Indigenous Social Enterprises and Health and Wellbeing: A Scoping Review and Conceptual Framework.

Indigenous people and communities are establishing social enterprises to address social disadvantage and overcome health inequities in their communities. This review sought to characterize the spectrum of Indigenous social enterprises in Australia, New Zealand, Canada, and the United States to identify the operational models and cultural values that underpin them and their impact on Indigenous health and wellbeing. The scoping review followed Arksey and O'Malley's six-stage methodological framework with recommended enhancements by Levac et al. underpinned by Indigenous Standpoint Theory, and an Indigenous advisory group to provide cultural oversight and direction. Of the 589 documents screened 115 documents were included in the review. A conceptual framework of seven different operational models of Indigenous social enterprises was developed based on differing levels of Indigenous ownership, control, and management: (1) individual, (2) collective, (3) delegative, (4) developmental, (5) supportive, (6) prescriptive and (7) paternalistic. Models with 100% Indigenous ownership and control were more likely to contribute to improved health and wellbeing by increasing self-determination and strengthening culture and promoting healing than others. Indigenous social enterprises could offer a more holistic and sustainable approach to health equity and health promotion than the siloed, programmatic model common in public health policy.