Turning Barriers Into Benefits to Facilitate Public Health and Business Partnership

On first impression, the business sector and public health in the United States may appear to be unlikely collaborators. The predominant view of business organizations reflects a doctrine articulated by economist Milton Friedman that the only social responsibility of a corporation is to increase its profits,¹ and most companies have limited interactions with public health. Thus, public health practitioners tend to see their relationships with corporations through a regulatory lens. A lot of time and effort has been spent enforcing laws and regulations that protect health and ensure safety, and less in collaborating with the private sector in mobilizing community partnerships to solve health problems. This is not without good reason; history is strewn with examples of corporations causing widespread harm from the products they have sold and environmental degradation from their operations. Business is seen as being indifferent at best, and hostile at worst to larger health concerns. Yet, whether they realize it or not, every business is in the health business. Table 1 provides examples of successful corporation public health interventions.

TABLE 1—

Strategies for Public Health: How to Turn Barriers Into Benefits to Facilitate Collaboration With Business

Barriers to Collaboration	Benefits to Business	Strategies	Examples
Health is either not valued by business or not seen as central to their mission. Investing in health is perceived as costly and detracting from business objectives.	Emphasize nonfinancial value: decreased absenteeism, reduced presenteeism, attraction and retention of workforce, employee engagement, and brand differentiation (e.g. corporate reputation); better understanding of community; and ethical values of leadership.	Align value proposition to the business mission.	Consumer health: CVS Pharmacy’s ban on the sale of tobacco products2
There is a lack of corporate experience in how or where to invest in health. There is concern that expenditures will not yield desired outcomes. Business may want to engage but does not know how to respond.	Create a strategic roadmap and operational playbook for companies. Cite evidence to show what works and how to prioritize limited resources to maximize outcomes. Reference corporate exemplars and best practices in relevant sectors and communities. Offer practical tools, training, assistance, and out-of-the-box programs when available.	Develop health as a strategic imperative. Define sustainable business processes.	Community health: Healthy KC—a partnership with the Chamber of Commerce and the Kansas City Missouri Health Department on healthy eating, active living, workplace wellness, and tobacco cessation Wellness Now—a partnership with the Oklahoma City Health Department and the Greater Oklahoma City Chamber on economic development
There is no way of measuring impact or demonstrating broad values to stakeholders (e.g., stockholders, business analysts, media).	Leverage public health assessment and measurement expertise. Consider multiple types of dissemination methods to communicate nonfinancial values. Understand corporate needs and give corporate leaders early wins.	Use Environmental, Social, and Governance measures. Use various established recognition workplace health awards.	Employee health: American Heart Association Workplace Health Assessment Index Healthy Arizona Worksite Awards with Maricopa County Department of Public Health and Greater Phoenix Chamber Foundation
There may be limited public concern or advocacy to motivate companies.	Emphasize prevention and proactive relationships to build on trust, protect reputation, compensate for existing negative health impacts, and facilitate future responses to unintended consequences and crises.	Offer to convene or participate in advisory committees to provide input on product and service usage and safety. Promote Leaders in Energy and Environmental Design (LEED) certification.	Environmental health: Minneapolis Health Department Health Green Cost Share Program’s work with area businesses to reduce pollution Walmart’s emergency response initiatives to truck clean water and supplies into disaster areas at the request of local health departments

STANDARDS OF CORPORATE RESPONSIBILITY

For better and the worse, companies affect population health in four broad domains: (1) through the health and safety of the products and services they sell (consumer health); (2) through the health, safety, and well-being of their employees, dependents, and retirees, including workers in their supply chains (employee health); (3) through the effect they have on the environment (environmental health); and (4) through the investments they make in the communities in which they do business (community health).³ In each of these domains, exemplars of corporate best practices exist. These domains represent an opportunity to increase the reach and effectiveness of the public health sector, enhance business participation in the overall public health system, and improve thoughtful collaboration to achieve the shared goals of improving health (https://bit.ly/2MgjhMs).⁴

Shared goals with business may seem foreign, but many in the health field likely missed an important development in August 2019 that reflects a notable transformation within the private sector. The Business Roundtable, a trade association representing almost 200 chief executive officers of America’s most prominent companies from all sectors of the economy, issued a new “Statement on the Purpose of the Corporation” (https://bit.ly/2tyUUmK). In a sharp break from the Friedman Doctrine and their own long-held principles on the primacy of shareholders, these industry leaders established an updated standard of corporate responsibility. In addition to generating shareholder value, companies should also deliver value to their customers, invest in their employees, deal fairly and ethically with other companies, and support the communities in which they work. Public health should take this opportunity to engage at a deeper level than in the past.

As the corporate sector is beginning to engage more broadly in the health of their communities, literature is emerging to support the connections between corporate social responsibility and business outcomes. Studies have shown that companies deemed socially responsible (i.e., having sponsored programs that address the environment, the community, or health and safety in the workforce) either outperformed in the stock market, or did no worse, than non–socially responsible companies.⁵ While the demonstrated financial value seems stronger for return on investment in workplace health and wellness programs than it does for external investments in community health,⁶ financial return on investment is not necessary to create successful public health partnerships. Strengthening the business case for investments in health should involve communicating value that is often intangible and difficult to measure.

FIDUCIARY RESPONSIBILITY

The value of investing in health may not be as self-evident to business as it is to those in public health. While appeals to ethical values may resonate with individual business leaders, they have a fiduciary responsibility to the company. Thus, value propositions are stronger if they are aligned with a company’s business objectives. For instance, investing in employee health programs can improve absenteeism from chronic health issues that may be rooted in social causes.^2,7 These local investments can create a healthier workforce, and addressing community-based social factors such as education, transportation, food, and overall quality of life can additionally improve a company’s ability to recruit and retain a skilled workforce. The public is increasingly expecting more of business, holding companies accountable for a broad range of social and political behaviors. Consumers’ behavior may consider corporate social responsibility as a criterion in purchase decisions and prioritize corporations that demonstrate market differentiation in corporate social responsibility; they care about issues such as labor conditions in the supply chain, environmental degradation, and inclusion and diversity in hiring practices. These corporate social responsibility practices are critical to building a positive reputation and brand loyalty.

Beyond the potential to scale population health impact within the four large domains of consumer, employee, environmental, and community health, there are many advantages to a collaborative multisector partnership.⁵ While business can bring new resources to health endeavors, the potential is far greater than corporate philanthropy. Companies can provide a variety of in-kind resources and technical expertise to help to strengthen and build capacity in community organizations. For example, business can leverage a skilled workforce to provide pro bono services not typically found in the nonprofit sector, such as marketing, design, and communications. Establishing relationships may result in newfound lines of communication and opportunities to engage with business leaders to influence corporate practices and policies. Business can also recruit within their own networks to enlist new partners into coalitions and bolster advocacy in ways that nonprofit and government organizations cannot.

Recognizing the large footprint that business has in health and understanding the evolving willingness in the business community to engage in broader social issues is a start, but it may not be enough. Even though public health has many assets it brings to the table, those seeking to partner with the private sector must understand how to anticipate and overcome key barriers. Businesses are often as bureaucratic as governments, and health-related functions can be diffused across separate departments that do not communicate or coordinate. Knowing which levers to pull within a company for specific programs or issues is essential. Table 1 outlines a few of the barriers with suggestions on how to overcome them to collaborate effectively.

PUBLIC–PRIVATE PARTNERSHIPS

In an apocryphal story that is often invoked in medicine to help students focus their diagnostic efforts, when asked why he robbed banks, Willie Sutton was supposed to have said, “Because that is where the money is.” Governmental agencies often view corporations as a cause of poor health to be regulated, and community agencies often approach local business as deep pockets to support their programs. It is time to expand this perspective and approach business as a true collaborator rather than just a financier. Public–private partnerships to improve health and well-being will be challenging; business and public health have widely different cultures, speak different languages, have different priorities, and often see each other as traditional foes. Businesses will need to look beyond their day-to-day imperatives and their quarterly revenue targets to prioritize longer-term investments in health. Public health will need a revised perspective when courting partners to improve health and should be willing to help address short-term business priorities and needs to creatively identify small, early wins that build trust. The power of partnership and reciprocity between the private sector and public health is only limited by individual perspectives.