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Am J Public Health. 2015 Apr;105 Suppl 2:S318-22. doi: 10.2105/AJPH.2014.302388. Epub 2015 Feb 17.

Assessing entrepreneurship in governmental public health.

Author information

Peter D. Jacobson and Johanna R. Lauer are with the School of Public Health, University of Michigan, Ann Arbor. Jeffrey Wasserman and Helen W. Wu are with the RAND Corporation, Santa Monica. Helen W. Wu is also with the Pardee RAND Graduate School, Santa Monica, CA.



We assessed the feasibility and desirability of public health entrepreneurship (PHE) in governmental public health.


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.


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.


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.

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