The Healthy Community Playbook
A Guide to the ‘Why’ and ‘How’
for Industrial Project Operators
November, 2016
HE ALTH I M PACT CONSULTI NG
Acknowledgement:
Development of this Playbook was supported by the Health Impact Project, a collaboration of the
Robert Wood Johnson Foundation and the Pew Charitable Trusts.
The views expressed are those of the author[s] and do not necessarily reflect the views of the Health
Impact Project, the Robert Wood Johnson Foundation or The Pew Charitable Trusts.
How to cite this document:
Evans, A., Orenstein, M. and Westwood, E. (2016). The Healthy Community Playbook: A Guide to the
‘Why’ and ‘How’ for Industrial Project Operators. Habitat Health Impact Consulting Corp.
Table of Contents
INTRODUCTION .................................................................................................................................. 1
Which Industries Are We Talking About? ......................................................................................................... 1
WHAT FACTORS CONTRIBUTE TO HEALTH? ...................................................................................... 2
WHY CARE ABOUT COMMUNITY HEALTH? ....................................................................................... 4
The Business Case and the Bottom Line Benefit .............................................................................................. 4
HOW TO ACT FOR COMMUNITY HEALTH .......................................................................................... 7
A. Employee / Workplace Wellness ................................................................................................................... 7
B. Corporate Social Responsibility ..................................................................................................................... 8
C. Managing the Effects of Your Operations .................................................................................................... 9
MITIGATE .......................................................................................................................................... 18
ENGAGING THE COMMUNITY .......................................................................................................... 20
CASE STUDIES ................................................................................................................................... 23
Case Study #1: The Stillwater Mining Company ............................................................................................ 24
Case Study #2: Dow Chemical ......................................................................................................................... 26
CONCLUSION: ON “DOING RIGHT” FOR THE COMMUNITY............................................................ 28
ADDITIONAL RESOURCES ................................................................................................................ 29
REFERENCES ..................................................................................................................................... 30
INTRODUCTION
2
The success of a company is inextricably tied to the health of its host community. Yet, for many
companies, the idea of improving community health is a daunting one. However, with knowledge,
planning and foresight, industrial project operators can both mitigate adverse impacts of their operations
and also enhance positive benefits, resulting in a healthier community and a business that is more
profitable and more aligned with societal expectations.
This Playbook is designed for companies that operate industrial projects and are interested in better
understanding the importance of managing community health effects, but aren’t sure about what needs
to be done or how to go about it. The Playbook may also be useful for industry associations and for
communities themselves to help identify how industrial projects can affect health and well-being, and
how all parties can work together.
Which Industries Are We Talking About?
This Playbook will be most relevant for companies that operate industrial projects that involve extracting,
processing, developing or converting products for use or consumption, including primary sector
industries such as mining, oil and gas, agriculture or forestry, or secondary industries such as
manufacturing or processing.
The Playbook is less relevant—but still potentially useful—for service-based industries such as banking, real
estate, education, or sales & marketing.
The business community, in its role as employer, heath care
purchaser, and respected community leader, is in a unique and
powerful position to be a change agent. Who else has both the
motivation and status in the community to play this key
leadership role?
- Andrew Webber & Suzanne Mercure, National Business Coalition on Health
1
WHAT FACTORS CONTRIBUTE TO HEALTH?
Achieving good health means much more than simply having access to health care. The social, economic
and physical environments in which people are born, grow, live, work and age are recognized as key
3
factors that contribute to overall health. These conditions of daily life, often called health determinants,
are often grouped into five categories:
•
The physical environment includes both the natural environment (air, water, animals, plants,
etc.) and the built environment (housing, infrastructure, waste and energy supply systems, road
networks, etc.). Both the natural and built environments contribute fundamental items we need
to survive, such as food, water and shelter. However, the physical environment also contributes
to the burden of disease. The World Health Organization estimates that 85 of 102 major
4
diseases or disease categories are influenced by environmental risk factors.
•
Social and economic circumstances comprise factors such as education, income, violence,
discrimination, social support networks and food systems. These represent institutional,
economic, familial, and cultural conditions that are not under the control of a single individual.
The social environment influences an enormous range of health outcomes including birth
outcomes, death rates, chronic conditions, disability, depression, child health outcomes, longterm illness and mental wellbeing.
•
Health behaviors encompass individual behaviors such as alcohol use, smoking, physical
activity and diet. Many of these behaviors have been shown to increase or decrease risk of
disease: for example, smoking increases the risk of lung cancer, and physical activity decreases
the risk of heart disease. Often, health behaviors are tied more closely to social circumstances
and norms rather than individual “choice”. This is why smoking rates are higher in some
countries than in others, or why doctors in the 1970s and 1980s had high smoking rates. Even
with knowledge of risk, our social patterning strongly affects how we behave.
•
Genetic characteristics such as sex and age influence patterns of disease (e.g., prostate cancer
occurs only in men and breast cancer primarily in women), as does genetic susceptibility to
disease.
•
Timely access to health services or medical care such as doctors, hospitals and medications, is
also important, particularly in minimizing the adverse consequences of health conditions such as
a heart attack or a broken bone.
These health determinants work together to influence the development of chronic conditions such as
cancer or heart disease, the spread of infectious diseases such as influenza or HIV, the occurrence of
injuries such as whiplash or burns, the experience of mental wellbeing issues such as depression, and the
occurrence of metabolic / nutritional issues such as obesity or malnutrition.
As shown in Figure 1, genetics and health behaviors together appear to account for about 25% of health
outcomes across the population. Medical care accounts for less than 20%. Social circumstances and the
physical environment exert the largest influence on health.
5
2
In other words, social, economic and physical circumstances have the greatest influence on our
health, and making changes in these areas offers the greatest opportunity to improve the health of
our population.
Figure 1: Factors That Contribute to Health
Health Behaviors
Genetics
Social
Circumstances
and Physical
Environment
Medical Care
This fact is relevant for industrial project operators as well as other types of businesses, because it makes
clear that by altering the social, economic or physical environment—either for better or for worse—
business is inextricably tied to community health experiences. These pathways for business to influence
health outcomes by affecting health determinants is shown in Figure 2.
Figure 2: How Industrial Projects Can Influence Health Determinants and Health Outcomes
3
WHY CARE ABOUT COMMUNITY HEALTH?
The Business Case and the Bottom Line Benefit
Evidence shows that promoting the health and vitality of the local community can lead to a more
successful business as well: one that is more profitable, faces less risk, and is more closely aligned with
societal expectations or values. The boxes below provide seven good reasons for a company to consider
and manage community health effects, based on a wide range of published research.
6-13
Cost savings. Assessing unintended community health effects at an early stage of a project helps
1
minimize the need for retrofits or other design or process changes to occur later, potentially avoiding
significant cost. In contrast, industries that cause concern about public health from pollution or other
14
issues can face the threat of costly public and legal disputes.
A review of 50 pulp and paper manufacturers from around the world found that
companies that invested in pollution-reducing technologies enjoyed significant
financial benefits compared to those who did not invest in such technologies,
15
measured over an 8-year period.
Early investment in clean technology was
found to lead to higher profitability than intensive investment.
Regulatory permitting. For industries requiring regulatory permits, the consideration of
community health effects can help minimize regulatory delays. Communities that are concerned
about health, environmental and social effects can hold up the regulatory permitting process,
potentially leading to financial losses or logistical issues for the company. However, companies that
have a demonstrated interest in the community’s wellbeing can move through the regulatory
permitting process faster.
2
In Australia, community objection to hydraulic fracturing operated by AGL
Energy increased the risk of delays in regulatory approval, and as a result
Credit Suisse (a financial services holding company) reduced its corporate
16
valuation of AGL Energy by 2.9%.
The Stillwater Mining Company in Montana (see Case Study 1 later in this
report) entered a Good Neighbor Agreement with its host community, which
17
helped speed up the regulatory permitting process.
4
Risk management. Risk management is a core business activity for many industries—and
3
particularly for the extractive and manufacturing industries, where environmental and social risks are
high. The potential consequences of unmanaged risk include interruption of operations, legal
challenges, loss of market share, liabilities and market devaluation, and reputational damage. Risks to
community health can be identified, assessed and managed along with other established risks.
Identifying ways to avoid such risks can not only prevent financial loss, but can create advantages
within the business cycle.
An increasing number of multinational industrial companies, including Shell,
Chevron and Barrick Gold, now require a Health Impact Assessment (HIA) to be
conducted at the onset of a new project to help them identify potential effects of
their operations on community health. These companies use HIA as a process to
help identify and mitigate risks at the onset of a project instead of dealing
with damage control years later.
Reputation and differentiation. The reputation of a company affects its financial performance,
6, 18
4
whether through its ability to attract or retain employees, its market valuation or customer loyalty.
19
Corporations are more and more frequently in the public eye, with the media scrutinizing actions.
Not surprisingly, companies that have a track record of negatively affecting public health gain a bad
reputation. Another aspect of reputation is differentiation: the ability of a corporation to be
distinguishable in the eyes of its customers from its competitors. Companies can use corporate
responsibility strategies—including attention to community health—to set themselves apart from their
competitors and build loyalty and a competitive advantage.
According to World Resources Institute, almost 75 percent of the market
capitalization of the companies in the Dow Jones Industrial Average is
20
intangible—primarily a company’s brand and reputation.
Research has found that when corporations engage with communities and
stakeholders who are external to the business process, this engagement plays
an “insurance-like” role that helps to mitigate reputational risks for the
21
operator in the case of a negative event.
Sustainable development. The public increasingly expects that all projects will be designed and
operated in a sustainable manner, with consideration to biodiversity, climate change, and human
health.
5
Statistics highlight the importance of corporate sustainability reporting, In 2015,
81% of S&P 500 companies produced a sustainability report, up from just 20%
22
of these companies in 2011. Some companies, such as 3M and Merck, choose
to use these reports to profile their efforts to improve community health.
5
Social license to operate. Companies are more likely to receive permission from governments
and be on good terms with local communities if their actions are viewed as beneficial—or at least free
of harm. This permission, referred to as the social license to operate, describes the implicit or explicit
authorization that companies need to receive from communities, governments and other
stakeholders in order to operate. Community health effects can often have a large influence over
social license, and when industrial developments respect community values and health, this can
create stability for operation.
6
A key part of social license to operate is having good stakeholder engagement activities, where
communities can express health concerns, among other potential issues. Meeting the expectations
of stakeholders is one important way for companies to prove publically that they are socially
8
responsible.
As discussed in Case Study 1, good relations between the Stillwater Mining
Company and its host community have helped the community become a
welcoming place for the company’s workers, and have helped to support longterm stability for the mining operations. This was made possible by respectful,
trust-building relations, and the choice to compromise with the community as
opposed to having a conversation in a courtroom.
An empirical study of 19 publicly traded junior gold mining companies found
that two-thirds of the market capitalization of these firms is a function of the
individual firm’s stakeholder engagement practices, whereas only one-third
23
of the market capitalization is a function of the value of the gold in the ground.
Staff performance. The consequences of poor health aren’t just borne by the individual:
communities, businesses, and economic vitality are also affected. A healthy community means that
workers take less time off for sick leave or to care for ill family members. Healthy communities also
attract skilled workers, and are associated with higher educational rates; all these factors are
24
beneficial for business.
7
Productivity losses as a result of employees who don’t come to work or who work
24
while sick cost U.S. employers over $225 billion annually.
A 2014 report from the Milken Institute estimated that the five most common
25
chronic diseases cost the US economy $1.5 trillion over a 3-year period.
6
HOW TO ACT FOR COMMUNITY HEALTH
Now that we have discussed the business rationale for addressing community health, let’s talk about how
businesses can go about making positive change.
There are three main avenues to consider, as shown in Figure 3: a) supporting employee / workplace
wellness; b) engaging in corporate social responsibility (CSR) initiatives; and c) managing effects of your
operations. Addressing any one of these three is an important first step; but in order to achieve the
bottom-line results discussed in the previous section, addressing all three is necessary. Although the first
two avenues are applicable to almost all business types, the discussion on managing effects of your
operations is geared specifically to operators of industrial projects.
Figure 3: Avenues for Supporting Positive Community Health
A. Supporting Employee / Workplace Wellness
Although addressing employee well-being does not directly address the health of the host community,
there are important ties between workforce wellness and community health. Employees make up a part
of the local community; and sickness or injury also affects the employee’s families, friends and social
networks.
Employers commonly address employee health and well-being in two ways.
The first is through ensuring that work environments are safe and that employees’ exposure to hazards is
minimized. Under the Department of Labor’s Occupational Safety and Health Act (OSHA), employers are
responsible for providing a safe and healthful workplace and complying with all applicable OSHA
standards.
7
The second is through providing employees with health insurance plans, Employee Assistance Programs
(EAPs), workplace wellness programs and other supports for physical and mental wellbeing. This
approach is common: almost 80% of US employers
offer some type of workplace health promotion
program.
1
Many companies have found that investing in the
health of their employees has led to large financial
returns for every dollar invested. The Harvard
Business Review estimated that every dollar invested
in employee wellness intervention yielded around $6
in savings to the employer, although the returns
varied.
26
Some examples of employer investment in
“Business leaders must understand that
an employer can do everything right to
influence the health and productivity of its
workforce at the worksite, but if that same
workforce lives in unhealthy communities,
employer investments can be seriously
compromised.”
- Andrew Webber & Suzanne Mercure,
National Business Coalition on Health
worker wellness resulting in financial gains for the
company are below:
•
A 10-year study among employees at Shell Oil in the US found that obese employees were likely
to be absent 3.7 more days per year than employees of a healthy weight, and the direct cost of
this absenteeism was estimated at $11,166,250 per year for Shell’s US operations (using
wages from the year 1999).
27
Shell since implemented wellbeing programs that included fitness
and nutritional supports on site, and incentives for meeting weight, educational and physical
activity goals. From 2013 to 2015, the company saw the proportion of employees at a healthy
weight increase from 15% to 23%.
•
Husky Injection Molding Systems reported a $6.8 million in annual savings from a $2.5
million
investment in worker wellness. Husky’s saving were a result of decreased
absenteeism.
•
28
29
Johnson & Johnson invested in comprehensive, strategically designed wellness programs to
address employees’ social, mental, and physical health. The company estimated that these
wellness programs resulted in a return of $2.71 for every dollar spent.
•
26
Dupont found that its workplace health promotion program, which included nutrition, led to a
14% decline in disability days and a return of $2.05 for every dollar invested.
29
B. Engaging in Corporate Social Responsibility Initiatives
Many businesses choose to invest in their host communities, often as part of a Corporate Social
Responsibility (CSR) or other corporate “giving” plan. This may involve a combination of funding,
employee volunteer time or both, and may be directed towards youth recreation programs and
recreational spaces, investment in education and training programs, investment in school programs,
support for housing or health care services, or support for community infrastructure, for example.
8
Over the last twenty years, the idea of Corporate Social Responsibility (CSR) has evolved substantially
from its initial focus on activities that were often undertaken to avoid fines or penalties, to engagement in
philanthropy, to the strategic creation of business and societal value.
Today, “CSR is being harnessed to create new innovations and systemic solutions that address the root
causes of society’s biggest challenges”.
30
Through social investments, communities can benefit from
spending on health care, education, and other vital community infrastructure, programs and services.
These investments “are not only essential to the creation of population health, but are also critical to
business success”.
2
Some have called the opportunity to promote population health “the next frontier of CSR”
30
as
companies increasingly recognize the linkages between good health and the social and environmental
conditions that shape it.
Supporting health doesn’t mean building a hospital!
As discussed earlier in this Playbook, there are a wide range of factors (‘health determinants’) that
influence physical, emotional and mental health. Investing in the health of a community doesn’t
necessarily mean investing in health care infrastructure such as hospitals or MRI machines. Investing in
health can take the form of supporting education, traffic safety programs, food banks, opportunities for
physical activity, elder care, affordable housing and a wide range of other infrastructure, programs and
services.
C. Managing the Effects of Your Operations
Although employee health and wellness and CSR are tools for improving community health that could be
relevant to any type of business, this last approach is more specific to industrial companies. In this
section, we ask you to consider how the establishment and operation of your industrial facility could
affect a wide variety of health outcomes – and what could be done differently to improve community
health and wellbeing.
Some of the effects discussed below are negative, in that they pose a risk to health and should be
mitigated; others are positive, represent an avenue to improving community health that can be
enhanced. Effects are discussed in terms of seven different components common to industrial
projects: 1) land acquisition and use; 2) employment opportunities; 3) construction workforces; 4) noise;
5) emissions and waste disposal; 6) traffic and transportation; and 7) accidents and malfunctions.
Table 1 shows the seven different components and the broad categories health outcomes and health
determinants that could be affected by each. It is likely that you will be familiar with some of the health
effects that stem from these components, such as the link between air emissions and increased risk of
respiratory disease. Some other effects may represent information you are not as familiar with, such as
the link between land acquisition and nutrition, or between construction workforces and social dynamics.
9
Table 1: Potential Interactions Between Project Components and Health
✔
✔
✔
Emissions and
Waste Disposal
Traffic and
Transportation
Accidents and
Malfunctions
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
Health inequity
✔
Health insurance
✔
Health care &
emergency
response services
✔
Access to goods &
services
Healthy lifestyle
✔
Stress & mental
wellbeing
✔
Infectious
diseases
✔
Noise
HEALTH
INEQUITY
HEALTH DETERMINANTS
Food and water
security
Land Acquisition
and Use
Employment
Opportunities
Construction
Workforces
Injury and fatality
Chronic diseases
HEALTH OUTCOMES
✔
✔
✔
✔
What is “Health Inequity”?
In Table 1, the last column shows ‘health inequity’ – and it appears that health inequity can be influenced
by every facet of an industrial project. Why?
Health inequity refers to unfair and avoidable differences in the distribution of ill health between
population groups.
31
With respect to an industrial project, health inequity may arise if the distribution of
the benefits of the project do not match the distribution of risk; for example, if the people who take on
the risk of exposure to contaminants or who experience decreases in access to recreational spaces are
not those who stand to benefit from the profits of the project or from the provision of jobs. Health
inequity is particularly important to consider with respect to vulnerable groups, as these populations are
the least resilient in terms of withstanding additional environmental, physical, or biological stressors. On
the positive side, vulnerable populations may derive the greatest health improvements if the positive
effects of the project are directed toward them.
The material below reviews these linkages in more depth. It should be noted that this information is not
exhaustive, in that it does not describe all the possible ways in which industrial projects can affect health,
but does lay out a number of important effects.
10
Land Acquisition and Use
Industrial facilities require land on which to be sited. There are a number of issues related to land
acquisition and use that have potential implications for community health.
If the site chosen for the facility was previously used for recreation or leisure purposes such as walking,
running, cross-country skiing or swimming, the conversion of the land for industrial use may result in
decreased opportunities for physical activity for the local population. As physical activity is linked to
health outcomes such as obesity, diabetes and mental wellbeing, this can have adverse impacts on health
unless alternatives are provided. This effect may occur not only on the site itself, but also within the
nearby environment, if people avoid the area due to restrictions or to fear of exposure to contaminants in
air or water.
If the site was previously used for subsistence purposes (i.e. the use of plants, animals and other natural
resources for personal as opposed to commercial benefit) this can also have impacts on community
health. Subsistence resources such as deer, ducks, fish or berries that are hunted, harvested or personally
grown may be used as a source of healthy, nutrient-dense food. There may be an adverse effect on
nutrition if areas used for subsistence purposes are removed from common use, or if wild animal
populations are displaced.
There are potential ‘positives’ for health as well. If the site chosen for a new facility is a brownfield—that is,
a site that had previous industrial development on it—then remediation may be required before the new
facility can begin construction. This remediation may improve environmental quality and result in
reduced health risks.
Finally, there may be improvements made to the site and surrounding areas that may benefit all
community members, such as upgraded road infrastructure, new recreational areas or enhancement to
other public amenities.
Useful questions to consider
?
•
Does the land currently provide an important food source—either for
agricultural or subsistence uses (e.g., community gardens, hunting for
population that rely on traditional subsistence foods)? If yes, how can
this be maintained?
•
Is there infrastructure or are there amenities on the land, such as parks,
trails, short-cuts or river access? What are the company’s plans for
providing these amenities elsewhere, or allowing access to these
amenities over the project lifespan?
•
Will the project remediate previous contamination? How can this benefit
be communicated to the public?
11
Employment Opportunities
Job opportunities constitute a key benefit of industrial projects; and income and employment have very
strong links to health. Income contributes to an individual’s ability to secure adequate housing, a healthy
diet and a high standard of living. Numerous studies suggest that income improves health outcomes
including overall mortality, birth outcomes, rates of specific diseases including cancer and heart disease,
mental well-being, and the need for health care service utilization.
32
Employment itself also has established links to health. In addition to providing an income, work provides
an individual with identity, social networks, a sense of self-worth, and opportunities for personal growth
(ACPH, 1999). A job that is adequate, appropriate and appreciated can result in longer life expectancy,
improved mental health, improved health behaviors and reduced rates of cardiovascular and other
diseases.
33
The mental and physical health benefits associated with employment and income extend not
only to the employed (or unemployed) individuals, but also to their families and communities.
By providing job opportunities, an industrial operation has the potential to substantially improve health
conditions for many people in nearby communities. However, the greatest benefit is generated for
community health when hiring is directed toward people who are unemployed or underemployed, as this
provides the opportunity to lift families out of poverty and make material improvements in their
circumstances—such as housing, education or food security—that may benefit health.
In addition, the provision of benefits such as health insurance and Employee Assistance Programs can
help support health and wellbeing by providing families with access to critical services.
Useful questions to consider
?
•
Can hiring be targeted so that specific groups can benefit, and so that
hiring decreases unemployment, rather than just shifting alreadyemployed workers to a new employer?
•
Are there supports that can be put in place (e.g., flexible working hours,
daycare arrangements, transportation arrangements) that would assist
the employment of people who face barriers to having a full-time job?
•
Are there training programs in place to enable greater employment
among disadvantaged groups?
•
Are the benefits that are offered to employees ones that would support
health and wellbeing among the employees and their families, such as
health insurance or Employee Assistance Programs?
•
Are all employees paid a wage sufficient for a person working full-time
to support their family without experiencing food or housing insecurity?
•
Do these employment practices that support health and wellbeing
extend to contracted workers as well, or only to direct hires?
12
Construction Workforces
When an industrial facility is being constructed, there is often a need for a large workforce of hundreds to
thousands of people hired temporarily for the construction phase. In some cases, and particularly in rural
or remote areas, there is not a sufficient pool of workers available in the local community, and workers
are brought in from other regions to fill the need. These temporary workforces are known by several
names: construction workforces, mobile workers, or FIFO (fly-in-fly-out) workers, or—from a municipality’s
point of view—a ‘shadow population’.
The importation of a mobile construction workforce has a number of implications for health. This
workforce can be a source of spending within the community, and provide economic vitality. However, it
can also place a strain on services and infrastructure that may not be prepared to handle a sudden large
increase in demand. Costs may also increase, and the ‘boom’ environment may force up the price of
housing, food and other basic necessities for all community members. This can place a great deal of
pressure on local residents who do not have the financial capacity to keep up with the price increases.
A mobile construction workforce can also place social pressures on a community. Often, this mobile
workforce is stereotyped as being young, male and single, and more interested in partying than
contributing to the wellbeing of the community.
34
However, in many cases the newcomers comprise a
welcome addition to the community, bringing new skills and social sets, and acting as a force for
economic revitalization and diversity. The pace at which changes take place often dictates how well
communities adapt.
35
Useful questions to consider
?
•
Will a construction workforce be required? If yes, is there likely to be a
substantial component of this workforce drawn from outside the local
area?
•
Where will this workforce be housed – in the local community or in a
construction camp?
•
Does your company have an understanding of how much capacity there
is for local services and infrastructure to be able to service the
construction workforce?
•
How can the company help the local community avoid a ‘boomtown’
situation that puts pressure on housing and food prices?
•
What is the local community’s reaction to the mobile workforce likely to
be? What are the company’s policies on the interaction of the mobile
workforce with the local community? What can be done to help smooth
the interaction and have the workforce be an asset to the community?
13
Noise
Excessive noise in or adjacent to communities can lead to annoyance and adverse health impacts.
36
According to the World Health Organization, “People annoyed by noise may experience a variety of
negative responses, such as anger, disappointment, dissatisfaction, withdrawal, helplessness, depression,
anxiety, distraction, agitation or exhaustion.”
37
Exposure to noise is also associated with interference with
oral and written communication, sleep disturbance, cardiovascular disease, and cognitive impairment in
children.
37, 38
disturbances.
Children, seniors and people with chronic illness tend to be more sensitive to noise
39
Many communities have regulations that limit noise from commercial or industrial sources. However,
from a public health perspective, adherence to local noise regulations may not be sufficiently protective
of public health.
There are three specific health-related outcomes for which threshold noise levels have been set. These
are:
1.
Sleep disturbance. The World Health Organization suggests an indoor night-time sound level of
30 decibels (dBA) as a threshold for sleep disturbance, or an outdoor level of 45 dBA.
2.
40
Interference with speech comprehension or learning. Indoor sound levels for continuous noise
40
should be maintained below 35 dBA to sustain adequate speech comprehension.
For effective
outdoor speech comprehension, the EPA advises that background outdoor sound levels be kept
below 55 dBA for continuous noise.
3.
41
Annoyance. The World Health Organization places the boundary for ‘moderate annoyance’ in
residential areas at 50 dB for a 16-h daytime average sound level, and the boundary for ‘serious
annoyance’ at 55dB.
42
Useful questions to consider
?
•
Does the facility cause noise at night? Are there residences close
enough to hear the noise? Is there anything the company can do to help
minimize sleep disturbance?
•
Are noise levels experienced in the community likely to be causing
stress or annoyance?
•
Does the company communicate with local residents and organizations
about anticipated periods of high noise?
14
Emissions and Waste Disposal
Industrial projects commonly generate emissions to air, water or soil through intentional activities (such
as incineration or discharge of fluids), through accidental spills or releases, or as the byproduct of
construction or excavation activities (for example, with dust).
There is a strong body of evidence linking exposure to high doses of some airborne chemical
contaminants with physical health effects including irritation or inflammation of the lungs, cardiorespiratory disease, cancer, and irritation of the eyes, nose or throat. The increase in risk depends on
several factors. These include the nature of the hazard (what the substance is that a person is being
exposed to); the amount and duration of exposure; and the susceptibility of the person who is exposed.
Several populations are at higher risk, including children, seniors, and people with some medical
conditions.
Under the Clean Air Act, EPA establishes air quality standards to protect public health with an “adequate
margin of safety”, considering the health of "sensitive" populations such as people with asthma, children,
and older adults.
43
every five years.
Industrial facilities must adhere to these standards. The EPA standards are updated
However, some professionals have argued that the air quality standards are not
sufficiently stringent to protect public health.
44
Although exposure to chemical contaminants has the potential to result in a specific set of disease
outcomes, the perception of contamination may lead to a different set of health problems. Perceived
contamination—whether or not “actual” contamination exists—can cause stress and anxiety and erode
mental wellbeing.
45, 46
In addition, the perception of contamination of subsistence food sources (e.g.,
household gardens, locally-caught fish, etc.) can lead some people to avoid those food sources and may
lead to less healthy diets.
47
Useful questions to consider
?
•
How will emissions be monitored over the life cycle of the project?
•
How will this monitoring information be reported to the public?
•
Is the public likely to trust monitoring and reporting that comes from the
company? If not, how can this trust be developed?
•
Are there subsets of the population who are likely to change their
behavior as a result of actual or perceived air emissions? Are there
subsets of the population who are likely to become stressed or worried?
•
How are cumulative exposures (that is, exposure to all sources of air
pollution, not just those from the project) being addressed? This may
not be solely the company’s responsibility, but the community’s
response to the company is likely to be shaped by concerns over
cumulative effects.
15
Traffic and Transportation
The need for transporting materials and personnel means that virtually all industrial facilities generate a
substantial amount of traffic. However, a number of factors can modify the risk of collisions, as well as
potentially influence their severity in terms of injury or fatality.
The first factor is number of vehicles. The larger the additional number of vehicles, the greater the
number of collisions. Strategies to reduce the total number of vehicles driving to or from the facility –
such as providing shuttle buses for workers – have been successful in reducing the risk of collision.
Second is the location of transport routes. Appropriate traffic management plans should consider the
location of vehicle routes in relation to sensitive areas such as schools, seniors’ facilities, pedestrian
zones, and cycling networks.
Third is driver behavior. Driver behaviors that increase the risk of collision include excessive speed, use
of a cell phone, use of alcohol or medicinal or recreational drugs, fatigue, and traveling in darkness.
Companies that have implemented strict penalties for drivers engaging in these risky behaviors have
been able to substantially reduce the frequency and severity of collisions.
Distinct from the issue of collisions is the problem of emissions from vehicles. These emissions, as
discussed above, may lead to adverse respiratory and cardiac health outcomes.
Useful questions to consider
?
•
Are there any strategies in place for reducing the number of private
worker vehicles on the road – for example, through bussing, shuttles or
carpooling?
•
What routes are used for traffic travelling to or from the facility? Can
sensitive areas be avoided (e.g., near schools during pick-up or drop-off
times)?
•
Are there mechanisms to communicate information about temporary
traffic anomalies to local authorities and to personnel from schools and
other sensitive sites?
•
What policies and procedures are in place for monitoring and enforcing
appropriate driving behavior among project vehicle drivers?
16
Accidents and Malfunctions
Accidents and malfunctions include events such as fires, explosions, spills, dam breeches, or releases of
hazardous materials. Depending on the type of industrial activity and its location in relation to the
community, a potential accident or malfunction, such as an explosion, could greatly impact public safety
and injury. Although accidents and malfunctions are rare and most businesses work hard to prevent
these adverse events, there are a number of distinct health effects to consider. These include:
•
The potential for injury or fatality.
•
The potential for exposure to contaminants among the general population or among clean-up
workers.
•
The potential for impact on the quality or acceptability of locally-grown or locally-sourced foods
(commercial or personal)
•
The potential for stress and anxiety among the general population.
•
The impact on health care services and emergency responders from both the primary and
secondary effects of the accident.
Useful questions to consider
?
•
What are the potential and most-likely accident scenarios for the facility?
•
What plans are there for communicating with local stakeholders about
short- and long-term effects in the event of an accident or malfunction?
•
Do management plans for incidents adequately consider the community
health effects and interests described above?
•
Have you discussed your emergency response plans with local hospitals,
health departments and emergency responders?
•
Are company and community resources available to adequately
respond to emergencies or accidents?
17
MITIGATE
There is no “one-size-fits-all” solution for mitigating community health risks. The best approach will
depend on the specifics of the project, the management structure, the local environment, the community
context and local regulations. However, the strategies listed below comprise a number of approaches
that can be used to stimulate thinking about how to identify appropriate mitigation strategies.
A. Are you keeping up with local regulations? Local regulations or ordinances around
noise, emissions, vehicle movements, hazardous waste management and other issues
are generally designed to be health-protective. They also change over time. A basic
risk management strategy is to periodically review these regulations to ensure your
operations are in compliance.
Although this may not be sufficient to address all
concerns about potential health hazards, it is a relatively simple exercise that will help
you stay ahead of problems.
B.
Do you need to upgrade your technology? Technology also becomes outdated,
and what was once state-of-the-art can eventually appear inadequate. As technology
(for example, scrubbers for emissions control) reaches the end of its functional life and
needs to be replaced, there is a concurrent opportunity to use improved technology
both to create better conditions for community health, and also generate a bottomline benefit for the company. For example, updated recovery systems can improve
performance, save the company money and cause fewer environmental problems.
C.
Do you need better systems and management plans?
Management plans and
business systems—such as emergency response plans, traffic safety plans, waste
disposal plans, and hiring and procurement practices—comprise the protocol that a
company and its contractors use to guide their actions. These plans and systems can
be a powerful tool for making small changes that improve community health.
D. Do you need a topic-specific study? Sometimes, you may identify an area in which
your operations are having an effect on community health, but you need to know more
before you can act. In this case, a topic-specific study is appropriate—for example, a
Human Health Risk Assessment (HHRA) to model human exposure to contaminants; a
noise study; or a traffic safety study. Often, the expertise to conduct such a study is not
within the industrial operation itself, and an outside consultant needs to be hired.
E.
Do you need to consult the community?
As described in the next section,
consulting with the local community can be an effective tool for uncovering problems,
pinpointing their source and identifying appropriate mitigations.
F.
Do you need better integration with local systems / infrastructure? Planning for
contingencies is important; and particularly for accident or malfunction scenarios.
However, planning can be made more efficient if your company works with local
agencies (for example, local health departments) to address issues. This can help your
18
company by giving you access to services and supports that you may not have known
about. It can also help those agencies prepare for future demand and coordinate
response.
G. Do you need better risk communication strategies? There can sometimes be a
disconnect between the company’s perception of what constitutes a ‘real’ risk, and
what local communities perceive as a risk. However, the community’s response to the
company and the actions that they take aren’t predicated on what the company thinks,
but on what the local residents themselves believe. Risk communication—if done well—
helps to bridge this gap by transmitting information in a way that generates trust and
belief.
Mitigating risk is mostly a process of identifying potential problems and providing solutions, very often
embedded into technology and management practices. Trying to use the opportunity of your company
operations to enhance community wellness, however, is generally a process that requires discussion with
the community about their priorities, and ways that they can see benefit being generated.
The next section describes processes that can be used for engaging the community around health and
wellness issues.
How can Health Impact Assessment (HIA) help?
Scoping
Plan the HIA study
Health Impact Assessment (HIA) is a systematic process used to
support decision-making by identifying how a project, policy or
program might influence human health. Normally, HIA is applied to
projects and policies that are not intended to directly affect health,
Baseline Health Profile
Describe the health status of the local
population
but that are nonetheless likely to result in unintended or
unrecognized health consequences. HIA identifies how a specific
project may positively or negatively affect both health determinants
and health outcomes, and produces recommendations for ways to
Assessment
Characterize positive and negative
health effects and their distribution
enhance the health benefits of the project and mitigate potential
harms.
Recommendations
HIA can be a useful tool for creating understanding of the full range
Develop recommendations to
mitigate harms and enhance benefits
of health effects that may be associated with an industrial project;
for bringing forward the perspectives of the local community; and
for developing approaches to address any problems and create
Reporting
Communicate results
shared wins.
Resources about HIA can be found on the website of the Society for
Practitioners
of
Health
Impact
Assessment
(SOPHIA)
at
Monitoring
Track changes over time
www.hiasociety.org.
19
ENGAGING THE COMMUNITY
Who is the “community”? In the context of industrial projects, community stakeholders may include
individual citizens and citizen associations, neighborhood and community groups, environmental
organizations,
government.
development
organizations,
non-governmental
organizations
(NGOs)
and
local
48, 49
Engaging with the community around health and wellness issues has a number of potential benefits for
both industry and the community. Engagement can help the company to:
•
Identify whether community members have health concerns about the facility (e.g., traffic,
emissions, etc.);
•
Identify those aspects of the company’s operations that can be adjusted to address those health
concerns;
•
Clarify whether there is a gap between how the community and the company perceive the
healthfulness / unhealthfulness of the facility;
•
Determine how to tailor risk communication strategies appropriately to address this gap;
•
Understand the health priorities of the community, and how to use CSR investment to best
address those priorities;
•
Understand health issues facing the company’s local employees, and how to address those
issues to result in more productive workers;
•
Identify opportunities to work synergistically with local organizations to affect community
health outcomes.
More generally, this type of engagement helps a company to improve decision-making and to build trust
and credibility in the community.
48, 49
On the community side, benefits include empowerment, as community stakeholders feel that their voices
have been heard; influence, through the ability to better align facility operations with community
expectations; and reassurance, if mistaken beliefs about the facility are dispelled.
Understanding the purpose and the rewards of community engagement may be relatively easy, but how
should it be done? There is a burgeoning field of community engagement theory and practice, with
many complex and competing frameworks about what constitutes effective community engagement.
What is most important to understand?
One important feature is level of engagement. There is a spectrum of possible engagement approaches
that runs from merely informing the community about the company’s planned actions, to collaborating
with and empowering the community to make changes to company operations. This spectrum is shown
in Figure 4. Each additional level of engagement adds complexity and the need for resources; but also
enhances the company’s ability to realize many of the benefits listed above.
20
Figure 4: Community Engagement Spectrum.
Source: Reproduced from the City of Burlington Community Engagement Charter - April 8, 2013
A second important feature is techniques for community engagement. What sorts of techniques and
tools can a company use to engage the local community around health and wellbeing issues?
Table 2, adapted from the Network for Business Sustainability, provides some clear and practical
examples of practices and techniques that can be used for community engagement, at different levels of
engagement. While an in-depth overview of the community engagement process is beyond the scope of
this Playbook, the Network for Business Sustainability’s report Engage Your Community Stakeholders: An
Introductory Guide for Businesses provides step-by-step instructions and a number of helpful tools for
developing a community engagement strategy.
21
Table 2: Good Practices, Techniques and Tools for Community Engagement
Level of
Engagement
Good Practices
•
Provide clear, instructive information,
accessible to all stakeholders.
•
Reach the greatest number of
stakeholders by using a variety of
information and communication
techniques.
•
Inform
Involve
•
Brochures and flyers
•
Advertisements
•
Information kiosks
•
Press releases
•
Newsletters
•
Door-to-door
•
Information sessions
•
Financial support
•
Surveys
Create informal places where you can
discuss stakeholders’ concerns with
them.
•
Studies
•
Interviews
•
Consultative committees
Guide the discussion in order to facilitate
dialogue and create a synergy among
participants.
•
Interactive website
•
Public hearings
•
Neutral forums
Consider local realities and use language
that will be understood by communities.
•
Be transparent and present factual
information.
•
Explain the uncertainties and limits of the
project; present several different
scenarios.
•
Be open to feedback.
•
Set up forums where stakeholders can
express their views on your project or
your activities.
•
•
Techniques and Tools
•
Encourage stakeholders to participate
within a climate of creativity, frankness
and spontaneity.
•
Develop routines that engage the
community in your strategic planning
processes and make sure employees are
familiar with them.
•
Joint project management
•
Strategic local or regional
partnerships
•
Sector discussion groups
Integrate solutions proposed by
concerned stakeholders into your
decision-making processes.
•
Joint brainstorming
•
Conflict resolution
•
Work groups
Empower
•
Adapted from: Network for Business Sustainability Report. 2012. Engage Your Community Stakeholders: An
Introductory Guide for Businesses.
22
CASE STUDIES
In this section, we present two case studies to illustrate some of the points brought forward in this
Playbook. The first describes a Good Neighbor Agreement signed between the Stillwater Mining
Company and a community in Montana. The second describes Dow Chemical’s partnership with the local
community to implement a diabetes prevention program. The two studies are intended to highlight
different approaches that have been taken by industry to the improvement of community health and
wellbeing, and how both the community and the company itself benefitted as a result.
23
Case Study #1: The Stillwater Mining Company
The East Boulder Mine in Montana. Credit: The Stillwater Mining Company
T
he Stillwater Mining Company (SMC) is
Stillwater Mining Company (SMC) “believed a
one of the largest primary producers of
GNA could help avoid production delays
platinum group metals in the world and
resulting from legal challenges to expansion
operates two mines on a large ore body in
plans, provide SMC a positive profile as a
Montana.
50
Although the Stillwater Mine has been
in operation since 1986, plans in the mid-1990s to
‘good neighbor’ in Montana, and possibly
increase its profitability”.
14
build an additional mine, the East Boulder Mine,
startled the community.
51
The legally-binding Good Neighbor Agreement
between the SMC, NPRC and affiliates (the
Mobilized by a local grassroots organization, the
Stillwater Protective Association and Cottonwood
Northern Plains Resource Council (NPRC), citizens
Resource Councils) was signed in May 2000, and
voiced concerns about potential impacts on water
remains in effect today.
quality, waste disposal, pollution, traffic, wildlife
the 40-page contract include the following:
habitat,
esthetics.
employee
14
housing,
culture
14, 52
Notable provisions of
and
When the State granted a permit for
GNAs are agreements between a community and
“At the end of the day, we all live here, we
all want to do it right. If you don’t have that
local community support I think it’s very
difficult if not impossible to move forward,
whether it’s on the permitting process or
day-to-day activities. We call it partnering,
you have to partner because these projects
impact people not working for the
company. If not I don’t think you have a
successful project.”
an industry to address specific issues of concern
- Representative of the SMC
the East Boulder Mine, the community felt it
represented a violation of environmental laws and
filed a lawsuit. This started three years of legal
disputes, during which time the project was
inoperative.
52
To remedy the situation without
further legal action, the community proposed to
meet with the SMC, and after lengthy discussion,
a Good Neighbour Agreement was developed.
in a collaborative way. Representatives of the
24
•
•
Funding by SMC for third-party technical
the local fire department, which is important as
consultants hired by the community who
the area experiences drought; and support to
ensure that mining practices align with
local
community interests;
initiatives—both within and outside of the GNA—
A bussing program for employees, which
prevents workers from driving private
vehicles to and from site;
•
services.
Many
of
these
result in benefits accruing not only to the
community, but also to the company. The
agreement also prevents litigation, which allows
any issues to be discussed between the two
Conservation Easements that prevent
parties until a solution has been reached. The
land from being developed, which is an
table below describes more of the shared wins for
important
both industry and the community from the GNA.
part
of
maintaining
rural
character in the community;
•
ambulance
Protection of local water sources.
Outside of the provisions within the GNA, there
are also several investments from SMC that
“The safety of the roads is really big. I
would be willing to bet everything I own
that the GNA has saved lives on the roads”
benefit community health. These include: the
company’s use of a local medical facility, which
- Jerry Iverson, Chairman of the Good Neighbor
Agreement Taskforce and Oversign Committee
Member for the East Boulder Mine
helps support operation of the facility; support for
Industry Wins
•
Avoided costly and timeconsuming delays in
17
production.
•
Developed trusting
communication structure to
prevent misinformation
17
spreading in the community.
•
Community welcomed
employees, rather than treating
them with suspicion, adding
long-term stability and
improving employee
17, 52
retention.
Shared Wins
•
Eliminated the need for an
“expensive, time-consuming,
and adversary-creating legal
14
suit”
•
Development of trust between
both groups helped support
good discussion and
17, 52
communication.
•
•
•
•
Sped up the permitting process
by acting as the required
17
consultation process.
Added stability to operations
and future planning, as “there is
some confidence that activities
can move forward provided
they are done in a responsible
17
manner”.
•
Created a formal process for
dispute resolution that to this
point has prevented legal
17, 52
arbitration.
Raised the bar for
environmental excellence by
setting goals and
objectives for developing new
53
technologies.
Helped give a predictable
future for the resource
developer, which has
benefitted the community
52
economically.
Community Wins
•
Provided local communities with access
to critical information about mining
operations and the opportunity to
address potential problems before they
53
occurred.
•
Ensured protection of quality of life and
53
productive agricultural land.
•
Established clear and enforceable water
quality standards that went above and
53
beyond state requirements.
•
Ensured public safety and security while
protecting the interest of miners through
traffic plans designed to reduce mining
53
traffic on country roads.
•
Community investment was used to
support health and social services (e.g.
fire department, clinic, training program,
ambulance).
•
Enhanced local revenue and economic
health, as the company provides
approximately 50% of the tax base of
52
Sweet Grass and Stillwater Counties.
25
Case Study #2: Dow Chemical
T
he Dow Chemical Company (Dow) is a
there was a glaring gap in services for those with
well-known chemical manufacturer, but
prediabetes.
Dow is also a key partner of the Michigan
Health Improvement Alliance, Inc. (MiHIA). MiHIA
MiHIA
is a
non-profit multi-stakeholder community
the health executive and leadership at Dow,
collaboration that works to improve wellness in
spearheaded the initiation and implementation of
1
a regional DPP model. The CDC’s DPP was the
service
perfect program to help improve lifestyles and
providers, Dow and MiHIA have partnered to
wellbeing of pre-diabetic patients, and also fit
implement
local communities within mid/central Michigan.
Alongside
an
extensive
the
network
CDC’s
of
National
and
Community
Leaders,
including
Diabetes
MiHIA’s goal for “sustainable system change” that
Prevention Program (DPP), a program that aims to
delivered a “long-term upstream change, not a
reduce the risk of type-2 diabetes in individuals
superficial solution”.
with prediabetes (this refers to someone who has
elevated blood sugar levels, and is at a high risk
for being diagnosed for diabetes type-2), through
a year-long lifestyle change program.
MiHIA
emerged
as
a
54
multi-stakeholder
collaborative with a desire to focus on the triple
aim (better health, at a lower cost, with improved
services) in the state of Michigan where Dow is
also headquartered. Initially, the MiHIA Board of
Directors felt there was a need to focus on
chronic disease, and found although there were
“We [Dow Chemical] are seeing the health
benefits, and expect we will save money in
our health plan. As a result, we are taking
the lessons learned and expanding them to
Dow’s global workforce. Having this
program available in the community is also
a huge asset. The fact that the program is
so widespread means that it’s much more
accessible.”
- Dr. Cathy Baase,
Chief Medical Officer of Health at Dow Chemical
substantial services available for diabetic patients,
26
Despite the fact that Dow spent 17% less on
chronic conditions than peer companies,
the prevalence of chronic disease among
Dow employees was reported in 2012 to be
17% lower than in similar peer companies,
and the overall health risk profile of
employees was 9% better.1
This program is driven by MiHIA and its regional
partners, but Dow acts as one local site for
delivering the interventions. The support for
MiHIA helped Dow to achieve its own company’s
strategies and vision, while developing systems
that also respond to regional needs.
What resulted from the DPP and this
There were also positive benefits that accrued to
Dow specifically, from offering both leadership as
well as their services as a local site.
55
•
Dow now has a healthier workforce. The
DPP has not just improved health for
prediabetic patients, but also has helped
to improve general health.
•
Healthier employees means that Dow
will save money on employee health.
•
The collaboration and the DPP align with
Dow’s overall company health strategy
and vision, while also advancing the
internal health philosophy. The success
of this program, from Dow’s perspective,
has led to expansion to sites across the
entire United States, beyond the three
Michigan counties.
collaboration?
The effectiveness of Dow’s approach has resulted
Many companies implement health programs that
advantage of this program for overall business,
in other corporations in the region seeing the
target the specific needs of their employees. The
and beginning to implement this program.
MiHIA and Dow collaboration is unique because it
is accessible not just to employees, but to the
whole community. The program has also created
a model for sustainable system change to tackle
chronic disease, beyond just diabetes.
This collaboration has resulted in a wide range of
positive
benefits
including:
55
for
the
local
community,
•
Improved health for prediabetic patients,
including a reduction in Body Mass Index
(BMI), weight loss and increased physical
activity.
•
Reduced healthcare costs.
•
Development of a network among
service providers that improved
customer service and accessibility for
patients.
•
Improved credibility with the medical
community and payers, which helped to
expand the network, enhancing program
accessibility.
“Dow has a national
implementation strategy for
diabetes prevention, with
implementation partnerships
offered throughout Dow’s national
sites. The outcomes related to DPP
are strong and effective, and very
much aligned to our internal health
philosophy.”
-
Peggy
Sczepanski,
Diabetes
Prevention Lifestyle Coach and Master
Trainer with Dow Chemical
27
CONCLUSION: ON “DOING RIGHT” FOR THE
COMMUNITY
“The old thinking was that if you make money you can do
this positive social and environmental stuff—but I think
the
true
philosophy
of
sustainability
is
the
interdependence. It’s not about charity; it’s about the fact
that if you do the right things in the community, the
community will do the right things for you. If you do the
right things for the environment, you’ll have a stronger
business so that you can make more money. It’s not
about sort of a condescending view . . . I don’t know if
that’s subtle or if people don’t get it, but it’s very
important. It’s about interdependence rather than
balance.
It’s
about
mutual
dependence
or
interdependence, rather than charity. It’s fundamental.”
- Manufacturing Executive13
28
ADDITIONAL RESOURCES
The resources below provide additional detail for further reading on specific topic areas.
Strategic Investing in Community Health
Oziransky, V., Yach, D., Tsao, T.-Y., Luterek, A., and D. Stevens. 2015. Beyond the Four Walls: Why Community is
Critical
to
Workforce
Health.
The
Vitality
Institute.
http://thevitalityinstitute.org/site/wpcontent/uploads/2015/07/VitalityInstitute-BeyondTheFourWalls-Report-28July2015.pdf
Pronk, N. P., Baase, C., Noyce, J. and D. E. Stevens. 2015. Corporate America and community health: Exploring the
business case for investment. Journal of Occupational and Environmental Medicine 57 (5): 493-500.
Stephan, U., Patterson M., and C. Kelly, C. 2013. Business-Driven Social Change: A Systematic Review of the
Evidence. Network for Business Sustainability. http://nbs.net/wp-content/uploads/NBS-Systematic-Review-SocialChange1.pdf
Robert Wood Johnson Foundation. 2016. Why Healthy Communities Matter to Businesses: Data Reveals Linkages
Between Health, Education, and Job Preparedness.
http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2016/rwjf428899
U.S. Chamber of Commerce Foundation. 2016. Healthy Returns: The Value of Investing in Community Health.
https://www.uschamberfoundation.org/best-practices/healthy-returns-value-investing-community-health
Workplace Safety and Health
Centers for Disease Control and Prevention. 2013. Workplace Health Promotion: Making a Business Case. Available
from: http://www.cdc.gov/workplacehealthpromotion/businesscase/
Robert Wood Johnson Foundation. 2008. Work Matters for Health. Issue Brief 4: Work and Health. Available from:
http://www.commissiononhealth.org/PDF/0e8ca13d-6fb8-451d-bac87d15343aacff/Issue%20Brief%204%20Dec%2008%20-%20Work%20and%20Health.pdf
United States Department of Labor. Undated. OSHA Law & Regulations. Available from: https://www.osha.gov/lawregs.html
Engaging with Community
Network for Business Sustainability. 2012. Engage Your Community Stakeholders: An Introductory Guide for
Businesses. http://nbs.net/wp-content/uploads/Community-Engagement-Guide.pdf
Good Neighbor Agreements
Kenney, D. S., Stohs, M., Chavez, J., and A. Fitzgerald. 2004. Evaluating the Use of Good Neighbor Agreements for
Environmental and Community Protection. Available from:
http://www.reviewboard.ca/upload/project_document/EA0809001_Good_Neighbor_Agreements_Evaluation_Report.
pdf
Lewis, S. J. 1993. The Good Neighbor Handbook, A Community-based Strategy for Sustainable Industry (2
edition). Apex Press.
nd
29
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Vera Oziransky, D. Y., Tsu-Yu Tsao, Alexandra Luterek,, and D. Stevens. 2015. Beyond the Four
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Pronk, N. P., C. Baase, J. Noyce, and D. E. Stevens. 2015. Corporate America and community
health: exploring the business case for investment. Journal of Occupational & Environmental
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3.
World Health Organization. 2015. What are the social determinants of health? Available at:
http://www.who.int/social_determinants/sdh_definition/en/.
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Pruss-Usten, A., and C. Corvalan. 2006. Preventing Disease Through Healthy Environments.
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