A 'health broker' role as a catalyst of change to promote health: an experiment in deprived Dutch neighbourhoods.

Urban social entrepreneurs have been suggested to play an essential part in the success of local health promotion initiatives. Up to now, roles like these have only been identified in retrospect. This prospective collaborative study explored the possibilities of institutionalizing a comparable role for a 'health broker' in four Dutch municipalities as an additional investment to promote health in deprived neighbourhoods. The theoretical notions of public and policy entrepreneurs as well as of boundary spanners were adopted as a reference framework. Documents produced by the collaborative project served as input for a qualitative analysis of the developments. We succeeded in implementing a 'health broker' role comparable to that of a bureaucratic public entrepreneur holding a formal non-leadership position. The role was empowered by sharing it among multiple professionals. Although positioned within one sector, the occupants of the new role felt more entitled to cross sectoral borders and to connect to local residents, compared to other within-sector functions. The 'health broker' role had the potential to operate as an 'anchoring point' for the municipal health sector (policy), public health services (practice) and/or the local residents (public). It was also possible to specify potential 'broking points', i.e. opportunities for health promotion agenda setting and opportunities to improve cross-sectoral collaboration, citizen participation and political and administrative support for health promotion efforts. The 'health broker' role we developed and implemented reflects the notion of systematic rather than individual entrepreneurship. Such a collective entrepreneurship may create additional opportunities to gradually strengthen local health promotion efforts.