Public-private partnerships to address social inequality in health: Lessons from the literature
Globally, social inequality in health is a major public health challenge. In both upper-middle-income and high-income countries, contemporary healthcare and social service systems are struggling to address these systematic differences in health trajectories between population groups. As public health scientists, we know that complicated interplays between factors at the individual, community and societal levels contribute to social inequality in health. These interplays pose challenges for institutions seeking to reduce social inequality in health, requiring novel and innovative approaches that engage multiple partners across public, private and academic institutions. From our interdisciplinary background in public health science, we have always been interested in understanding how research can benefit from diverse competencies, viewpoints and collaborations across different institutions.
Public-private partnerships (PPPs) have been suggested as a way to address some of the complex drivers of social inequality in health. PPPs are any partnership or arrangement between public and private institutions, where involved partners collaborate to achieve a common goal, such as addressing social inequality in health. However, evidence on the impact of such partnerships in public health is limited and there is a need to understand the potential impact and pitfalls. Therefore, we conducted a systematic review to identify opportunities and challenges in PPPs from interventions aiming to reduce social inequality in health, focusing on the scientific public health literature published between January 2013 to January 2023. This study was part of a Danish public-private partnership, ‘Lighthouse Life Science,’ an initiative to develop innovative healthcare solutions to reduce social inequality in health in Denmark.
We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. To be included, studies had to: 1) focus on an underserved population group in upper-middle-oncome and high-income countries, 2) implement PPPs as an intervention with a strategic focus on social inequality in health and 3) report on outcomes related to lessons learned as part of the PPPs. Two reviewers lead the data extraction and quality appraisal of the included studies.
Our comprehensive systematic literature search across five search engines yielded a total of 2,979 records. After title and abstract screening, 2,605 records were excluded. We then assessed the full text of 105 records, excluding 89, and ultimately included 16 studies conducted in the U.S., Slovakia, Israel, Norway and Thailand. These studies targeted underserved populations with interventions ranging from farmers’ markets in low-income neighborhoods to Medicaid enrollment initiatives, implemented at both micro- and macro-levels.
The lessons learned from these studies suggest that PPPs can mitigate social inequality in health. The findings highlight how these collaborations can address systemic disparities in health outcomes among underserved communities. However, valuable insights also emerged. We conclude that to ensure the impact and success of future PPPs, partners should focus on creating synergies through shared resources, maintaining clear communities and coordination, and fostering trustful relationships through transparency and continuous alignment of expectations. An important lesson from partnerships perceived as successful is the involvement of community-based organizations. Such organizations help public and private partners identify healthcare priorities, connect with local community members and enhance the acceptability of public health interventions. Future policy efforts to address social inequality in health should leverage the synergies created in PPPs, particularly considering the engagement of community-based organizations.
By Dr. Abirami Srivarathan, postdoctoral associate, Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Section of Health Services Research, Department of Medicine, Baylor College of Medicine
