Broadening sources of finance for health promotion and disease prevention: Smart capacitating investment

Smart Capacitating Investments (SCI) have been proposed as a means of mobilizing extra public and private investments in health promotion and disease prevention, but the concept needs clarification and development. To develop the concept SCI and explore available and emerging SCI models that could generate additional resources for health promotion and prevention. i) a rapid scoping review to explore existing examples of innovative investment in health promotion and disease prevention, ii) horizon scanning of recent/emerging examples of innovative investment models via expert interviews and web searches, and iii) a realist-informed synthesis of literature and interview-results to investigate investor motivations, barriers, and enablers for different forms of SCI. We present a definition of SCI that stresses these unconventional investments are either financial or non-financial, that they are made by reallocating and pooling public funds within the health sector or by involving other non-health public sectors, private not-for-profit or for-profit social impact investors. SCI models aim to sustainably enhance individual and community capacity for healthier behaviors, or to address determinants of health. We describe the broad range and nature of SCI via a classification and typology of SCI models. Social Impact Bonds were found to be the most frequently applied model across all levels of prevention. For successful implementation of blended SCI models by public–private partnerships, significant government involvement was important. SCIs are diverse and novel, and they have potential to bring about change, particularly if backed by government to attract private capital and ensure rigorous evaluation.