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Responsible Innovation in Health (RIH) represents an emerging Science, Technology and Innovation (STI) approach that could support not only the Sustainable Development Goal (SDG) "Good health and well-being" but also other SDGs. Since few studies have conceptualized the relationships between RIH and the SDGs, our goal was to inductively develop a framework to identify knowledge gaps and areas for further reflections. Our exploratory study involved: (1) performing a web-based horizon scanning to identify health innovations with responsibility features; and (2) illustrating through empirical examples how RIH addresses the SDGs. A total of 105 innovations were identified: up to 43% were developed by non-profit organizations, universities or volunteers; 46.7% originated from the United States; and 64.5% targeted countries in Africa, Central and South America and South Asia. These innovations addressed health problems such as newborn care (15.5%), reduced mobility and limb amputation (14.5%), infectious diseases (10.9%), pregnancy and delivery care (9.1%) and proper access to care and drugs (7.3%). Several of these innovations were aligned with SDG10-Reduced inequalities (87%), SDG17-Partnerships for the goals (54%), SDG1-No poverty (15%) and SDG4-Quality education (11%). A smaller number of them addressed sustainable economic development goals such as SDG11-Sustainable cities and communities (9%) and SDG9-Industry and innovation (6%), and environmental sustainability goals such as SDG7-Affordable and clean energy (7%) and SDG6-Clean water and sanitation (5%). Three examples show how RIH combines entrepreneurship and innovation in novel ways to address the determinants of health, thereby contributing to SDG5 (Gender), SDG10 (Inequalities), SDG4 (Education) and SDG8 (Decent work), and indirectly supporting SDG7 (Clean energy) and SDG13 (Climate action). Further research should examine how alternative business models, social enterprises and social finance may support the STI approach behind RIH.
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sustainability
Article
The Unexplored Contribution of Responsible
Innovation in Health to Sustainable
Development Goals
Pascale Lehoux 1,2 ,* , Hudson Pacifico Silva 2, Renata Pozelli Sabio 2and Federico Roncarolo 2
1Department of Health Management, Evaluation and Policy, University of Montreal,
Montreal, QC H3C 3J7, Canada
2Institute of Public Health Research of University of Montreal (IRSPUM), P.O. Box 6128,
Branch Centre-ville, Montreal, QC H3C 3J7, Canada; hp.silva@umontreal.ca (H.P.S.);
renata.pozelli.sabio@umontreal.ca (R.P.S.); federico.roncarolo@umontreal.ca (F.R.)
*Correspondence: pascale.lehoux@umontreal.ca; Tel.: +1-514-343-7978
Received: 6 October 2018; Accepted: 29 October 2018; Published: 2 November 2018


Abstract:
Responsible Innovation in Health (RIH) represents an emerging Science, Technology
and Innovation (STI) approach that could support not only the Sustainable Development Goal
(SDG) “Good health and well-being” but also other SDGs. Since few studies have conceptualized
the relationships between RIH and the SDGs, our goal was to inductively develop a framework
to identify knowledge gaps and areas for further reflections. Our exploratory study involved:
(1) performing a web-based horizon scanning to identify health innovations with responsibility
features; and (2) illustrating through empirical examples how RIH addresses the SDGs. A total of
105 innovations were identified: up to 43% were developed by non-profit organizations, universities
or volunteers; 46.7% originated from the United States; and 64.5% targeted countries in Africa, Central
and South America and South Asia. These innovations addressed health problems such as newborn
care (15.5%), reduced mobility and limb amputation (14.5%), infectious diseases (10.9%), pregnancy
and delivery care (9.1%) and proper access to care and drugs (7.3%). Several of these innovations
were aligned with SDG10-Reduced inequalities (87%), SDG17-Partnerships for the goals (54%),
SDG1-No poverty (15%) and SDG4-Quality education (11%). A smaller number of them addressed
sustainable economic development goals such as SDG11-Sustainable cities and communities (9%) and
SDG9-Industry and innovation (6%), and environmental sustainability goals such as SDG7-Affordable
and clean energy (7%) and SDG6-Clean water and sanitation (5%). Three examples show how RIH
combines entrepreneurship and innovation in novel ways to address the determinants of health,
thereby contributing to SDG5 (Gender), SDG10 (Inequalities), SDG4 (Education) and SDG8 (Decent
work), and indirectly supporting SDG7 (Clean energy) and SDG13 (Climate action). Further research
should examine how alternative business models, social enterprises and social finance may support
the STI approach behind RIH.
Keywords:
health technology development; innovation policy; health policy; sustainability;
Sustainable Development Goals; Responsible Research and Innovation
1. Introduction
In June 2016, a United Nations (UN) multi-stakeholder forum on Science, Technology and
Innovation (STI) was held in New York, bringing together more than 600 scientists, innovators,
entrepreneurs, technology experts and civil society members from different parts of the world. In its
follow-up report, the UN Economic and Social Council defined STI as a lever for achieving the
Sustainable Development Goals (SDGs), stressing that “the global community will have the important
Sustainability 2018,10, 4015; doi:10.3390/su10114015 www.mdpi.com/journal/sustainability
Sustainability 2018,10, 4015 2 of 21
task” of “taking full advantage” of STI, which is central to the advancement of the 2030 Agenda [
1
].
The Economic and Social Council also recommended that STI “be conceived as means of achieving”
the SDGs, not as ends in themselves.
While we agree with the notion that the contribution of STI to sustainable development cannot
be overlooked, there is a need to reconsider critically how STI should be supported and organized in
order to better support the fulfilment of the 17 SDGs [
2
]. In the health sector, more particularly, STI
approaches that have been established in the past decades and which entail profit-driven and highly
capital-intensive ways of producing new technologies not only threaten the sustainability of health
systems worldwide, but they also fail to respond to the most pressing population health needs [
3
,
4
].
Since the 1980s, most OECD countries have organized the financing of their healthcare systems in
such a way that “the healthy support the sick, the young support the old, and the rich support the
poor” [
5
]. Nonetheless, it is now clear that health systems also perform better when they are supported
by “healthy” public policies in domains that are not directly related to health services but which affect
variations in health outcomes such as education, transportation, housing and the environment [
6
].
These domains are intimately linked to the broader determinants of health [7].
It is within such a broad interdisciplinary perspective that our aim in this article is to explore the
ways in which a novel STI approach, called Responsible Innovation in Health (RIH) [
8
,
9
], could support
not only the SDG3 (Good health and well-being), but also SDGs related to economic development and
environmental sustainability. For Silva and colleagues, RIH refers to
a collaborative endeavor wherein stakeholders are committed to clarify and meet a set of
ethical, economic, social and environmental principles, values and requirements when they
design, finance, produce, distribute, use and discard sociotechnical solutions to address the
needs and challenges of health systems in a sustainable way [9].
This definition posits that RIH encompasses social innovations, which aim at creating social
change and may benefit health and wellbeing, and sustainable innovations, which aim at reducing
environmental harms and may benefit health and wellbeing [
10
]. More specifically, RIH could,
in principle, tap into innovative solutions (SDG9 Industry and innovation) to fulfill SDG3 (Good
health and well-being), while addressing concurrently SDGs that encompass determinants of health
such as SDG4 (Quality education) or SDG6 (Clean water and sanitation) and SDGs that emphasize
environmental concerns such as SDG7 (Affordable and clean energy) or SDG13 (Climate action).
We stress “in principle” because although the literature on RIH is growing rapidly, the relationships
it entertains with the SDGs remain underexplored. The goal of our study was thus to inductively
develop a preliminary framework to help identify key knowledge gaps and areas for further reflections.
Because of the current paucity of theoretical and empirical studies on the topic, we adopted an
exploratory study design. We applied a problem-oriented STI policy research approach to gather and
analyze data stemming from: (1) a web-based horizon scanning that identified health innovations
possessing responsibility features; and (2) empirical examples that illustrate how RIH can address
SDGs by combining in novel ways entrepreneurship and innovation.
We explain below the novel STI approach that underlies RIH and why the current STI approach
limits the emergence of innovations that can support sustainable and equitable health systems.
In Section 2
, we describe our approach and methodology. In Section 3, after providing descriptive
statistics about a large set of health innovations (n = 105), we discuss three examples in greater detail
and present a framework of the relationships RIH entertains with SDGs. Section 4highlights the key
knowledge gaps this framework emphasizes and suggests further research on how new business
models, social enterprises and social finance can support the development of RIH. In Section 5,
we conclude on the importance of finding new ways to interface society and STI in the pursuit of
the SDGs.
Sustainability 2018,10, 4015 3 of 21
The STI Approach of Responsible Innovation in Health (RIH)
According to the UN Economic and Social Commission for Asia and the Pacific, science,
technology and innovation are “inextricably connected” even though they refer to different domains of
activities [
2
]. Whereas science refers to the “systematic study of the physical or material world (natural
science) and of society (social science)”, technology entails the application of scientific knowledge to
develop and produce goods or services for practical purposes. Innovation characterizes the novelty or
significant improvement of a product, service, process, social organization or commercial method [
2
].
RIH embodies a novel STI approach that draws on and follows suit to the policy-oriented field of
research called Responsible Research and Innovation (RRI). The aim of RRI is “to create a society in
which research and innovation practices strive towards sustainable, ethically acceptable and socially
desirable outcomes” [
11
]. RRI shares important affinities with the late 2000s European Union’s
“Grand Challenges” and with the SDGs. The Grand Challenges fueled “scholarly interest in the role
of STI in strategic responses to collective problems” and acknowledged that such challenges were
“qualitatively different from traditional STI concerns, often considered under the logic of national
systems of innovation geared towards economic growth” [
12
]. Tackling the Grand Challenges calls for
“system transformation” since different actors and perspectives across policy issues and geographical
domains have to be mobilized in order to agree on STI solutions [12].
Acknowledging the “inherently complex yet fluid nature” of STI, RRI can contribute to a renewed
STI framework for sustainable development, one that: (1) integrates “the social and environmental
as well as the economic dimensions of sustainable development”; (2) adheres to “the principles of
openness, inclusivity and collaboration”; (3) incorporates “the role of a more diverse range of actors”;
and (4) reflects the “regional and global dimensions of STI” [
2
]. As Spangenberg [
13
] points out, one
should acknowledge that “many sustainability problems have been caused by business activities” and
reconsider the role business should play in sustainable development.
Within this perspective, a growing number of RRI scholars recognize that entrepreneurs may
deliberately design solutions of greater social and environmental value [
14
]. From a RRI standpoint,
innovation production could be developed and organized in order to remain economically sustainable,
to provide shared value and to foster inclusive and sustainable industrial development with stable
sources of income and improved work conditions [
1
]. For Stahl and colleagues, RRI could even
have a positive impact on businesses: “the adoption of RRI could help a company develop its links
with stakeholders including customers; it could facilitate alignment with societal and regulatory
expectations and requirements; and it could improve employee satisfaction” [
15
]. These potential
benefits hinge, however, on the companies’ understanding of the principles and implications of
RRI and thus on the ability of RRI scholars to adapt their concepts to the context in which these
companies operate. Similarly, Lubberink and colleagues encouraged RRI scholars to recognize that
commercialization “is an essential stage within the innovation process”, one that remains largely
shaped by the culture of businesses and the constraints that affect their practices.
Commercially-driven innovation processes differ from those in research due to the priority
given to achieving economic impact. Furthermore, the interests and values of innovators
in the business context may differ from others (e.g., researchers in academia) and Research
and Development departments face different constraints regarding confidentiality and
public image [16].
In their review of the literature on RRI in the business context, Lubberink and colleagues
observed that efforts to identify whether an innovation had negative implications or could generate
additional desirable impacts were “scarce”, but a number of companies were already engaging in
systems-thinking, seeking to understand the needs of beneficiaries or consumers and discussing
with stakeholders ways to remain responsive to important needs [
16
]. Likewise, Auer and Jarmai,
who interviewed CEOs of small and medium-sized enterprises in the Austrian medical device sector,
Sustainability 2018,10, 4015 4 of 21
underscored that while these entrepreneurs had no prior knowledge of RRI, their enterprises were
operationalizing certain aspects of RRI [17].
Therefore, as Figure 1summarizes, the current literature supports the notion that RRI embodies a
novel STI approach that could enable entrepreneurs to address significant societal challenges, including
the SDGs. However, further reflections and empirical studies are needed since “there are deep-seated
contradictions” that can limit the potential success of RRI as well as its implementation in the business
context [15].
Sustainability 2018, 10, x FOR PEER REVIEW 4 of 21
deep-seated contradictions” that can limit the potential success of RRI as well as its implementation
in the business context [15].
Figure 1. A visual representation of the streams of knowledge on which this paper builds. Source: The
authors.
H1.2. Why the Current STI Approach in Health Innovations Needs to Be Transformed
In the health sector, scholars have begun to reconsider the extent to which the STI approach that
was established in the 1980s to finance, design and bring to market new drugs and medical devices,
is still to be promoted [18–20]. This STI approach increases inequalities and undermines the
sustainability of health systems around the world, be they publicly or privately funded [7,21,22]. For
Fineberg, sustainable health systems should be (1) affordable to patients and families, employers and
third-party payers; (2) acceptable to patients and health professionals; and (3) adaptable to new diseases,
changing demographics, scientific discoveries and technological innovations [23]. All three
characteristics are directly affected and typically constrained by the STI approach of the medical
device and pharmaceutical industries, which now both operate on a global scale [24].
The economic contexts in which health innovation took shape during the second half of the 20th
century supported shifting dynamics between the demand for, and the supply of innovations [25]. In
the 1950s, the post-war economy in industrialized countries contributed to the demand by supporting
the development of health systems. As the knowledge gained through military R&D benefitted STI
in the medical sector, the emergence of universal healthcare coverage provided the capacity to pay
for these new technologies in industrialized countries. Then, in the 1980s, the growth of health
spending entered into conflict with a market economy ideology that imposed budgetary constraints
and fiscal austerity in government-led programs. In these years, disparities in access to novel drugs
and devices increased within and between countries. To protect equity, “the governments of most
OECD countries have become heavily involved in the regulation, financing and sometimes the
provision of medical care” since the “problem of reconciling rising demand and increasing costs”
mainly fell in the public sector even though private companies were responsible for price increases
[5].
This tension between innovation and access represents a thorny issue for health policymakers
[4,26]. For instance, Sofosbuvir-based medicines with “a US list price of about $90,000” per 3-month
treatment course have recently “challenged government budgets and led to rationing” [27]. By
offering cure rates of over 90%, these drugs represent an important breakthrough for patients with
hepatitis C infection, which largely affects vulnerable groups such as people who inject drugs or
suffer from HIV/AIDS. According to Roy and King [27], “one argument for the high prices has been
that the curative drugs represent a major advance in value to patients and health systems” and they
are indeed “more cost effective than many expensive medicines that provide only marginal benefit”.
The company’s ability to charge high prices relies on its monopoly, while the public sector is paying
“twice”, it supports STI and then purchases innovative products.
Equity and sustainability challenges also arise because health innovations rely on health services
that are labor-intensive, require specialized personnel and are thus concentrated in large urban
centers [5]. New health technology often requires substantial infrastructure, which may not exist in
Adopting a novel Science, Technology &
Innovation (STI) approach
Responsible Research &
Innovation (RRI)
Addressing the 17 Sustainable
Development Goals (SDGs)
Aligning entrepreneurship with
societal challenges
Figure 1.
A visual representation of the streams of knowledge on which this paper builds. Source:
The authors.
H1.2. Why the Current STI Approach in Health Innovations Needs to Be Transformed
In the health sector, scholars have begun to reconsider the extent to which the STI approach
that was established in the 1980s to finance, design and bring to market new drugs and medical
devices, is still to be promoted [
18
20
]. This STI approach increases inequalities and undermines
the sustainability of health systems around the world, be they publicly or privately funded [
7
,
21
,
22
].
For Fineberg, sustainable health systems should be (1) affordable to patients and families, employers
and third-party payers; (2) acceptable to patients and health professionals; and (3) adaptable to new
diseases, changing demographics, scientific discoveries and technological innovations [
23
]. All three
characteristics are directly affected and typically constrained by the STI approach of the medical device
and pharmaceutical industries, which now both operate on a global scale [24].
The economic contexts in which health innovation took shape during the second half of the 20th
century supported shifting dynamics between the demand for, and the supply of innovations [
25
].
In the 1950s, the post-war economy in industrialized countries contributed to the demand by
supporting the development of health systems. As the knowledge gained through military R&D
benefitted STI in the medical sector, the emergence of universal healthcare coverage provided the
capacity to pay for these new technologies in industrialized countries. Then, in the 1980s, the growth
of health spending entered into conflict with a market economy ideology that imposed budgetary
constraints and fiscal austerity in government-led programs. In these years, disparities in access to
novel drugs and devices increased within and between countries. To protect equity, “the governments
of most OECD countries have become heavily involved in the regulation, financing and sometimes
the provision of medical care” since the “problem of reconciling rising demand and increasing costs”
mainly fell in the public sector even though private companies were responsible for price increases [
5
].
This tension between innovation and access represents a thorny issue for health
policymakers [4,26]
.
For instance, Sofosbuvir-based medicines with “a US list price of about $90,000” per 3-month treatment
course have recently “challenged government budgets and led to rationing” [
27
]. By offering cure rates
of over 90%, these drugs represent an important breakthrough for patients with hepatitis C infection,
which largely affects vulnerable groups such as people who inject drugs or suffer from HIV/AIDS.
According to Roy and King [
27
], “one argument for the high prices has been that the curative drugs
represent a major advance in value to patients and health systems” and they are indeed “more cost
effective than many expensive medicines that provide only marginal benefit”. The company’s ability
Sustainability 2018,10, 4015 5 of 21
to charge high prices relies on its monopoly, while the public sector is paying “twice”, it supports STI
and then purchases innovative products.
Equity and sustainability challenges also arise because health innovations rely on health services
that are labor-intensive, require specialized personnel and are thus concentrated in large urban
centers [
5
]. New health technology often requires substantial infrastructure, which may not exist in
many poor countries. Considering that “as many as 50% of all patients with cancer would be expected
to benefit from radiotherapy”, the lack of radiotherapy facilities in many countries in sub-Saharan
Africa is “particularly troubling” [
28
]. For Pramesh et al. [
29
], India faces “a problem common to other
emerging and high-income economies” since it struggles with the unsustainable prices of cancer drugs.
Even in a rich country like the United States, the difficulty of deploying technologies and qualified
personnel to remote and/or rural areas induces significant inequalities in access to basic primary
care [
30
]. MacDonnell and Darzi [
31
] suggest prioritizing innovations that simultaneously improve
outcomes and reduce labor intensity. This includes innovations that support general practitioners,
community health and social care providers and the patient’s capacity for self-care.
The problems raised by the current STI approach to health innovations are not limited to the
healthcare sector. Rather, its socioeconomic underpinnings affect how the SDGs can be fulfilled in rich
and poor countries alike: (1) higher unit costs of innovations ultimately result in greater inequalities
in access since third-party payers are forced to either increase insurance premiums or engage into
rationing; and (2) a greater share of a country’s Gross Domestic Product (GDP) spent on healthcare
entails a reduced ability to maintain a diversified economy in which the other determinants of health
(education, food insecurity, land use, etc.) can be properly addressed. This is troublesome considering
that a healthy population represents “a precondition for, an outcome of, and an indicator of” the
economic, social and environmental dimensions of sustainable development [32].
Another reason why it is important to critically examine the current STI approach to health
innovations lies with the recognition that it is largely driven by speculative investments, where short-term
returns prove more important than long-term health gains. Public resources around the world are used to
support health technology-based entrepreneurial activities, which remain highly dependent upon venture
capital [
33
]. One must thus consider how capital investors’ preferences and financial markets affect
the kinds of innovation being introduced in health systems [
18
,
34
]. From the investors’ standpoint,
with an estimated 21.6% net profit margin, health technology is highly attractive [
35
]. Lehoux and
colleagues observed that capital investors prefer to invest in technologies that are likely to find their
“purchaser” swiftly and “do not automatically see value in ventures that address pressing needs unless
these ventures can compete as winners in the healthcare ‘marketplace’” [
21
]. Innovations that are seen
as less risky by venture capitalists are those that address very large and easy to reach markets, that
offer to physicians, the means to generate revenues and that will be acquired within a relatively short
timeframe by established medical device manufacturers [
20
]. This short-term logic enables recouping
one’s investment, but it reproduces the technology creation paradigm that makes health systems
unsustainable and produces, ultimately, marginally innovative technologies [36].
Overall, the literature underscores the STI dynamics that contributed to shaping today’s health
innovation creation paradigm, which threatens the equity and sustainability of health systems. It also
highlights the relevance of examining more closely the STI approach that RIH embodies and which
could support the fulfillment of SDG3 (Good health and well-being) while concurrently addressing
SDGs related to the determinants of health and sustainable economic development.
2. Approach and Methods
2.1. Inductive STI Policy Research Approach
Because there have been so far very few attempts to conceptualize or empirically examine the
relationships between RIH and the SDGs [
22
,
37
], we adopted an inductive STI policy research approach.
According to Colquitt and Zapata-Phelan, empirical studies that rely on an inductive approach draw
Sustainability 2018,10, 4015 6 of 21
on existing theory to guide the categorizing of empirical observations, but they “do not include a priori
hypotheses as a starting point” [
38
]. The data gathered in such studies are mainly used to inform the
development of “propositions that can be tested in future studies” [
38
]. For Morlacchi and Martin, STI
policy research “is primarily a problem-oriented field” that considers the central role of businesses
in the evolution of STI by drawing on social sciences such as economics, sociology, political science
or organizational science [
39
]. Theorizing in STI policy research is mostly inductive, a feature that
differentiates the field from other disciplines where theory often “comes first” and the empirical work
is performed to test the theory [39].
Following this approach, we gathered and analyzed empirical data and examples to develop a
preliminary framework of the relationships between RIH and the SDGs that could help to identify key
knowledge gaps and areas for further reflections. Our empirical investigation was embedded within
a broader research project that was aimed at developing a tool to assess the degree of responsibility
of health innovations [
9
]. Relying on a horizon scanning methodology, we created an inventory of
innovations that possessed certain responsibility features in order to identify and organize the more
generic dimensions and attributes the tool had to include.
2.2. Web-Based Horizon Scanning
As an exploratory research method, horizon scanning has found a particular niche in STI since it
helps to support policy development around emerging innovations. Horizon scanning may pursue an
“alerting function” in order to help policymakers to anticipate emerging issues or threats, or a creative
function in order to contribute to opening up new policy options [
40
]. In the field of Health Technology
Assessment (HTA), horizon scanning is performed periodically to identify potentially significant
technologies that may become available on the market within the next 5 years [
41
]. To identify
these technologies, a combination of sources is recommended since it increases the usefulness of the
information and its likely accuracy [41].
To fulfill our study’s aim, we followed the methodological principles applied in HTA and
performed a social media horizon scanning that was supplemented by targeted searches on dedicated
websites. Our assumption was that a large number of responsible innovations may not yet be reported
in the scientific literature, but could be identified through social media platforms such as Twitter,
Reddit, Facebook, LinkedIn and Instagram [
42
]. We thus iteratively retrieved and analyzed information
from a variety of digital sources following the distinction made by Palomino and colleagues between
searching and scanning: “in the case of searching, what is likely to be interesting must be known before
it is sought, whereas in the case of scanning, the interest is judged after retrieval” [
43
]. These two types
of activity are in fact complementary since an issue-centered scanning approach starts with a number
of criteria that are gradually refined [40].
Because digital sources addressing a similar topic are closely interconnected (in terms of contents
and hyperlinks), a “snowball sampling” of the most relevant websites is recommended [
43
]. We began
with social media accounts and websites that were familiar to our team members and the sample
rapidly expanded until saturation where new sources did not yield novel innovations. Key sources
were either focused on health innovations (Hinnovic blog, Innovation Countdown 2030, PATH) or
on societal challenges (various chapters of the Grand Challenges, Appropedia, Index Awards, Not
impossible, SilverEco). Our searches, which took place between May and August 2016, used key
words reflecting responsibility features that could qualify the innovative product (e.g., affordability,
accessibility, appropriateness, eco-responsibility), its purposes (e.g., equity, sustainability) and the
processes by which it was developed (e.g., inclusiveness, responsiveness, openness). Aiming to capture
innovations from a large number of countries, these searches were repeated using the same key words
in English, French, Spanish and Portuguese (the languages spoken by our team members). Two team
members independently categorized 20% of the innovations retrieved in order to develop consistent
inclusion and exclusion criteria, which were then applied by one team member to the remaining
sample. We excluded innovations that relied mainly on software (e.g., apps) or mainly on human
Sustainability 2018,10, 4015 7 of 21
intervention (e.g., clinical or educational approaches) to provide an individualized solution to the user
since our tool is meant to assess innovations that include technical components to address the social
determinants of health [9].
2.3. Data Analyses
We captured on a login/password-secured website images, brief descriptions and technical
documentation about the innovations found (n = 105). We also collected in an Excel spreadsheet data
about the country of origin, the target region, the medical indications for these innovations and the
SDGs they addressed. We searched for and downloaded, when available, peer-reviewed publications
pertaining to these innovations as well as other sources of information such as reports produced
by independent organizations and technical documentation. All this material was used to inform
regular discussions among team members about the key responsibility features these innovations
shared (or not). Gradually, we focused our attention on the ways in which these innovations addressed
(or not) sustainable development challenges and may contribute directly or indirectly to various SDGs.
This is the point at which our iterative strategy turned back to the literature [
38
]. Like Lubberink
and colleagues, we observed that the literature on business considerations of social, frugal and/or
sustainable innovation was very informative [
16
]. It enabled us to develop a framework that gradually
became more consistent as we more closely examined the similarities and differences between the
105 innovations. In the next section, after providing descriptive statistics about the sample as a whole,
we discuss in greater detail three innovations that are sufficiently diverse (in terms of function, region,
target population, business model, etc.) to illustrate key relationships between RIH and the SDGs.
3. The Relationships RIH Entertains with the SDGs
3.1. An Overview of Health Innovations with Responsibility Features
A total of 105 innovations were identified through the horizon scanning: 69% of them were at an
advanced stage of development (i.e., available for use), 28% at an intermediary stage (i.e., functionalities
or production processes not finalized) and 3% at a very preliminary stage (i.e., in the form of a prototype).
Among the 105 innovations, 57% had been developed by for-profit organizations, 24% by non-profit
organizations, 15% by universities, 3% by hospitals and 1% by a large network of volunteers.
Table 1indicates the countries of origin of these innovations. It shows that close to half (46.7%)
originate from the United States, 16.2% from Canada and 10.5% from the United Kingdom. These results
need to be interpreted with caution since Internet-based searches are known to produce different
hits depending on one’s location and Internet search attributes (e.g., language, type of browser, IP
address, etc.). It is nonetheless interesting to observe that both India and Brazil are part of the listed
countries. This is compatible with the sustainable development principle of supporting domestic
technology development.
Table 1. Country of origin of the innovations identified through our horizon scanning.
Country of Origin n %
United States 479 46.7
Canada 17 16.2
United Kingdom 11 10.5
India 7 6.7
Norway 3 2.9
Brazil 3 2.9
France 2 1.9
Others 113 12.4
Total 105 100
1
Argentina, Austria, Belgium, Botswana, Burkina Faso, Spain, Global community, Israel, New Zealand, Uganda,
The Netherlands, Peru, Switzerland, Thailand.
Sustainability 2018,10, 4015 8 of 21
Table 2shows the geographical regions explicitly targeted by the 105 innovations. While 11.3%
of the innovations were developed to be used worldwide, the large majority (64.5%) was targeted at
users located in Africa (22.6%), South Asia (17.7%), low-income countries (13.7%) and Central and
South America (10.5%). Very few of these innovations aimed to address health problems in North
America (5.6%), Europe (3.2%) or Australia (0.8%). This is not entirely surprising, but it underscores
the lack of responsiveness of the established STI model in developed countries.
Table 2. Regions targeted by the innovations.
Target Region N %
Africa 28 22.6
South Asia 22 17.7
Unspecified 18 14.5
Low income countries 17 13.7
Global 14 11.3
Central and South America
13 10.5
North America 7 5.6
Europe 4 3.2
Australia 1 0.8
Total 124 100
Note: The total is larger than 105 since more than one region could be targeted by one innovation.
We extracted information about the types of health problem addressed by the 105 innovations.
Table 3indicates that a large portion of these innovations are targeted at health issues that are prevalent
in developing countries such as newborn care (15.5%), reduced mobility and limb amputation (14.5%),
infectious diseases (10.9%) and pregnancy and delivery care (9.1%). One may also note that a fair
number of these innovations address the challenge of ensuring proper access to care and drugs (7.3%)
or the needs of chronically ill patients who suffer from cardiovascular diseases (3.6%) or cancer (2.7%),
which are becoming more prevalent in poor countries.
Table 3. Health indications of the innovations.
Indication N %
New-born complications 17 15.5
Reduced mobility & limb amputation 16 14.5
Malaria, infectious diseases & diarrheal diseases 12 10.9
Pregnancy & delivery complications 10 9.1
Visual & hearing dysfunctions 9 8.2
Tuberculosis & respiratory diseases 8 7.3
Access to care & drugs 8 7.3
HIV/AIDS 7 6.4
Cardiovascular diseases 4 3.6
Cancer 3 2.7
Anemia 2 1.8
Diabetes 2 1.8
Other 112 10.9
Total 110 100
Note: The total is larger than 105 since more than one indication could be addressed by one innovation.
1
Burns,
adverse events, epilepsy, hemorrhage due to violence, feminine hygiene, infections, musculoskeletal, gastrointestinal,
obesity, parasites, upper limb tremors, care network.
Table 4shows the distribution of the SDGs addressed by the 105 innovations. By “addressed”,
we do not mean that the innovation fulfilled a given SDG, but that its responsibility features (in terms
of product, development processes or purposes) were aligned with this SDG. In order to emphasize
the most important SDGs for RIH, we identified a maximum of five SDGs for each innovation, which
Sustainability 2018,10, 4015 9 of 21
necessarily included SDG3-Good health and wellbeing. Table 4indicates that the innovations were
more frequently aligned with SDG10-Reduced inequalities (87%), SDG17-Partnerships for the goals
(54%), SDG1-No poverty (15%) and SDG4-Quality education (11%). A smaller number of innovations
addressed SDGs that emphasize sustainable economic development such as SDG11-Sustainable cities
and communities (9%) and SDG9-Industry and innovation (6%). The same observation applies to
environmental sustainability goals such as SDG7-Affordable and clean energy (7%), SDG6-Clean water
and sanitation (5%) and SDG 15-Life on land (2%).
Table 4. Distribution of the SDGs addressed by the innovations.
Sustainable Development Goal N %
SDG3. Good health & well-being 105 100
SDG10. Reduced inequalities 91 87
SDG17. Partnerships for the goals 57 54
SDG1. No poverty 16 15
SDG4. Quality education 12 11
SDG11. Sustainable cities & communities 9 9
SDG7. Affordable & clean energy 7 7
SDG9. Industry, innovation & infrastructure 6 6
SDG6. Clean water & sanitation 5 5
SDG5. Gender equality 3 3
SDG15. Life on land 2 2
SDG2. Zero hunger 1 1
SDG8. Decent work & economic growth 1 1
SDG12. Responsible consumption & production 1 1
SDG13. Climate action 1 1
SDG14. Life below water 1 1
SDG16. Peace, justice & institutions 0 0
Note: An innovation could be aligned with a maximum of 5 SDGs.
Figure 2shows the extent to which the innovations could be aligned with multiple SDGs. It is
striking that only a very small portion (5%) of the innovations addressed only one SDG, that is,
SDG3-Good health and wellbeing. Close to a third (27%) of the innovations addressed two SDGs.
The fact that a large portion (41%) addressed three SDGs and that a small yet sizeable number addressed
four SDGs (16%) and five SDGs (11%) underscores the potential RIH holds for consolidating the SDGs.
Below, to illustrate in greater detail how RIH may build on the novel STI approach presented above
and contribute, directly or indirectly, to the SDGs, we present three contrasting innovations from
the sample.
Sustainability 2018, 10, x FOR PEER REVIEW 9 of 21
environmental sustainability goals such as SDG7-Affordable and clean energy (7%), SDG6-Clean
water and sanitation (5%) and SDG 15-Life on land (2%).
Table 4. Distribution of the SDGs addressed by the innovations.
Sustainable Development Goal N %
SDG3. Good health & well-being 105 100
SDG10. Reduced inequalities 91 87
SDG17. Partnerships for the goals 57 54
SDG1. No poverty 16 15
SDG4. Quality education 12 11
SDG11. Sustainable cities & communities 9 9
SDG7. Affordable & clean energy 7 7
SDG9. Industry, innovation & infrastructure 6 6
SDG6. Clean water & sanitation 5 5
SDG5. Gender equality 3 3
SDG15. Life on land 2 2
SDG2. Zero hunger 1 1
SDG8. Decent work & economic growth 1 1
SDG12. Responsible consumption & production 1 1
SDG13. Climate action 1 1
SDG14. Life below water 1 1
SDG16. Peace, justice & institutions 0 0
Note: An innovation could be aligned with a maximum of 5 SDGs.
Figure 2 shows the extent to which the innovations could be aligned with multiple SDGs. It is
striking that only a very small portion (5%) of the innovations addressed only one SDG, that is, SDG3-
Good health and wellbeing. Close to a third (27%) of the innovations addressed two SDGs. The fact
that a large portion (41%) addressed three SDGs and that a small yet sizeable number addressed four
SDGs (16%) and five SDGs (11%) underscores the potential RIH holds for consolidating the SDGs.
Below, to illustrate in greater detail how RIH may build on the novel STI approach presented above
and contribute, directly or indirectly, to the SDGs, we present three contrasting innovations from the
sample.
Figure 2. Distribution of the innovations addressing multiple SDGs.
3.2. Three Examples
The first innovation highlights how user-driven innovations can address the social determinants
of health as well as one key health system challenge in developed countries. In Canada, like in other
industrialized countries, formal health services are struggling to meet the needs of a growing elderly
population. As a result, more than 80% of Canadians offer unpaid voluntary health and social care
Innovations aligned with 5
SDGs; 12; 11%
Innovations aligned with 4
SDGs; 17; 16%
Innovations aligned with 3
SDGs; 43; 41%
Innovations aligned with 2
SDGs; 28; 27%
Innovations aligned with 1
SDG; 5; 5%
Figure 2. Distribution of the innovations addressing multiple SDGs.
3.2. Three Examples
The first innovation highlights how user-driven innovations can address the social determinants
of health as well as one key health system challenge in developed countries. In Canada, like in other
Sustainability 2018,10, 4015 10 of 21
industrialized countries, formal health services are struggling to meet the needs of a growing elderly
population. As a result, more than 80% of Canadians offer unpaid voluntary health and social care
assistance to family or community members [
44
,
45
]. The innovation is an online platform developed
to support communication and coordination of the network of caregivers who attend to a vulnerable
person. It can be used to archive documents, share news and photos, and synchronize a calendar
with caregivers, family and friends. It can be used by both individuals and institutions since the
platform can be adapted on demand to meet the needs of its users. For example, the technology was
purchased by Saint Elizabeth Healthcare, Canada’s largest non-profit nursing service providers. While
its use requires electronic hardware such as a computer, smartphone or tablet, it is offered free of
charge to all Saint Elizabeth Healthcare clients. The company that developed the platform obtained
a “B Corporation” certification, which requires examining carefully the impact of its decisions on
employees, suppliers, community, customers and the environment. Considering that there is “no
structured way for a company to evaluate the degree to which its practices align with RRI”, this
example supports the importance of incentive structures [15].
This first example thus highlights that innovation in health does not only aim at SDG3 (Good
health and well-being), but can wisely mobilize SDG9 (Industry and innovation) to address important
health system-level challenges. It also shows that entrepreneurs may deliberately choose to adopt and
maintain responsible corporate behaviors when governance and accountability frameworks such as
the B Corporation are made available and are valued by customers and employees.
A second example illustrates how RIH could contribute to both SDG5 (Gender equality) and
SDG4 (Quality education) and may have long-term effects contributing to SDG13 (Climate action).
Menstrual hygiene is an important issue in parts of the world where women do not have access to
sanitary products because of cost or unavailability. A company developed a menstrual cup, which is
distributed with the help of philanthropic organizations and through a “buy one, give one” business
model: It is made freely available to those who need it in East Africa. This business orientation is
aligned with research showing that socially-oriented entrepreneurs may be able to address sustainable
development issues in a more comprehensive manner than large companies, but may concurrently
have to rely on donors and/or initial public funding in the early stages of their journey [
37
]. The initial
cost of the menstrual cup is 40 dollars, that is equivalent to 5 or 6 months of use of conventional
products such as sanitary napkins or tampons. However, the cup has a lifespan of 10 years, which
reduces the overall cost by 95% [
46
,
47
]. Access to sanitary products is essential because without them
millions of women around the world miss school or work days or use unsafe alternatives that may
trigger infections. It is estimated that girls can lose up to 20% of their school year due to a lack of
access to sanitary products [
47
]. As of 2017, the company distributed menstrual cups to more than
24,000 women in East Africa through its redistribution program and field agencies [
47
]. The product is
generally well accepted, but may be less culturally appropriate in some circumstances [
46
]. On average,
a woman will use over 11,000 disposable sanitary products during her reproductive life, which is
equivalent, for example, to 200,000 tons of waste each year in the United Kingdom [48].
Hence, this second example relies on an innovative business model that seeks to provide more
value to purchasers, users and society and a responsive solution that incorporates climate action
(SDG13), gender equity (SDG5) and educational concerns (SDG4).
The third example illustrates how RIH may tackle SDG10 (Reduced inequalities), contribute
to SDG1 (No poverty) and be aligned with both SDG7 (Affordable and clean energy) and SDG8
(Decent work). A Brazilian company provides hearing aids that use solar-powered rechargeable
batteries at 20% of the market cost. Its mission is to break the vicious circle of poverty in which
deaf children are born and raised. The innovation was initially developed in Botswana where the
price of a battery with a 1-week lifetime is $1 and where average revenues are between $1.25 and
$2.50/day [
49
]. The rechargeable batteries cost around $2.50 and last 2–3 years. Although such frugal
innovations may prove “ecologically sustainable in a local context”, it remains difficult to estimate
their efficient use of materials from a product life-cycle perspective [
37
]. Knowing that 200 million
Sustainability 2018,10, 4015 11 of 21
disposable batteries are discarded annually, the solar charger reduces the negative environmental
impacts associated with hearing aids. The manufacturer also recruits people with a handicap, which,
from a public health standpoint, represents an important asset since it enables a vulnerable group
to earn stable revenues and thus improve their overall health. This business decision hence goes
beyond “traditional” corporate social responsibility activities such as social marketing campaigns or
cooperation with NGOs to donate goods to economically vulnerable people [37].
This third example thus shows that health innovation entrepreneurs can develop an affordable
and less environmentally harmful product (SDG7) as well as create an enterprise that, by design, pursues
a societal mission in a holistic manner. The latter does not only “do good”, but it relies on business
dynamics to concurrently address several SGDs. It illustrates how STI can be mobilized to tackle key
determinants of health by providing vulnerable groups with decent work opportunities (SDG8).
3.3. A Preliminary Framework of the Potential Relationships between RIH and the SDGs
Figure 3summarizes the relationships between RIH and the SDGs that were inductively identified
by examining innovations that reflect the purposes, processes or products of RIH as well as examples
that seek to tackle multiple SDGs. At the core of this Figure lies the notion that RIH, as an emerging
STI model, builds on SDG9 (Industry and innovation) to provide a broad set of solutions to positively
affect SDG3 (Health and well-being). This Figure then positions RIH along three axes: its purposes,
approaches and long-term impacts.
First, at the top of this Figure are located the SDGs that form important purposes for RIH.
This group of SDGs underscores how RIH could address several key determinants of health: It may
contribute to SDG1 (No poverty), SDG2 (Zero hunger), SDG4 (Quality education), SDG5 (Gender
equality), SDG6 (Clean water and sanitation) and SDG10 (Reduced inequalities). This principle is
compatible with recent findings from Strezov and colleagues [
32
] for whom “public health may be the
single most important overarching precondition of sustainable development”.
Second, on the left of the Figure are located the SDGs that are related to the STI approaches
that RIH can mobilize. If appropriate business models, governance structures and human resources
strategies are set in place, the STI approaches underlying RIH may support SDG8 (Decent work and
economic growth), SDG12 (Responsible consumption and production), SDG16 (Peace, justice and
institutions) and SDG17 (Partnerships for the goals). As we further discuss in the next section, for
these SDGs to be supported, one needs to recognize that moving towards RIH cannot be achieved by a
small set of innovators. Rather, such a shift requires institutional transformations that support new STI
approaches and new types of STI partnerships.
Third, considering that certain health innovations may be designed, manufactured and disposed
of by taking energy efficiency, reduced waste and end-of-life solutions into account, RIH could, in
the long-run, generate impacts that are aligned with SDG7 (Affordable and clean energy), SDG11
(Sustainable cities and communities), SDG13 (Climate action), SDG14 (Life below water) and SDG15
(Life on land). Though we found only a few innovations that addressed the welfare of non-humans (e.g.,
replacing animal models in biomedical research by computational solutions), this vision is consistent
with the emerging literature on the “one health” concept and the planetary health approach [
50
].
According to the report of the Rockefeller Foundation–Lancet Commission on planetary health, the
advent of the SDGs represents an important opportunity to “tackle health, social, and environmental
challenges in an integrated way” [
50
]. Not only are human and animal health closely connected
but “the landscape, ecosystems, and the biodiversity they contain can be managed to protect natural
systems, and indirectly, reduce human disease risk” [50].
Given its preliminary nature, the framework should be interpreted in view of the descriptive
statistics we presented above, which suggest that many solutions are being developed to address
multiple SDGs. The innovations we identified were typically developed in industrialized countries
and are meant to be used in resource-poor settings [
4
,
7
,
22
]. Nonetheless, we identified innovations
from India and Brazil and one may expect that in the coming decades the number of innovations from
Sustainability 2018,10, 4015 12 of 21
emerging economies will significantly transform the health innovation landscape [
26
]. This is likely to
include frugal innovations developed for the local needs of low- and middle-income countries [
37
]
as well as adaptation of such innovations to the needs of rich countries [
51
]. The framework should
also be interpreted keeping in mind that the three examples we discussed are not without limitations.
They illustrate how entrepreneurs may deliberately choose to develop innovations that are better
aligned with the common good. Ostrom argued that individuals are more likely to create and conserve
common resources when they have credible and reliable information about the pros and cons of
various options and “when they have an opportunity to decide the rules of the game” [
52
]. RIH is
likely to operate according to entrepreneurial rules that differ from the rules of the game already in
place, in particular, those prevalent in the highly financialized pharmaceutical and medical device
industries [
19
,
24
]. The fact that up to 43% of the innovations we inventoried were developed by
non-profit organizations, universities or volunteers, lends support to this hypothesis.
Sustainability 2018, 10, x FOR PEER REVIEW 12 of 21
without limitations. They illustrate how entrepreneurs may deliberately choose to develop
innovations that are better aligned with the common good. Ostrom argued that individuals are more
likely to create and conserve common resources when they have credible and reliable information
about the pros and cons of various options and “when they have an opportunity to decide the rules
of the game” [52]. RIH is likely to operate according to entrepreneurial rules that differ from the rules
of the game already in place, in particular, those prevalent in the highly financialized pharmaceutical
and medical device industries [19,24]. The fact that up to 43% of the innovations we inventoried were
developed by non-profit organizations, universities or volunteers, lends support to this hypothesis.
Figure 3. A preliminary framework of the relationships RIH may entertain with the SDGs. Source:
The authors.
4. Key Knowledge Gaps and Areas for Further Reflections
4.1. Knowledge Gaps
While there is a lack of research on the business and financial strategies that can bring
responsible innovations to the market [16,53,54], our findings indicate that socially-oriented
enterprises are relevant players in RIH and sustainable development. According to Mendell [55],
definitions of social entrepreneurship vary between and within countries, but they confirm the
existence of a “hybrid organizational form that combines social and economic objectives in new
ways”. What makes social entrepreneurship different from entrepreneurship tout court lies in its
mission [56]. A social enterprise is structured to deliver blended value, i.e., social and economic [57–
59]. Our findings suggest that social enterprises are well positioned to engage in an STI model
RIH builds on
SDG9. Industry, innovation &
infrastructure and is aiming at
SDG3. Good health & well-being
RIH provides solutions
that address the social
determinants of health
SDG1. No
poverty
SDG2. Zero
hunger
SDG4. Quality
education
SDG5. Gender
equality
SDG6. Clean
water &
sanitation
SDG10.
Reduced
inequalities
RIH may have long-term
effects on
SDG7. Affordable &
clean energy
SDG11. Sustainable
cities &
communities
SDG13. Climate
action
SDG14. Life
below water
SDG15. Life
on land
RIH applies an approach
that supports
SDG8. Decent
work & economic
growth
SDG12.
Responsible
consumption &
production
SDG16. Peace,
justice &
institutions
SDG17.
Partnerships for
the goals
Figure 3.
A preliminary framework of the relationships RIH may entertain with the SDGs. Source:
The authors.
4. Key Knowledge Gaps and Areas for Further Reflections
4.1. Knowledge Gaps
While there is a lack of research on the business and financial strategies that can bring responsible
innovations to the market [
16
,
53
,
54
], our findings indicate that socially-oriented enterprises are
relevant players in RIH and sustainable development. According to Mendell [
55
], definitions of
social entrepreneurship vary between and within countries, but they confirm the existence of a “hybrid
Sustainability 2018,10, 4015 13 of 21
organizational form that combines social and economic objectives in new ways”. What makes social
entrepreneurship different from entrepreneurship tout court lies in its mission [
56
]. A social enterprise
is structured to deliver blended value, i.e., social and economic [
57
59
]. Our findings suggest that
social enterprises are well positioned to engage in an STI model wherein “the value created accrues
primarily to society as a whole rather than private individuals” [
60
]. Such a view on value creation
“puts a great deal of weight on the difference between social and private problems to be solved” and
“the social and private value created as a consequence of novel solutions” [
60
]. This view also begs
the question of the normative orientation of RRI, which aims to transform the governance of STI
and, ultimately, the current political and socioeconomic system [
16
]. For Lubberink and colleagues,
alternative approaches to innovation such as social entrepreneurship can bring a relevant contribution
to RRI but would be fraught with normative tensions:
Social entrepreneurship and social innovation are anything but value-free, and have
politically significant judgments of what the world should look like, and the role that
innovation plays in this. Following from responsible innovation, one would suggest that in
these alternative approaches to innovation, stakeholders should also be able to negotiate the
terms of their inclusion and deliberation, including the politics behind these novel systems,
and the substantive biases that can exist [16].
Although we agree that RRI and social entrepreneurship are not value-free, the same observation
applies to traditional for-profit organizations. What scholars need to better understand is what organizational
forms are, in practice, better able to fulfill which SDGs and through what kinds of partnership.
Large companies active in sustainable development indeed tend to partner with non-governmental or
not-for-profit organizations when certain market segments are less profitable [
37
]. While we do not exclude
the possibility for traditional for-profit organizations to support RIH, further research should examine
the role of alternative business models, and hybrid organizational forms such as social enterprises and
social finance in the design, financing, production and commercialization of RIH.
Along these lines, three key knowledge gaps stand out (see Figure 4):
Gap 1: Identifying what alternative business models fit with sustainable and equitable health
systems and what makes such business models better adapted to RIH;
Gap 2: Identifying the organizational capacity needed by social enterprises to design and
commercialize RIH, the risks these enterprises face and how the blended value (i.e., social and
economic) they generate responds to health system-level challenges;
Gap 3: Clarifying under what conditions social finance provides technology-based ventures with
the resources and conditions they need to design and commercialize RIH, what metrics may be
used to appraise their social and economic returns and what milestones are appropriate to track
their progress.
Sustainability 2018, 10, x FOR PEER REVIEW 13 of 21
wherein “the value created accrues primarily to society as a whole rather than private individuals”
[60]. Such a view on value creation “puts a great deal of weight on the difference between social and
private problems to be solved” and “the social and private value created as a consequence of novel
solutions” [60]. This view also begs the question of the normative orientation of RRI, which aims to
transform the governance of STI and, ultimately, the current political and socioeconomic system [16].
For Lubberink and colleagues, alternative approaches to innovation such as social entrepreneurship
can bring a relevant contribution to RRI but would be fraught with normative tensions:
Social entrepreneurship and social innovation are anything but value-free, and have
politically significant judgments of what the world should look like, and the role that
innovation plays in this. Following from responsible innovation, one would suggest that in
these alternative approaches to innovation, stakeholders should also be able to negotiate
the terms of their inclusion and deliberation, including the politics behind these novel
systems, and the substantive biases that can exist [16].
Although we agree that RRI and social entrepreneurship are not value-free, the same
observation applies to traditional for-profit organizations. What scholars need to better understand
is what organizational forms are, in practice, better able to fulfill which SDGs and through what kinds
of partnership. Large companies active in sustainable development indeed tend to partner with non-
governmental or not-for-profit organizations when certain market segments are less profitable [37].
While we do not exclude the possibility for traditional for-profit organizations to support RIH,
further research should examine the role of alternative business models, and hybrid organizational
forms such as social enterprises and social finance in the design, financing, production and
commercialization of RIH.
Along these lines, three key knowledge gaps stand out (see Figure 4):
Gap 1: Identifying what alternative business models fit with sustainable and equitable health
systems and what makes such business models better adapted to RIH;
Gap 2: Identifying the organizational capacity needed by social enterprises to design and
commercialize RIH, the risks these enterprises face and how the blended value (i.e., social and
economic) they generate responds to health system-level challenges;
Gap 3: Clarifying under what conditions social finance provides technology-based ventures with
the resources and conditions they need to design and commercialize RIH, what metrics may be
used to appraise their social and economic returns and what milestones are appropriate to track
their progress.
Figure 4. Constructs of interest for further research on RIH and key knowledge gaps. Source: The
authors.
4.1.1. Alternative Business Models and RIH
For Chesbrough and Rosenbloom [61], a business model is a dynamic entity that “mediates
between technology development and economic value creation”. The process begins with identifying
a value proposition “latent” in the new technology. Entrepreneurs can in principle exploit a large
spectrum of latent attributes, but they have to ponder how they will respond to the expectations of
stakeholders who do not have the same weight in the development process. They include health and
New Business Models
Social Finance
Responsible Innovation in H ealth (RIH )
S ocial E nterprises
Gap 1
Gap 3
Gap
2
Figure 4.
Constructs of interest for further research on RIH and key knowledge gaps. Source:
The authors.
4.1.1. Alternative Business Models and RIH
For Chesbrough and Rosenbloom [
61
], a business model is a dynamic entity that “mediates
between technology development and economic value creation”. The process begins with identifying
Sustainability 2018,10, 4015 14 of 21
a value proposition “latent” in the new technology. Entrepreneurs can in principle exploit a large
spectrum of latent attributes, but they have to ponder how they will respond to the expectations of
stakeholders who do not have the same weight in the development process. They include health and
social care providers, patients and third-party payers to whom value is offered (i.e., clinical benefits)
and investors for whom value is captured (i.e., returns on investment). To respond to investors’
concerns and generate revenues faster, those who design technology are often pressured to redefine
who the key users are and what latent attributes matter, thereby ending up with an innovation that is
sellable, but whose added value may prove marginal from a health policy standpoint [
20
]. Investors
and entrepreneurs may find it difficult to agree on and articulate all the components of a business
model. For example, what should be the revenue model of a venture that provides home monitoring for
the chronically ill? How does one monetize the value of what this technology prevents from occurring
such as unnecessary emergency room visits and hospitalizations?
Since new business models “should be tested and encouraged, especially in areas of public health
concern” [
27
], it is important to identify what alternative business models are better adapted to RIH
by building on the business model innovation literature [
62
,
63
]. Considering the challenges health
systems face, this would entail, for instance, an alignment between value capture and system-level
benefits, and between market segment and health inequalities. Scholars should also examine the extent
to which “collaborative business modelling” may improve organizational performance and the extent
to which enterprises can engage in an “honest” dialogue and share with stakeholders transparent
information “without putting their competitive advantage at risk” [16].
4.1.2. The Design and Commercialization of RIH through Social Entrepreneurship
Social enterprises may include enterprising charities, cooperatives and social purpose for-profit
businesses (with limitations on profit distribution). In practice, most of them are not-for-profit,
collectively owned and do not have shareholders [
55
]. A review of the social entrepreneurship
scholarship confirmed the existence of an emerging evidence base about the establishment and growth
of social enterprises [64]. However, the extent to which social enterprises can support the design and
commercialization of technology-based products and services remains ill understood.
While RRI emphasizes the importance of user-centered design and of technologies that are
ethically and socially responsive to the context of adoption, when social enterprises seek to innovate
“for society and with society”, practical knowledge management appears particularly important [
16
].
For Stilgoe and colleagues [
65
], RRI is characterized by anticipation, reflexivity, inclusion and
responsiveness. Burget et al. [
66
] add to these principles sustainability and care. All of these principles
could help social entrepreneurs and their stakeholders to adopt design processes adapted to RIH.
In theory, health innovations can either alleviate or exacerbate the challenges health systems are
facing [
67
]. For instance, an effective health information system could support the production and use
of reliable and timely evidence by service providers who cater to the same patient. At the same time, the
implementation of such a new information system requires additional training and personnel, which
may impact other areas of care [
68
]. Research on RIH should thus aim at clarifying the organizational
capacity social enterprises need in order to design and commercialize technologies that apply the
principles of RIH. This entails examining their governance, knowledge-based capabilities, resource
mobilization and partnerships [56,64].
4.1.3. The Unlocking of RIH by Social Finance
Dambrin et al. [
24
] observed that pharmaceutical laboratories are under strong incentives to
“replicate” more than “innovate” when growing margins of profit have to be measured and reported
to shareholders. The overreliance on venture capital subjugates innovation to financial speculation,
prioritizing value extraction, i.e., generating profits, over value creation, i.e., providing a valuable
health product [
19
]. As a result, the purpose behind the creation of innovative companies “is not to
Sustainability 2018,10, 4015 15 of 21
substantially improve health as much as to provide a temporary vehicle for generating returns on
investment” [21].
Scholars should thus turn their attention to social finance (or impact investing), which refers
to “the active investment of capital in businesses and funds that generate positive social and/or
environmental impacts, as well as financial returns” to the investor [
57
]. Social finance greatly differs
from philanthropy since it consists in “the application of tools, instruments and strategies where
capital” is deliberately and intentionally put to the service of social and economic returns [
59
,
69
].
According to the Canadian Task Force on Social Finance [
57
], impact investing could reach 1% of all
managed US assets and a comparable shift in Canada “would yield $30B for investment in social
enterprises”. Although this form of financing is rapidly growing and could leverage responsible
innovation, the ability of social finance to unlock RIH has not been examined. Social finance may
offer the more “patient” and long-term financial support that small firms need to engage in R&D
activities and bring to market responsible innovations. Since financial viability remains a key issue
for socially-oriented ventures, scholars have begun to examine what represents a fair level of profit
for social enterprises such as microfinance institutions [
70
]. Scholars could further examine under
what conditions the governance and accountability frameworks [
69
] of social finance may support the
design and commercialization of RIH. For instance, if a venture were to develop cyber-therapies for
patients afflicted by chronic mental illnesses, it would entail identifying how the long-term social and
economic returns are estimated and which milestones are used to measure progress.
4.2. Areas for Further Reflections
4.2.1. The Need for Innovation within Innovation
We began this paper by quoting the multi-stakeholder report of the Economic and Social Council
of the UN, which highlighted that the 2030 Agenda for Sustainable Development implies “a radical
departure from business as usual” [
1
]. Nonetheless, the STI vision laid out in this report evokes a rather
classical technology-push model wherein new technologies are seen as providing solutions to which
societies must adapt. As Morlacchi and Martin [
39
] point out, the current STI model originates from
a school of thought in economics that trusts market mechanisms and views the role of the State and
public policymakers as one of facilitating market interactions and supporting a form of self-regulating
collective process among firms. Current scholarship tends to emphasize the extent to which this model
cannot handle complex STI policy matters such as sustainable development [
16
,
53
,
54
]. To support
social and economic inclusion and promote environmental sustainability around the world, we believe
that a more radical STI model is needed. Likewise, the UN Economic and Social Commission for Asia
and the Pacific argued that the “most critical shift” required to meet the ambitions of the 2030 Agenda
lies with the integration of the “people, planet and prosperity” elements of sustainable development
“in and through” STI policy [2].
We thus concur with Roy and King [
27
] for whom “what we ultimately need is innovation
in innovation”: without a transformation of the established profit-driven and financialized STI
approach, inequitable and unsustainable health systems could result in deleterious impacts on the
SDGs. Many new products of the biotechnology revolution “are bound to be more expensive than the
technologies they replace” and are likely to be “owned by commercial enterprises, allowing monopoly
prices to be charged for them until the patents expire” [
5
]. Although third-party payers in different
countries could, together, negotiate with companies to “force prices down towards the costs of production”,
these companies would argue that it undermines incentives to innovate [
5
]. They would not be entirely
wrong considering that steady growth and increasing profit margins are what they need to thrive on
financial markets. However, this argument only makes sense in the current, highly financialized STI
approach, which pushes away from the kind of STI that is needed to support RIH and the SDGs.
Of course, a wholehearted belief in social entrepreneurship could be rightly criticized as overly
naive. Yet, as aptly put by Auerswald [
60
], it would be equally naive to trust the transformative power
Sustainability 2018,10, 4015 16 of 21
of governments, international organizations and multinational corporations. While there is widespread
agreement that governments around the world should actively support STI to tackle societal
challenges, providing “comprehensive solutions” to problems that are global and interconnected
“exceeds the capacity of single states or market forces alone” [
12
]. Likewise, Hajer and colleagues
called “cockpit-ism” the “illusion that top-down steering by governments and intergovernmental
organizations alone can address global problems” [71].
Hence, it is important to further reflect on the way responsible innovation may thrive under the
collective action of inclusive and locally governed institutions that can cooperate on the basis of a clear
definition of what a sustainable utilization of resources from the commons entails (e.g., land, water, air,
etc.). For Forsyth and Johnson [
52
], systems characterized by multiple governing authorities at differing
scales (e.g., community, firm, municipalities, trade association, etc.) have an important bearing on
the way resources are shared, protected, renewed and distributed. If one mainly views the “strategic
behaviour and rhetoric” of politicians and policymakers who prefer to avoid taking responsibility (and
subsequent blame) for controversial decisions [
39
], one may easily conclude that research on responsible
innovations will remain of marginal value to STI policymakers. Alternatively, if one posits policymakers
as “reflexive practitioners” who are eager to share their own expertise with researchers and improve
how the government serves citizens’ interests [
72
], the scaling up of responsible innovations may
proceed more swiftly. Overall, scholars and policymakers need to reflect on the large-scale partnerships
that can transform how different countries address SDGs at the local scale.
4.2.2. Responsibility in the Practice of (Social) Entrepreneurs
For Stahl and colleagues, “when understood as a meta-responsibility, the role of RRI is to shape,
maintain, develop, coordinate and align” STI processes, actors and responsibilities [
15
]. Yet, these
authors stress that the private sector represents a “missing central concept” in RRI. For Hajer and
colleagues, since business plays a key role in sustainable development, it needs to be “held more
directly accountable” and policy incentives targeted at innovative entrepreneurs could be deployed
wisely, that is, as a means to affect the rules of the game [71]. For instance,
Targets on sustainable production and resource efficiency that directly address businesses
will not only support front runners in developing sustainable business models but will also
put pressure on laggards to change unsustainable corporate practices [71].
Lubberink and colleagues found that companies involved in responsible innovation tend to
involve stakeholders who share similar values and are motivated to align their interests with the
shared objective of the innovation, while avoiding those holding conflicting values or who might
oppose the innovation [
16
]. This tendency could also characterize social entrepreneurship. Scholars
should thus reflect on the challenges raised by the operationalization of RRI in different entrepreneurial
contexts, which may include a “selective openness” when sharing information and a tendency to
maintain power over the innovation process [16].
Notwithstanding the multifaceted and controversial role of the private sector in sustainable
development [
13
], entrepreneurs, be they socially-oriented or not, are increasingly affected by a
shifting corporate culture, which may influence how they perceive the value of sustainable innovation.
Ait Sidhoum and Serra [
73
], who studied global firms, observed a positive link between economic and
environmental performance, pointing out that the business community has been able to make these
two dimensions “complementary rather than substitutional”. Their findings suggest that “effective
reduction of pollution and promotion of social welfare” positively affects employee satisfaction and
retention as well as consumers’ loyalty. Hence, STI policies that foster the development of sustainable
innovation may benefit from broad public support.
Sustainability 2018,10, 4015 17 of 21
4.3. Strenghts and Limitations of This Study
There are limitations inherent to an exploratory study like ours. First, the lack of both theoretical
and empirical studies on RIH and the SDGs implies that our findings cannot be directly confronted
to an existing, well-defined body of knowledge. Second, our web-based horizon scanning strategy
cannot be straightforwardly reproduced: innovative companies disappear as quickly as new ones
emerge, digital contents change rapidly and social media platforms yield results that vary across users,
space and time [
42
]. Third, our dataset is limited to innovations that were described in at least one of
the languages spoken by our research team members (English, French, Portuguese and Spanish) and
thus exclude innovations from a large part of the world. One should particularly keep in mind the
innovative capacities of Asian countries that our sample failed to capture. Despite these limitations, our
study establishes the groundwork needed to begin a more systematic examination of how innovations
possessing responsibility features may help to address various SDGs.
5. Conclusions
Since the late 1980s, technological advances in health have been accompanied by both hope and
hype. Often driven by rich countries, STI have overpromised, typically neglecting the commercial and
financial dynamics that make it impossible for poor countries to obtain the benefits of these advances.
For instance, hype characterized the human genome project since its beginnings as “deciphering the
genetic make-up of new or resurgent infectious diseases such as AIDS, malaria and tuberculosis” could
lead to new ways of eliminating them [
5
]. Perhaps it is true that it may technically happen, but current
economic and political arrangements make the claim extremely weak: Neither the problem nor the
solution is simply a technological matter.
Because certain types of innovation are more likely than others to help tackle the intractable
problems of health systems, it is important to clarify the mechanisms by which a different STI approach
can address the needs of a growing population, support patients who are afflicted by chronic diseases
and reduce health disparities. Such research bears implications for entrepreneurs and policymakers
worldwide as it can generate the knowledge needed for each country to achieve greater social and
economic benefits. This paper thus sought to contribute the groundwork that may lead to a better
understanding of how RIH responds to the call for new ways of interfacing society and STI in the
pursuit of the SDGs.
Author Contributions:
All four authors conceived the paper. P.L. wrote the first draft of the manuscript and H.P.S.
supervised data collection and analysis. H.P.S., R.P. and F.R. reviewed and edited the manuscript and approved
the final version.
Funding:
This research was funded by the Canadian Institutes of Health Research (CIHR; #FDN-143294). The first
author holds a University of Montreal Chair on Responsible Innovation in Health (2015–18). Our research group
infrastructure is supported by the Fonds de la recherche en santédu Québec (FRQ-S).
Acknowledgments:
This paper draws on work conducted within the In Fieri research program (www.infieri.
umontreal.ca). We thank members of our research team who provided us with useful information and shared
insightful comments: Catherine Beaudry, Jérémy Bouchez, Geneviève Daudelin Jean-Louis Denis,
Philippe Gauthier,
Dominique Grimard, Nicola Hagemeister, Réjean Hébert, William Lazonick,
Marguerite Mendell,
Fiona A. Miller,
Xavier Pavie, Patrick Vachon and Andrew Webster. We thank Andrée-Anne Lefebvre for her assistance with the
social media horizon scanning project.
Conflicts of Interest:
The authors declare no conflict of interest. The funders of the study had no role in the
design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the
decision to publish the results.
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... Labor issues maximize likelihood of positive impact on at least 10 SDGs. Particularly, it contributes to poverty reduction (SDG1) and reducing inequalities (SDG5, SDG10) by promoting decent work and reducing unemployment (Figure 4) (Hackl, 2018;Lehoux et al., 2018). Furthermore, improved labor conditions can increase quality of life and improve productivity, therefore, this could in turn lead to better health (SDG3), nutrition (SDG2), education outcomes (SDG4), and improve prosperity and economic growth (SDG8) (e.g., Mohiuddin et al., 2020;Rakotoniaina, 2018). ...
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Background: Achieving the United Nations Sustainable Development Goals (SDGs) is beyond the capacity of any single organisation. The principles of engaging stakeholders suggest that an engaged, multi-sectoral approach, such as described in models of Responsible Research and Innovation (RRI), hold promise to mobilise humanity to solve complex and urgent global issues. Methods: This scoping review explores the characteristics of effective and sustainable inter-organisational networks for fostering RRI in service of the SDGs. The review focuses on strategies to initiate and maintain international communities of practice relevant to the implementation of RRI and/or SDGs. The search began with themes derived from prior network theory, focusing on: (a) the type and function of networks; (b) the aims and vision; and (c) the relationships between networks and network members. In total, 55 articles on inter-organisational network theory were included for the final analysis. Results: Results are reported under themes of: (1) Effectiveness, Sustainability, and Success; (2) Governance and Management; and (3) Network Relationship. Network structures, forms of management and funding are linked to sustainable networks. Potential threats include power imbalances within networks, and internal and external factors that may affect relationships at network and community levels. Few studies examine diversity or cultural viewpoints. Studies highlight the benefits of networks such as enhancing knowledge sharing among researchers, practitioners, and other stakeholders. Conclusions: The effectiveness of the managerial structure may be observed as outputs of the intention and values of an inter-organisational network. Our review demonstrates that a global inter-organisational network approach is achievable. Such a network would have many benefits, including allowing organisations to be responsive and flexible towards change and innovation.
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The scholarship on responsible research and innovation (RRI) aims to align the processes and outcomes of innovation with societal values by involving a broad range of stakeholders from a very early stage. Though this scholarship offers a new lens to consider the challenges new health technologies raise for health systems around the world, there is a need to define the dimensions that specifically characterise responsible innovation in health (RIH). The present article aims to introduce an integrative RIH framework drawing on the RRI literature, the international literature on health systems as well as specific bodies of knowledge that shed light on key dimensions of health innovations. Combining inductive and deductive theory-building strategies and concomitant with the development of a formal tool to assess the responsibility of innovations, we developed a framework that is comprised of nine dimensions organised within five value domains, namely population health, health system, economic, organisational and environmental. RIH provides health and innovation policy-makers with a common framework that supports the development of innovations that can tackle significant system-level challenges, including sustainability and equity.
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Although microfinance organizations are generally considered as inherently ethical, recent events have challenged the legitimacy of the sector. High interest rates and the excessive profitability of some market leaders have raised the question of how to define a fair profit level for social enterprise. In this article, we construct a fair profit framework based on four dimensions: profitability, social mission, pricing, and surplus distribution. We then apply this framework using an empirical sample of 496 microfinance institutions (MFIs). Results indicate that satisfying all four criteria is a difficult, although not impossible, task. According to our framework, 24 MFIs emerge as true double bottom line organizations. These MFIs are characterized by higher outreach to women, lower portfolio risk, and higher productivity in high-density environments such as South Asia. We argue that excessive profits can be better understood relative to pricing, the outreach of the MFI, and organizational commitment to clients in the form of reduced interest rates.
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Background Musculoskeletal disease is one of the leading clinical and economic burdens of the UK health system, and the resultant demand for orthopaedic care is only set to increase. One commonly used and one of the most expensive hardware in orthopaedic surgery is the surgical drill and saw. Given financial constraints, the National Health Service (NHS) needs an economic way to address this recurring cost. We share evidence of one frugal innovation with potential for contributing to the NHS’ efficiency saving target of £22 billion by 2020. Methods Exploratory case study methodology was used to develop insights and understanding of the innovations potential for application in the NHS. Following a global search for potential frugal innovations in surgery, the Arbutus Drill Cover System was identified as an innovation with potential to deliver significant cost savings for the NHS in the UK. Results The Arbutus Drill Cover System is up to 94% cheaper than a standard surgical drill available in the UK. Clinical and laboratory tests show that performance, safety and usability are as good as current offerings in high-income countries and significantly better than hand drills typically used in low-and-middle-income countries. The innovation meets all regulatory requirements to be a medical device in the Europe and North America. Conclusions The innovation holds promise in reducing upfront and life span costs for core equipment used in orthopaedic surgery without loss of effectiveness or safety benchmarks. However, the innovation needs to navigate complicated and decentralised procurement processes and clinicians and healthcare leaders need to overcome cognitive bias.
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This paper addresses the question of how Responsible Research and Innovation (RRI) can be implemented in Small and Medium-Sized Enterprises (SMEs). It builds on existing knowledge about RRI in business as well as on insights into motivations, drivers and barriers from the related fields of eco-innovation and sustainability innovation. Expert interviews with CEOs of SMEs in the Austrian medical device sector are analyzed to develop insights into the companies’ research and innovation activities and potential drivers and barriers for RRI. The findings support the assumption that SMEs are largely unaware of the RRI concept. At the same time, however, it is possible to identify current practices that already operationalize aspects of RRI. It is argued that SMEs could build upon existing practices to further develop ways of being responsible and that implementation of RRI should be in line with specific organizational and contextual factors.
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While the concept of Responsible Innovation is increasingly common among researchers and policy makers, it is still unknown what it means in a business context. This study aims to identify which aspects of Responsible Innovation are conceptually similar and dissimilar from social- and sustainable innovation. Our conceptual analysis is based on literature reviews of responsible-, social-, and sustainable innovation. The insights obtained are used for conceptualising Responsible Innovation in a business context. The main conclusion is that Responsible Innovation differs from social- and sustainable innovation as it: (1) also considers possible detrimental implications of innovation, (2) includes a mechanism for responding to uncertainties associated with innovation and (3) achieves a democratic governance of the innovation. However, achieving the latter will not be realistic in a business context. The results of this study are relevant for researchers, managers and policy makers who are interested in responsible innovation in the business context.
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Background While there is an extensive literature on Health System (HS) strengthening and on the performance of specific HSs, there are few exhaustive syntheses of the challenges HSs are facing worldwide. This paper reports the findings of a scoping review aiming to classify the challenges of HSs investigated in the scientific literature. Specifically, it determines the kind of research conducted on HS challenges, where it was performed, in which health sectors and on which populations. It also identifies the types of challenge described the most and how they varied across countries. Methods We searched 8 databases to identify scientific papers published in English, French and Italian between January 2000 and April 2016 that addressed HS needs and challenges. The challenges reported in the articles were classified using van Olmen et al.’s dynamic HS framework. Countries were classified using the Human Development Index (HDI). Our analyses relied on descriptive statistics and qualitative content analysis. Results 292 articles were included in our scoping review. 33.6% of these articles were empirical studies and 60.1% were specific to countries falling within the very high HDI category, in particular the United States. The most frequently researched sectors were mental health (41%), infectious diseases (12%) and primary care (11%). The most frequently studied target populations included elderly people (23%), people living in remote or poor areas (21%), visible or ethnic minorities (15%), and children and adolescents (15%). The most frequently reported challenges related to human resources (22%), leadership and governance (21%) and health service delivery (24%). While health service delivery challenges were more often examined in countries within the very high HDI category, human resources challenges attracted more attention within the low HDI category. Conclusions This scoping review provides a quantitative description of the available evidence on HS challenges and a qualitative exploration of the dynamic relationships that HS components entertain. While health services research is increasingly concerned about the way HSs can adopt innovations, little is known about the system-level challenges that innovations should address in the first place. Within this perspective, four key lessons are drawn as well as three knowledge gaps. Electronic supplementary material The online version of this article (10.1186/s12913-017-2585-5) contains supplementary material, which is available to authorized users.
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Nature Human Behaviour, vol. 2, no. 1 (2018); doi:10.1038/s41562-017-0281-4 (Nature Research). URL: https://www.nature.com/articles/s41562-017-0281-4
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With rising stakeholder concerns over sustainable development, corporate social responsibility (CSR) has become key for the business community, moving the business model beyond financial performance to a new voluntary paradigm based on natural resource conservation, social welfare, stakeholder engagement and economic performance. This article aims to answer whether profitable business is compatible with balanced sustainability by investigating the relationship between the economic, social, environmental and governance performance for a sample of global firms. A canonical vine (C-vine) copula is used for this purpose. Results show the existence of a fairly strong positive relationship between economic, social and environmental performance. The corporate governance dimension is shown to have a weak relationship with the rest of the CSR dimensions. Important policy implications are derived from these results. Copyright © 2017 John Wiley & Sons, Ltd and ERP Environment