By Bobby Stroup
If advocates working to address health disparities want to overcome seemingly insurmountable obstacles, perhaps they should adopt the mindset of people who do that on a daily basis: entrepreneurs.
Applying the entrepreneurial spirit to advocacy around the social determinants of health (SDOH) sounds like a potentially beneficial way to further the cause. But can we manufacture that attitude through public policy? Law is a tool we use to protect fundamental rights and empower social progress. But does that mean we should use it to make people care about SDOH innovation?
In this article, I will consider potential law and policy-based approaches to promoting entrepreneurial innovation in the realm of health equity.
Persuading Providers
Clinical care is only responsible for about 20% of an individual’s health, and most of the remaining 80% consists of SDOH factors (e.g., education, employment, housing). Nonetheless, it’s natural to think addressing health inequities is the responsibility of our formal healthcare systems. Medical practitioners do take oaths to care for their patients and also have a legal duty of care. The tort of medical malpractice exists, at least in part, to motivate doctors to provide care at an acceptable level.
However, this common law does not function as a mandate for entrepreneurial innovation. In fact, the policy actually preserves the status quo, incentivizing physicians to follow existing medical norms. It also instills fear of failure, meaning providers avoid innovative treatment plans—even if a novel method might be more clinically effective. Thus, these tort-law remedies not only fail to motivate innovation, but may actually solidify the problems we want to solve.
Conscripting Citizens
Given SDOH’s cross-industry issues, we might also look to how law affects behavior for people outside of formal healthcare roles. For example, a few U.S. states have Good Samaritan laws requiring bystanders to provide “reasonable assistance” to save another person’s life. But upon further examination, these laws fall short, even if they were universally enforced. There is a large chasm between requiring someone to call emergency services and forcing someone to develop a business solution to systemic harms.
Other non-medical common law, a duty to rescue, holds those who create risk liable for saving the victims who experience the risk. Unfortunately, this policy also proves insufficient for our goals. Though we might simplify SDOH by having a guilty party shoulder the burden of health inequities, the complicated nature of SDOH can make it difficult, if not impossible, to identify specific individuals who are liable for system-wide problems.
Promoting SDOH innovation by threatening individuals with the force of law seems like the wrong strategy. Legal penalties have been shown to effectively drive entrepreneurial innovation in areas with clearly definable objectives, but choosing which industry metrics will result in desired public health outcomes is no easy task. Accordingly, before we swing a hammer of legal penalties, we should ask whether our problem is truly a nail.
Empowering Entrepreneurs
We can avoid the question of how to instill entrepreneurial mindsets if we can find a way to leverage the entrepreneurs who already exist. Howard Stevenson, Professor Emeritus at Harvard Business School, defines entrepreneurship as “the pursuit of opportunity beyond resources controlled.” In other words, because entrepreneurs dream big dreams, they often cannot achieve those dreams on their own. Instead, they take leaps of faith, believing that their vision will be enough to attract the people and finances necessary for success. This bullish outlook enables entrepreneurs to achieve incredible feats of innovation, because they do not limit themselves to the way the world currently works.
In America, entrepreneurs make up 16% of the adult workforce, and 70% of those individuals are motivated by wanting to make a difference in the world. Furthermore, countless innovators regularly dedicate their lives to causes because of personal connections to the problems they’re solving.
The Big Shakespeare
Shaquille O’Neal, Ed. D., also known as “Shaq,” is a prime example of someone with an entrepreneurial mindset and a personal connection to SDOH issues. Shaq has openly discussed how opportunity at a young age was a stepping stone toward his successful career in the NBA. As a way to pay it forward, he has chosen to invest his time and resources in community development and youth education programs.
In one recent example, Shaq partnered with the New Jersey HMFA to build a real estate development in his hometown. Though real estate developers historically neglected the area, Shaq stepped in by supporting the construction of the largest mixed-income project in the state. The state, city, and Shaq experienced a win-win-win deal through a combination of tax relief and a commitment to reserving units for affordable housing. Contrast this deal with the tort remedies mentioned above, and we can see that collaborative support, not a legal threat, fosters an environment where entrepreneurship can thrive.
We shouldn’t expect everyone to aspire to develop a billion dollars of affordable housing. Nor are we likely to see the general populace investing in venture capital to increase access to education. Therefore, government leaders should not aim to solve health inequities by punishing people who shun the burden of entrepreneurship. Instead, these leaders should invest in partnership policies to equip social change, both big and small. In conclusion, policymakers reading this article need only remember two pieces of wisdom. First, you catch more flies with honey than you do with vinegar. Second, as the Big Shakespeare would say, “The only person who can really motivate you is you.”
