce preparation and diversify job prospects through public health entrepreneurship. This proposal has the ancillary benefit of contributing higher numbers of women to business and enterprise, as women outnumber men in public health.

DEFINING PUBLIC HEALTH ENTREPRENEURSHIP

Public health entrepreneurship builds on the momentum generated by social entrepreneurship, which has gained significant traction during the past decade.^7,8 The notion that, as an entrepreneur, one can succeed economically and do right by society is compelling.⁹ Achieving this double bottom line satisfies many entrepreneurs' desire for self-sufficiency and social impact. Dees' heavily cited definition of social entrepreneurship posits:

Social entrepreneurs play the role of change agents in the social sector by (1) adopting a mission to create and sustain social value (not just private value); (2) recognizing and relentlessly pursuing new opportunities to serve that mission; (3) engaging in a process of continuous innovation, adaptation, and learning; (4) acting boldly without being limited by resources currently in hand; and (5) exhibiting a heightened sense of accountability to the constituencies served and for the outcomes created.¹⁰

As a nascent field, social entrepreneurship is broad in its purview and covers ventures ranging from education, workforce development, public works, and micro-finance to clean energy and global health initiatives. Health has been, and continues to be, a central facet of social enterprise; for example, Housing Works uses profits from smaller business ventures to fund the organizational mission of ending homelessness and human immunodeficiency virus/acquired immunodeficiency syndrome.¹¹ Although health is inherently social, a focus on public health is sufficiently unique to merit its own designation. Public health entrepreneurship encapsulates enterprises rooted in health promotion, disease prevention, health-care services, and the social determinants of health. Therefore, public health entrepreneurs would subscribe to the five principles outlined by Dees, but with a specific emphasis on achieving health impacts.

Several examples of successful public health-related entrepreneurial ventures have emerged in the public health literature, but more must be done to promote public health enterprise.^12–15 Figure 1 outlines several industries and ventures that are ripe for public health entrepreneurs.

Figure 1.

Industries relevant to public health with entrepreneurial potential

A CALL FOR INNOVATION IN THE PUBLIC HEALTH CURRICULUM

How do we train a new generation of public health entrepreneurs with the requisite skills to develop health-related ventures addressing the most pressing health and social problems with a market-driven focus? The specific form that a graduate-level public health entrepreneurial training initiative might take would vary according to the capacity of the school or program, but would entail an interdisciplinary approach across professional backgrounds. Public health entrepreneurial training can be implemented as (1) a track or concentration within an existing master of public health (MPH) or master of business administration program; (2) a certificate with required courses in public health, business, and related fields such as law, engineering, and public administration; or (3) an entirely new master's degree program with cross-listed courses ideally housed in public health and executed in collaboration with experienced entrepreneurs and faculty with expertise in business and related fields. While the current offerings of relevant training opportunities are limited, Innovate Health Yale is among the earliest adopters of a training model that catalyzes entrepreneurship and innovation to promote health.¹⁶ Through wider advancement of such an integrated curriculum, students would simultaneously gain competencies in business and public health principles while laying the foundation for innovation, leadership, economic growth, and health impacts.

RECOMMENDATIONS FOR DEVELOPING A CURRICULUM ON PUBLIC HEALTH ENTREPRENEURSHIP

Based on our knowledge of public health and examination of business school curricula, we propose training in three domains that should be adopted within schools and programs of public health: (1) legal and regulatory structures; (2) marketing and communications; and (3) finance, market research, and evaluation (Figure 2).

Figure 2.

Sample cross-disciplinary curriculum for training in public health entrepreneurship

Public health and health-care institutions have a specific regulatory and legal framework, and health-related ethical considerations differ from other areas of enterprise. Students would learn to identify relevant legal and corporate structures and would acquire skills in navigating complicated legal processes and systems that include initiating partnerships, interpreting contracts, and understanding intellectual property rights.

Branding enhances the success of any enterprise through structured messaging to encourage product sales. Public health students would learn about marketing and communications within the context of health promotion and communications with a market-driven focus. They would learn to apply branding, digital marketing, and social media campaigns to products and services that promote health. Additionally, public health theories and approaches would be used to target initiatives and understand the impacts. For example, using the socioecological model to analyze new wireless exercise tracking applications illustrates not only individual behavioral change but also, via social media, health promotion within social networks.

The need for metrics is a shared interest of business and public health, although their respective outcomes and measures differ. Entrepreneurs must analyze markets to ensure a niche for their product or service and learn how to position it through market landscape analysis. The entrepreneur must identify revenue sources and potential customers, determine pricing and valuation of the venture, and maintain healthy credit-to-debt ratios. The ultimate goal is an enterprise that contributes to the health and well-being of our communities; as such, students would learn to measure the double bottom line and balance economic, social, and health metrics accordingly.

CONCLUSION

Entrepreneurial training during graduate school would serve as an incubator for public health innovation and enterprise. Business start-up risks and costs could be mitigated by providing expert guidance and advice along the way, while simultaneously adding value to the public health degree and jump-starting the process. While in school, students would gain relevant training and mentoring experiences; exposure to the business development process, including fostering access to seed capital and professional networking; and also develop a more realistic view of the risk and reward structure inherent to entrepreneurial ventures. Ultimately, students could make more informed decisions and shorten the start-up period by launching their enterprises while in school or shortly thereafter, thereby differing substantially from Jaclyn, who sought to launch her venture post-graduation without any entrepreneurial coursework to get her started.

The conundrum of what to do beyond graduation that satisfies the imperative to promote health while also making a living lends itself to a timely reconceptualization of public health training and career paths. Schools and programs of public health have a unique opportunity to increase their course offerings and collaborate with business programs to facilitate public health entrepreneurship. A curriculum focused on developing a new generation of public health entrepreneurs has the potential to enhance our students' ambitions, increase job prospects, establish new applications for health promotion, and support innovation in public health training. Students will exit their public health education with a sense of opportunity and prospects for self-reliance along with a license to lead and innovate. In this way, public health entrepreneurship can add incredible value to the mission of the field.