文章基本信息

标题：Assessing Entrepreneurship in Governmental Public Health
本地全文：下载
作者：Peter D. Jacobson ; Jeffrey Wasserman ; Helen W. Wu 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2015
卷号：105
期号：Suppl 2
页码：S318-S322
DOI：10.2105/AJPH.2014.302388
语种：English
出版社：American Public Health Association
摘要：Objectives. We assessed the feasibility and desirability of public health entrepreneurship (PHE) in governmental public health. Methods. Using a qualitative case study approach with semistructured interview protocols, we conducted interviews between April 2010 and January 2011 at 32 local health departments (LHDs) in 18 states. Respondents included chief health officers and senior LHD staff, representatives from national public health organizations, health authorities, and public health institutes. Results. Respondents identified PHE through 3 overlapping practices: strategic planning, operational efficiency, and revenue generation. Clinical services offer the strongest revenue-generating potential, and traditional public health services offer only limited entrepreneurial opportunities. Barriers include civil service rules, a risk-averse culture, and concerns that PHE would compromise core public health values. Conclusions. Ongoing PHE activity has the potential to reduce LHDs’ reliance on unstable general public revenues. Yet under the best of circumstances, it is difficult to generate revenue from public health services. Although governmental public health contains pockets of entrepreneurial activity, its culture does not sustain significant entrepreneurial activity. The question remains as to whether LHDs’ current public revenue sources are sustainable and, if not, whether PHE is a feasible or desirable alternative. Despite the public health system’s significant past achievements, many observers have questioned whether it can adequately respond to the nation’s existing public health needs, let alone to emerging disease threats. 1 The governmental public health system faces declining public investment, sustained attacks from opponents (including affected industries and antigovernment political groups), limited political power, and competitors encroaching on its responsibilities. From 2008 to 2010, the local health department (LHD) workforce declined by approximately 19%. 2,3 As a result, the governmental public health system must either develop new and innovative strategies to generate revenue or face increasing declines in its ability to protect the public’s health. 4 If maintaining the status quo is untenable, what alternatives might be considered? One possibility is for public health to develop an entrepreneurial strategy that supplements public funds with revenues from other sources, what we call public health entrepreneurship (PHE). We conducted an exploratory case study examining PHE and assessing its feasibility within governmental public health. Because there is no consensus definition of entrepreneurship as applied to governmental activities, 5–8 we define PHE as the application of entrepreneurial skills to advance the public health mission. Indicia of PHE include skills in appraising human and resource needs, building constituent and stakeholder partnerships, generating revenue, and ensuring sustainability. 9 PHE describes 2 closely linked dimensions: public health as an economic activity generating revenue and entrepreneurial innovations to provide more efficient services.