The role of small, locally-owned businesses in advancing community health and health equity: a qualitative exploration in a historically Black neighborhood in the USA

ABSTRACT

Multi-sector efforts to address the structural drivers of health inequities faced by racial and ethnic minority communities in the USA often ignore the potential of action by for-profit businesses, perhaps due to skepticism about the role of business in such efforts. However, given the need to harness diverse forms of capital to address structural harms, and recent calls to identify oft-ignored systemic pathways to health, we examined the role of business – specifically small, locally-owned businesses – in promoting community health and well-being. This study explored the role of small, locally owned businesses in community health, and local understandings of the value of such action, in the context of Roxbury, Massachusetts, a historically Black community with a substantial Latinx population. We conducted 20 semi-structured interviews between June and November 2021 with small business owners and staff, as well as leaders and staff from local non-profit organizations, anchor institutions, and one large business. Constructivist and critical perspectives guided the work. We used a team-based, thematic analysis approach; the team included residents and a small local business owner. Participants described pride in the neighborhood and emphasized small businesses’ contribution to long-term community well-being by investing social, cultural, human, and financial capital. Business owners saw their work as a way of giving back and did so in ways reflecting their deep understanding of community needs, aspirations, and identity. Public health efforts should engage pro-social small businesses embedded in marginalized communities, thereby supporting and amplifying businesses’ existing contributions to advancing equitable community health.

KEYWORDS:

• Small business
• health inequalities
• marginalized communities
• USA

Introduction

Multi-sector action to address the social, economic, and environmental conditions that create and exacerbate health inequities rarely involves for-profit businesses, which can – and should – contribute to local health and well-being (Ndumbe-Eyoh & Moffatt, 2013; Werts et al., 2022). Businesses may be overlooked due to skepticism among public health practitioners, organizers, and community members generated by examples of damaging corporate practices, concerns about conflict of interest, and the weakening of the public sector (Marks, 2019). However, public health attention to the role of business – especially concerning business’ impact on marginalized communities – tends to be dominated by a focus on large businesses. In line with a ‘healthy publics’ approach (Hinchliffe et al., 2018) and critical calls for greater attention to more varied and hitherto ‘hidden’ publics (Campbell & Cornish, 2021; Green et al., 2022), we focus instead on the role of small, locally owned businesses. In this paper, we qualitatively explore diverse perspectives on the role of small, locally-owned businesses in promoting health and well-being within a community contending with structural racism and health inequities.

Diverse capitals, hidden publics, and systemic pathways to health within marginalized communities

Understanding health as contingent on access to material, social and emotional resources (World Health Organization, 1986), many racial and ethnic minority groups in the USA are placed at significant risk for poor health outcomes by structural forces that negatively impact their societal contexts (Bailey et al., 2017). Examples include the impact of redlining on access to safe housing and neighborhoods and how community disinvestment restricts access to high-quality education and occupational opportunities (Bailey et al., 2017; Geronimus, 2000). As Bassett and Galea (2020) have highlighted, structural racism bars racial and ethnic minority communities from equitable access to the resources driving good health. Overcoming these inequities demands a systemic perspective that 1) attends to the complex assemblage of diverse resources needed for health, and 2) is inclusive of a wide range of publics, including members of the communities most affected by structural harms (Campbell & Cornish, 2021; Hinchliffe et al., 2018).

Community capitals implicated in contending with inequities include material resources, such as the built and natural environments, and financial capital affecting the provision of or access to quality education, employment, and other resources (Fey et al., 2008). They also include social capital (including community networks, norms, and trust) and cultural capital (including values, heritage recognition, and celebration) that nourish identity and belonging, relationships, and the creation of safe community spaces. These supports are foundational to individual and collective health promotion processes (Campbell & Murray, 2004; Fey et al., 2008).

Generating, harnessing, and sustaining diverse forms of capital requires involving diverse publics (Hinchliffe et al., 2018). For example, multi-sectoral efforts to improve community health often involve housing, medical, education, and community development organizations. Critical health scholars, however, highlight the need for a more expansive and inclusive view of relevant publics than traditional forms of public health (Green et al., 2022; Hinchliffe et al., 2018). Problematizing dominant notions of where agency to address health inequities is located and critiquing top-down approaches, this perspective centers the engagement of those with lived experience of exclusion from opportunities for good health in efforts to tackle local health inequities (Aveling & Jovchelovitch, 2014; Campbell & Cornish, 2021; Loewenson et al., 2020). Their involvement is crucial to identify aspirations and needs and leverage existing assets, capacities, and more ‘quiet’ activities within communities hitherto unrecognized by external actors (Campbell & Cornish, 2021; Kretzmann & McKnight, 1993). Marginalized communities, such as those contending with structural racism, have a long history of mutual aid and of mobilizing community capital and agency to meet needs and fill gaps in community services otherwise unmet or under-resourced by larger institutions and public systems (Cornish, 2021; Lofton et al., 2022; Spade, 2020).

The role of small businesses in advancing community health

Recent efforts to engage business in systemic approaches targeting the conditions underlying health inequities (e.g. through impact investing, shared value, and anchor business agendas) seek to move business beyond a narrow focus on traditional philanthropy, workplace wellness, or health insurance (Aveling et al., 2020; Business Roundtable, 2019; Porter & Kramer, 2011; L. Taylor et al., 2022). Much of this literature on pro-social business activity focuses on large corporations while neglecting small, local businesses (Panwar et al., 2017). Yet in 2020 in the USA, small businesses with five or fewer employees accounted for about half of all private sector jobs and two out of three new jobs between 2000–2017 (McKinsey and Company, 2020b; U.S. Census Bureau, 2022). About 1.1 million small businesses in the USA are owned by racial and ethnic minorities, employing 8.7 million people and generating economic output of over $1 trillion (McKinsey and Company, 2020a).

The relative lack of attention to small businesses may reflect a perception that precarity or smaller profit margins hinder their ability to channel capital for health-enabling action. However, small, locally-owned businesses, including minority-owned businesses, may have distinctive assets supporting systemic pathways to health. Small business owners in marginalized communities may be particularly motivated to engage in pro-social, community-directed action (Fitzgerald et al., 2010; Schnake-Mahl & Norman, 2017). In addition, small businesses may foster trusted relationships between community members and staff and a direct connection to health through their services or products. This may include the cultural significance of spaces, products, and services, such as where Black-owned businesses support access to valued goods and the neighborhood’s cultural vibrancy (Prince et al., 2021).

Within public health, recognition of such assets has predominantly resulted in engagement with small, local businesses as sites for direct public health intervention to leverage their trusted positions in the community and serve as ‘public health extenders’ (L. Taylor et al., 2022). Examples include engaging with minority-owned barbershops and corner stores/bodegas to deliver health education and outreach programs (Bleich et al., 2012; N. K. Taylor et al., 2022). In contrast, and aligned with calls for greater attention to the quieter systemic pathways to health, we sought to examine how small, locally owned businesses in a historically Black, marginalized neighborhood in Boston, Massachusetts, may already generate, mobilize, or sustain diverse forms of capital that contribute to health. In addition, we explored local understandings of the value of such community-directed action by businesses for supporting systemic pathways to health.

Methods

This analysis was part of a larger project examining the potential for businesses to play pro-social, anchoring roles in their communities. The broader dataset included 40 interviews with employees and leaders of small businesses, non-profit organizations, large businesses, and traditional anchor institutions. The initial informational interviews for that work emphasized the importance of small businesses for the health and well-being of racial and ethnic minority communities, prompting this line of inquiry. We collected data between June and November 2021, when the COVID-19 pandemic and heightened attention to structural racism in the USA added strain and focus on the businesses under study.

Study context

Roxbury is a low-income neighborhood in Massachusetts (population ~55,000), rich in history and culture. About 53% of the population is Black (including longstanding African-American communities and Caribbean and African immigrants and their descendants), and about 31% is Hispanic (Roxbury Crossing Historical Trust, 2020). Roxbury has been a social and economic hub for Black Bostonians since the 1950s, with many thriving Black-owned businesses and community organizations, a vibrant arts community, and numerous entertainment venues (Davis, 2017). The neighborhood was home to many local and national activists and civil rights leaders, including Melnea Cass and Dr. Martin Luther King, Jr. Many homes, businesses, schools, and churches were torn down in the 1960s and 1970s as part of urban renewal projects, but recent years have seen efforts to revitalize the community (Boston Planning and Development Agency, 2022; Roxbury Historical Society, 2014).

Design, participants, and data collection

We approached the work with critical and constructivist perspectives, understanding that the knowledge from this study would be a) co-created by the study team, advisors, and participants in a reflection of our values and positions and b) generated with a commitment to addressing injustice through transformative processes (Denzin, 2015). We used purposeful and snowball sampling approaches to recruit adults to the study. We identified 14 community-oriented small businesses in Roxbury through online resources and interviews with planning councils, development agencies, local business associations, academics, and non-profits. We contacted these organizations and those nominated by participants. We also interviewed individuals based in organizations that link with small businesses in Roxbury. The Harvard University Area Institutional Review Board reviewed the study procedures and deemed the study exempt (protocol IRB20-2085).

We conducted 20 interviews across 16 organizations, including six business owners and three employees from six small businesses based in Roxbury. To protect participants’ privacy in this small, tightly-knit community, we offer high-level descriptions of the business types: four retail establishments and two service providers. We also interviewed seven individuals from six non-profit organizations that served the Roxbury community, three from three traditional anchoring organizations,¹ and one from a large business from Boston that was deeply engaged in Roxbury. Interviews averaged 42 minutes (range 18–62) and were conducted via videoconference software or in a private, in-person setting at the business (e.g. an office). After learning about study procedures, participants consented to participate before the interview. Participants received $25 or $50 for interviews lasting up to 30 or 60 minutes, respectively. All discussions were audio recorded and professionally transcribed.

For employees and leaders of small businesses, the interview guide focused on the local context/community, the business, how their organization impacts community health and well-being, goals and markers of success for this work, constraints and facilitators for supporting local communities, and organizational networks related to action around community health and well-being. We also asked about the impact on their work and community of COVID-19 and the increased attention to racial justice in the USA at that time. For those operating outside of small businesses, we asked similar questions but in the context of providing perspective on the role of small businesses in Roxbury.

Data analysis

We used a team-based, reflexive thematic analysis approach drawing on the procedures detailed by Braun and Clarke (2013, 2019). The analysis team (SR, EA, SW, SK) developed an initial codebook based on the interview guide, and two coders (SW and SK) applied it to six transcripts. This group used an iterative process to capture emergent codes and suggest codebook refinements. The analysis team met to review, modify, and finalize the codebook. The updated codebook facilitated systematic inductive exploration of the data related to our research questions (how small businesses supported community health and well-being, perceived value of community-directed action, and contextual factors). We managed data with NVivo (QSR International Pty Ltd, 2021). One coder focused on local businesses’ efforts to support their communities and organizational, neighborhood, and societal context. The other coder focused on data related to small businesses’ networks, the Roxbury business ecosystem, and partners’ perspectives. After refining the initial codes, the core analysis team developed coding summaries for priority codes. The full analysis team met regularly to review the summaries, generate themes, and elaborate on the connections between themes.

Team composition

Interviews were conducted by experienced qualitative researchers with doctoral degrees in public health, social psychology, health policy and management, and organizational theory (SR and EA) and two researchers newer to qualitative methods with degrees in public health (SW and SK). The analysis team has expertise in implementation science, community health, cross-sector collaboration, and health equity. All team members have professional interests in social justice and health equity and incorporated reflexive practices in data collection and analysis processes. Two team members identify as Black residents of Roxbury, including one university-based researcher and one small business owner/local historian. All but one of the other members of the team reside in the Greater Boston area.

Findings

To contextualize the contributions of small businesses to their community’s well-being, we first describe participants’ perspectives on the community context and the challenges they felt their community faced. We then explore the range of capital small businesses leverage to support community health. Finally, we elaborate on local understandings of the value of community-directed action by these businesses and the systemic pathways to health such actions may harness and support.

Perceptions of the neighborhood: pride and challenges

Participants emphasized many positives about the neighborhood, including deep community connections, rich history, and its position as a center of Black culture in Boston. Local community organizing (ranging from the actions of Dr. Martin Luther King, Jr. to current-day activism) was seen as an essential asset. The large and growing Hispanic population, with attendant cultural contributions, was also highlighted as a critical strength.

At the same time, participants expressed concern about the challenges facing their community, describing them as the results of historical dis-investment and contemporary external pressures (such as the COVID-19 pandemic and regional economic trends). For example, participants noted stigmatizing external perceptions of the neighborhood as ‘unsafe’, rapid and unequal gains in wealth in the city and limited entry-level job opportunities. Although participants rarely framed these as ‘health’ issues, they nonetheless theoretically constitute resources for health.

Community-level challenges were described as important influences on the ability of small businesses to survive and contribute to the community. Some participants shared experiences of lenders and banks restricting access to opportunities for Roxbury-based businesses. However, a few participants also expressed a sense that larger financial institutions were becoming more interested in investing in the neighborhood and black-owned businesses, partly in response to a resurgent focus on racial justice following the murder of George Floyd.

The concern that Roxbury was dismissed quickly as being too unsafe to spend time in came up repeatedly as a challenge for local businesses to attract customers.

… if you look at the crime statistics in Roxbury versus the Boston Commons or downtown Boston, where we all go shop, I’m sure the difference in terms of overall crime statistics is not that different, but they would not think twice of, say, venturing downtown on the Boston Commons at any time of the day. But they’ll think twice of coming to Nubian Square at high noon because of our perception. (INT 37 – non-profit employee)

Other participants noted that despite the surrounding area being quite wealthy, with numerous universities and hospitals, there was often little follow-through from initial discussions of support from these organizations. Participants noted that support could be built into seemingly small transactions (e.g. ensuring lunch orders at a hospital were filled by small, local businesses) but that collectively these would have a significant impact.

The rapidly increasing wealth of the area was also linked to pressing local needs related to affordable housing as gentrification threatened displacement for many current residents. Similarly, business owners voiced concerns that they could not afford to stay, given competing offers from larger businesses for physical space.

I’m at risk of being displaced out of the city of Boston, because I’m not a lab. (INT 02 - small business owner)

Diverse capitals leveraged by small businesses to promote community health

Participants described how small businesses mobilized and invested diverse social, cultural, human, and financial capital to support a vibrant local business community and community well-being in the long term.

Social capital: leveraging intra-community relationships to counter disinvestment

Participants reported inter-organizational collaboration within the neighborhood across sectors (e.g. non-profits, small businesses, local government) to protect and grow community assets in the face of underinvestment, gentrification, and racism.

Roxbury is a very resilient, strong community and they have a lot of agencies all working towards the same goal, improving the quality of life of residents in and around Roxbury. (INT 37 –non-profit employee)

This mission-driven ethos of local organizations led to natural partnerships within the community, such as between small businesses and local community development corporations or business development councils. Examples of the power of collaborative efforts were a local social justice-themed music festival and ‘Roxbury Restaurant Week’, during which local restaurants offered discounts and broad advertising campaigns promoted the restaurants and other attractions in the neighborhood.

So that’s where Roxbury Restaurant Week came in, it was between [a local non-profit], [a local business development organization], and [a government-affiliated group] – doing something that benefited the businesses is how we can see for-profits and non-profits create equitable solutions that actually help sustain the neighborhood and everybody in it. (INT 31 – non-profit employee)

In addition to inter-organizational collaboration, participants highlighted how small businesses supported activities that promoted connections among community members to allow for community-building and mobilizing for change, for example, by providing physical space for organizing events.

It’s like providing a space for having those discussions and coming and being able to connect to different groups of different levels of people, to come have discussions and come to more of an understanding of each other. So, we really see ourselves as this grassroots space that is inviting for people to come and connect and discuss. (INT 06 – small business owner)

Cultural capital: offering community-specific, affirming services

Participants described businesses responses to community-specific identities, customs, and needs. For example, they offered culturally responsive services addressing unmet needs related to racial and/or ethnic identities. This was seen as critical for community members who wished to continue their cultural traditions, whether using traditional cooking ingredients or finding products for cultural events that could not be found elsewhere.

We have deep roots with our customers. So, over the years, we have come to know our clientele so well that we have what they want. You know, we have products from Africa, from South America, we have products from the islands, from the Caribbean. (INT 03 – small business employee)

Another store owner noted that local children do not see themselves reflected in certain retail products and sought to reframe how children see themselves and their community by focusing on products developed by and centering racial and ethnic minority groups. Several participants described the importance of small businesses in supporting and celebrating the culture of Black Bostonians.

Human capital: taking an employee-centered approach to hiring and retention

Many participants described hiring employees from the community and focusing on employees’ needs in ways that reflected the local context. For example, one business owner described trying to create employee benefits, such as rent subsidies, to mitigate the effects of rising rents and gentrification. Another business routinely hired recent immigrants with families in other countries and allowed individuals to take extended time off, guaranteeing their jobs would be waiting for them.

If somebody needs to go back to the Dominican Republic for four weeks, you know, that wouldn’t really be allowed in a lot of companies. We allow stuff like that. (INT 01 – small business owner)

Financial capital: investing in the neighborhood

Participants described small businesses’ strategic use of limited financial capital to support the local community, such as through in-kind donations for community events. While donations were often small (e.g. money for youth sports team shirts), they were valued for being easily accessible, in contrast to applications for support from larger organizations. Identifying ways to ‘keep dollars local’, such as sourcing locally, was another strategy emphasized by participants.

My chicken that I buy, I buy it from down the street in the meat market … When I buy it from them, I’m helping them to create local jobs. (INT 03 – small business employee)

Value of local businesses’ community-directed actions for systemic pathways to health

Participants saw value in small businesses’ actions, describing them as rooted in deep understanding of the community’s specific needs, assets, aspirations, and identity. Most of the small business owners in this study were Roxbury residents, had family ties, or had spent a significant portion of their lives in the neighborhood. In addition, small business owners were described as having extensive networks, as they were connected to customers, employees, and partners through direct, personal involvement in all aspects of their business. Through daily interactions with customers on the shop floor, working ‘shoulder to shoulder’ with employees and suppliers, business owners described their deep familiarity with the concerns and desires of these diverse constituents.

This local knowledge and embeddedness also allowed them to respond quickly and mobilize collaborative efforts during times of crisis. For example, during the COVID-19 pandemic, a food delivery service partnered with numerous local organizations to increase the number of meals they provided to the community, while another local restaurant owner determined that the restaurant could best serve the community by feeding schoolchildren no longer receiving free school meals and recruiting local volunteers to support the effort.

I would say that all of the relationships were known prior to the pandemic but blossomed during the pandemic, right? I’m a firm believer that pressure does two things, man. Either bust pipes or makes diamonds […] And I will argue to say that my community and the individuals who support my community during the pressure of COVID, formed some diamonds. (INT 10 – small business owner)

Both staff and external partners highlighted the value of small business owners being accessible, which enabled quick decision-making and action in response to donation requests, employee concerns, or opportunities to collaborate during a crisis.

Another thread in participant accounts was the emphasis on the role of business as part of a collective effort and the value of business owners’ long-term commitment to the well-being of their community. Though relatively small in scale, the diverse types of actions businesses took were, collectively, seen as central to strengthening and maintaining the fabric of community: as one non-profit participant put it, ‘it’s what makes community’. Moreover, the commitment of small local businesses to supporting ‘their’ community – as opposed to seeing the location as important for profitability – was often contrasted with the lack of support from larger organizations in the city.

So, it’s always the small businesses that support community events. It’s never these big organizations, ones with money. It’s always the poor people that will work with the community to host community events or sponsor a youth sports league, or what have you. So, despite them needing help themselves, they’re still going to be the ones to give back. (INT 32 – non-profit employee)

For their part, business owners viewed their business as the vehicle through which they could serve their community and ‘give back’ to Roxbury. Examples of such action included providing entry-level jobs, offering culturally affirming products and services, and inspiring youth to have pride in the neighborhood or broader career aspirations.

And it’s [business owners] that have grown up in the community, lived in the community, that network in the community. It’s also like giving hope for young people to say, ‘Hey, he came from my neighborhood and he’s owning his own business, and I can do this too’. (INT 22 – non-profit employee)

Finally, participants from across sectors saw a thriving business community as a good in itself: in a context of under/disinvestment and isolation from the wealth and resources in other parts of the city, the neighborhood needed businesses.

The fact that they’re there and they’re choosing to stay there and stay in business and try to maintain and grow their businesses is what matters. More than leading a protest or, you know, starting a petition. Like the fact that they’re there, and they’re committed to being in business in these communities and making sure that these communities have places to go, places to shop, places to feel that connection. (INT 28 – non-profit employee)

However, as described, survival for many small businesses in the area was precarious. As such, participants saw supporting local businesses – and business owners’ efforts to help each other – as part of a collective effort for collective gain. The expectation was that individual businesses’ success would lead to the local business community thriving, leading to long-term community benefit.

My dream is to see Roxbury become a destination for the city of Boston and have a full thriving community business district […]We hope to close that [wealth] gap and just have a full thriving community neighborhood filled with life and vitality where we can highlight the people, the us, the culture, and the music from the African American diaspora. (INT 37 – non-profit employee)

Discussion

This study explored the role of small, local businesses in promoting the health and well-being of a community rich in cultural and social assets but also experiencing the harms of structural racism and economic disinvestment. Our findings highlight small, locally-owned businesses’ valuable contributions to supporting systemic pathways to health in ways specific to their community’s needs and desires, even in the context of limited material resources. Central to the value of these businesses’ impact on community health is the diversity of their contributions and the distinctive assets that make these businesses so well-positioned – individually and collectively – to advance pathways to health within their communities.

The diversity of small businesses’ contributions is essential, given the need for a wide range of resources to support community functioning and resilience, particularly among marginalized groups (Kavanagh et al., 2022). Equally, participants underscored the value of diverse and highly locally responsive contributions, noting that although individually small-scale, they were integral to the collective community efforts needed to promote local well-being and compensate for historic and current dis-investment. In addition, local owners had deep ‘insider’ knowledge of the socio-economic conditions affecting community health, were embedded within local networks, and operated believing that their financial success was intertwined with community flourishing. This positioned them well to identify and mobilize existing assets, capacities, and context-specific contributions needed to advance systemic pathways to health (Hinchliffe et al., 2018; Kretzmann & McKnight, 1993). They were also poised to emphasize inclusion, diversity and long-term change in meeting community members’ current and future needs and avoid the displacement and disenfranchisement often accompanying ‘revitalization’ efforts (Murphy & Taylor, 2020; Pike et al., 2007). Many of the participants’ ideas link with the notion of ‘community cultural wealth’, which emphasizes the range of capitals (aspirational, familial, social, linguistic, resistant and navigational) that racial and ethnic minority communities can nurture and deploy (Yosso, 2005).

For many small business owners, establishing and running a business was the vehicle through which they chose to help combat challenges facing their community. In this sense, these small, locally owned for-profit businesses might be understood as more akin to mutual aid organizations oriented to meeting community needs and filling gaps left by external institutions and broader systems (Lofton et al., 2022; Spade, 2020) than to the large corporations that garner so much public health criticism and skepticism.

Together, these findings suggest the need for a more critical and nuanced discussion of the role of different types of businesses in enhancing public health. Although small business owners in our study did not explicitly connect their community-directed action to public health, as other studies have similarly noted (Egan et al., 2021; Roy, 2017), this should not mean small businesses, or their contributions, remain invisible to or overlooked by external public health actors as potential partners in addressing health inequities. Collaborative public health efforts must move beyond positioning minority-owned businesses as ‘public health extenders’ (N. K. Taylor et al., 2022) – i.e. trusted community sites for public health interventions. Rather, public health actors should seek out pro-social businesses as partners and explore ways to complement and amplify their diverse contributions to community health.

This potential notwithstanding, small businesses in our study struggled with the same material realities and broader structural forces disadvantaging the health of local residents. Study participants’ concerns reflect broader trends showing minority-owned businesses have disproportionately less access to capital, contracts, and core business supports (McKinsey and Company, 2020a). In Boston recently, of $2.1 billion in city contracts over five years, only 1.2% went to businesses owned by Black and Latinx individuals (Leung, 2021). Nationally, minority-owned businesses have been disproportionately impacted by the COVID-19 pandemic, with the number of Black and Latinx business owners in the United States decreasing by 41% and 32%, respectively, compared to 17% for White business owners between February and April 2020 (Fairlie, 2020).

We echo Egan and colleagues’ call (2021) for realism in recognizing the limits of what individual businesses or within-community alliances of businesses owners, residents, and local non-profits can be expected to achieve concerning health inequities rooted in broader social, economic, and political issues. Equally important is recognizing another implication for a ‘healthy publics’ agenda: the need for alliances involving small, local businesses and external groups that command more power in current systems. These alliances can enable small businesses’ contributions to community health by addressing barriers minority-owned businesses and businesses operating in marginalized communities face in accessing the resources they need to thrive – such as access to technology, contracts or loans, and investment that encourages businesses to continue to ‘scale deep’ rather than prioritize rapid expansion outside of the local community (Kim & Kim, 2021). Such alliances require action not only from financial institutions but also from a more comprehensive array of organizations across sectors. For example, non-profit and for-profit anchor institutions (L. Taylor et al., 2022) should do more not just to purchase from local businesses, but to collaborate in innovative ways to address the structural barriers they and their communities face. Such collaboration may also help mitigate the risk that communities contending with structural inequities experience deleterious consequences of large organizations’ proximity (e.g. gentrification, cultural displacement) yet minimal benefits (e.g. well-paying jobs or contracts).

Limitations and strengths

Our study has limitations. First, we focused predominantly on the leaders of organizations, as greater employee participation proved infeasible given the extreme pressures facing small businesses during the COVID-19 pandemic. Second, in purposefully sampling locally rooted businesses with positive reputations for pro-social action, we aimed to comment on what small local businesses can do; we do not claim this is typical of all small businesses in this or comparable neighborhoods. Similarly, we recognize that institutions of any size may engage in exploitative and health-damaging practices within communities. Finally, while the sample includes some variation in business types, a greater range may have identified more diversity in forms of capital or ways of strategically leveraging available assets. Further research assessing the extent to which small, locally owned businesses engage in pro-social actions and what hinders/motivates doing so will support a more holistic agenda for engaging the small business community in advancing health equity. At the same time, the study’s contributions are substantial. First, the inquiry focused on a historically Black neighborhood with a rich history of collective action in the face of structural harm. Second, we utilized a critical lens, ensuring attention to systemic health influences while emphasizing the need for action that supports health equity. Third, the diversity of perspectives on the team (including two Roxbury residents, one of whom is a small business owner) increased the rigor of the analysis.

Conclusion

Findings from this study highlight the opportunity for public health efforts to engage locally owned small businesses in marginalized communities in more holistic ways. In doing so, this work adds to a growing body of research on small businesses in the public health space and critical calls for a more inclusive view of the ‘publics’ of public health. By highlighting the diverse forms of capital locally owned small businesses can mobilize and leverage, we draw attention to existing, albeit ‘quieter’, systemic pathways to health fostered by such businesses. We suggest this calls for innovative and committed efforts to include small businesses in wider collectives as more than ‘public health extenders’, and to create alliances with more powerful, external actors that help locally owned small businesses – and their communities – thrive in the face of structural inequities.

Acknowledgements

We are grateful for the time and insight shared by the participants in our informational and formal interviews.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

De-identified versions of the data that support the findings of this study are available on reasonable request from the corresponding author (SR). The data are not publicly available as they contain information that could compromise the privacy of research participants.

Additional information

Funding

This work was supported by the Robert Wood Johnson Foundation under Award [77667].

Notes

1. The term ‘anchoring organizations’ refers to organizations with institutionalized place-based strategies to improve a defined local area through community investment, personnel decisions, purchasing, government engagement, and sustained commitment.