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Suggested Citation:"7 Reflections on the Day." National Academies of Sciences, Engineering, and Medicine. 2016. Applying a Health Lens to Business Practices, Policies, and Investments: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21842.
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7

Reflections on the Day

A health in all business practices approach is an important avenue for engaging businesses, said George Isham of HealthPartners. The cases discussed show that some businesses are beginning to look at the triple bottom line of financial, social, and environmental impacts. Some companies are taking a shared value approach and aligning self-interest with social good, or are considering health as a component of corporate sustainability. David Kindig of the University of Wisconsin School of Medicine and Public Health concurred. He said he was encouraged by the examples of companies moving beyond the profit model to embrace social responsibility as a fundamental part of their business model, as well as the examples of shared value. He also noted that the phrase “health in all practices” may be something that the roundtable could encourage. If many workplaces, including businesses in health care, took a health in all practices approach, it would cover a lot of the population. As is often the case in the roundtable’s workshops, Isham noted, the examples discussed showcase leaders in the forefront of the business community in transforming business practices. In moving forward, he highlighted the value of multisector conversations, and observed that different sectors operate within different cultures, beliefs, and values and thus use different terminology when talking about health, which is something that others need to consider when having cross-sector dialogue.

Isham called on participants to share their reflections and suggestions for how to move forward on private-sector involvement and engagement in population health. The following topics were highlighted by individual

Suggested Citation:"7 Reflections on the Day." National Academies of Sciences, Engineering, and Medicine. 2016. Applying a Health Lens to Business Practices, Policies, and Investments: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21842.
×

roundtable members and participants as highlights from the presentations they heard.

COLLABORATION

Michelle Larkin of the Robert Wood Johnson Foundation (RWJF) observed that discussions often focus on what the private sector or business can do for advancing health, but the population health sector also needs to think about how it can be helpful to business in terms of accomplishing their goals and objectives. She was encouraged by the examples presented, which showed thoughtful collaboration among sectors that are creating value. She also noted that collaboration is coming from both directions in the community, from businesses engaging their employees, as well as employees and community members coming together to talk about their goals for the health and well-being of their community. This is how we empower communities, and create opportunities for them to be healthier and have a more robust economy, she said. Pamela Russo, also of RWJF, agreed with Larkin and said that in addition to thinking about what businesses are doing, there was also discussion of taking a business approach to thinking about population health. It is important for population health to understand what it takes to make an investment and to achieve health aims.

George Flores of The California Endowment noted the importance of remembering that other voices that represent business can be mobilized. He pointed out that generally the senior executives of a company or the owners of a business speak for the business sector. However, there are also opportunities for partnership through the voice of employees and organized labor. Flores said that in California, the trade unions are consistently in front of policy bodies, advocating for progressive change for improving health, education, and opportunities for communities.

Russo emphasized that health departments are also potential partners. Isham reiterated the need for engagement of multiple sectors, including health care delivery, public health, education, transportation, and others.

SUSTAINABILITY

Roundtable members discussed corporate sustainability (i.e., sustainable business practices, operations, supply chains, products/services, workplaces, etc.), and the ability to sustain the initiatives and the engagement of partners for the long term.

Russo observed that for some of the businesses, corporate sustainability was a major part of their sense of social good and impact, although sustainability was not an element of all of the examples. She was inter-

Suggested Citation:"7 Reflections on the Day." National Academies of Sciences, Engineering, and Medicine. 2016. Applying a Health Lens to Business Practices, Policies, and Investments: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21842.
×

ested in having more discussion on the sustainability element of population health. She referred to an article by Hollender (2015) on net positive impact, which is the concept that a business needs to do more good than it does harm to be sustainable.

Thomas LaVeist of the Johns Hopkins Bloomberg School of Public Health noted that he was heartened by the presentations about the different ways that the power of private enterprise could be harnessed to improve the health of the population. At the same time, LaVeist had been thinking about the issue of sustainable engagement. As an example, he cited the practice of redlining, which was the practice of deliberately not investing in select communities such as West Baltimore from the 1920s through the 1970s. LaVeist wondered if there would be sufficient interest to sustain private efforts to overcome the impact of decades of disinvestment. LaVeist asked what the model for sustainability would be and if there are incentives strong enough to keep business engaged long enough to overcome the impact of disinvestment. He added that he would like to see a more systematic effort by the health sector to collect data on the health impacts on individuals of getting jobs in order to understand it at a population health level. Isham said social change on the scale that is needed in Baltimore, for example, will not come easily or quickly. Sustainability of these efforts may require a fundamental change in the way business leaders think about the function and purpose of business in society.

Sanne Magnan of the Institute for Clinical Systems Improvement said she would like to hear more about sustaining civic engagement such as that described as an element of Detroit Future City. The roundtable has discussed social movements, but less so, the contribution of civic engagement.

MEASURING IMPACTS

José Montero of Cheshire Medical Center/Dartmouth-Hitchcock Keene suggested that more discussion is needed on measuring the impacts of the many different initiatives and approaches. It is important to connect initiatives with outcomes so that funders, payers, or systems can see the changes occurring, and understand the social, environmental, and financial impacts. LaVeist also expressed the need for evaluation of these interventions to see whether they are actually improving population health. Isham reminded participants that the roundtable would be convening a workshop on July 30, 2015, to discuss “Metrics That Matter for Population Health Action.”1

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1 See http://iom.nationalacademies.org/Activities/PublicHealth/PopulationHealthImprovementRT/2015-JUL-30.aspx (accessed November 15, 2015).

Suggested Citation:"7 Reflections on the Day." National Academies of Sciences, Engineering, and Medicine. 2016. Applying a Health Lens to Business Practices, Policies, and Investments: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21842.
×

Larkin agreed that more work is needed on both measuring the contribution of the private sector to population health, and moving beyond return on investment as the primary measure. She reiterated the comment made throughout the workshop that it is not just about cost savings or financial gains, but about capturing the value of community development and a vibrant economy to individuals, families, and communities. There needs to be a better way to capture the value of the partnerships, collaborations, and coordination between business and the population health sector, said Larkin. Isham noted that in the business literature, return on investment is also used to refer to nonfinancial returns, including social returns on investment.

Russo raised the issue of tracking other social goods for their impact in a community as health status measures (e.g., education, employment). Isham agreed that health itself is a very important social outcome, but only one of a number of significant social outcomes to consider in thinking about the determinants of health and well-being.

THE PUBLIC INFLUENCE OF THE PRIVATE SECTOR

In considering the engagement of business in the policy arena, Montero said that businesses have a voice in the policy discussion by nature of the power that they hold and the economic impact that they have. Population health, community outcomes, and economic well-being involve policy and politics. He was encouraged by the examples of companies embracing the triple bottom line of social, environmental, and financial impacts. These companies face the critical challenge of becoming a consistent, unified system, he asserted.

Bobby Milstein of Rethink Health suggested that private is a misnomer when it comes to the private-sector role in population health. The private sector has massive public influence, and is also public in the sense that it needs people to support it and help do its public work well.

ENGAGING BUSINESSES OF ALL SHAPES AND SIZES

Montero also noted the need to scale initiatives appropriately for use across the country. The examples discussed at the workshop were from big companies, but a large portion of Americans are employed by smaller businesses. Montero asked how businesses with 15, 20, or 50 employees can be engaged. How do we provide them with technical assistance and help their CEOs to understand their role and tie into these efforts?

Larkin agreed that the businesses discussed at the workshop are influencers in the field, and have been champions for incorporating population health into their practices. With regard to engaging smaller businesses,

Suggested Citation:"7 Reflections on the Day." National Academies of Sciences, Engineering, and Medicine. 2016. Applying a Health Lens to Business Practices, Policies, and Investments: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21842.
×

she said that RWJF recently embarked on a campaign with the U.S. Chamber of Commerce Foundation called Better Health Through Economic Opportunity. The campaign engages chambers of commerce across the country and businesses of all sizes and shapes, and provides toolkits to help them take action in their communities to address health and economic issues. The campaign is also conducting research focusing on the links among health, economic opportunity, and growth and development.

MAKING THE EXEMPLARS THE NORM

Milstein said that long before the work of Michael Porter, there was a rogue economic theory that great wealth flows to different actors through economic transitions. Moving from agriculture to the industrial age, the wealth flowed to those that built out the infrastructure of manufacturing and transportation. In moving from a manufacturing economy to an information economy, great wealth is flowing to the information technology and service sectors. The theory was that of a transformation economy, where great wealth flows to those entities that solve society’s entrenched problems. He suggested that the examples shared at the workshop are attempts to move toward a transformation economy. These examples are far outside of the mainstream, he said. The question for the roundtable and for leaders in population health is how to use these exemplars effectively and share the practical lessons across fields and sectors.

Isham agreed that the current information revolution is changing our social, organizational, and institutional structures. This impacts the international flow of commerce and economic value, and he wondered how that might change institutional responsibilities for some of the social and environmental outcomes discussed.

Mary Lou Goeke of the United Way of Santa Cruz County, California, was inspired by the companies that are delivering on the triple bottom line, but shared a case that she believes shows the need to educate consumers and policy makers to value products that are “good all the way around” and not just select the lowest cost product. She shared that the manufacturer of a well-known organic snack food is an exemplar of a good corporation doing good for both the company and the environment (e.g., pays a living wage, built a park in an impoverished neighborhood, very generous in the community). However, the company is essentially being driven out of business by other companies in the region that do not pay living wages or care about the environment. Instead, she added, these other businesses are producing snacks that are more valued by the buyers for high-end grocery stores and big box stores, due to their perceived lower cost for consumers.

Suggested Citation:"7 Reflections on the Day." National Academies of Sciences, Engineering, and Medicine. 2016. Applying a Health Lens to Business Practices, Policies, and Investments: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21842.
×

GENERAL IMPRESSIONS

Magnan observed that a theme of hopefulness ran throughout the presentations, even in the face of rising health care costs, poor national outcomes, and persistent inequality. The Institute of Medicine has a role to play by using its position to elevate the national conversation on economic well-being and health, and to legitimize the role of businesses in population health, she said.

Many participants were particularly impressed by the scale and ambition of the efforts presented. Milstein said that the Partnership for a Healthier America, for example, is working to change whole generations; Health Care Without Harm is working to change entire sectors; Future City Detroit and HOPE SF are transforming entire cities; and some of The Dow Chemical Company’s initiatives will arguably impact the entire planet.

Echoing the sentiment of many members, Raymond Baxter of Kaiser Permanente said he was impressed by the range of approaches and the scope of the activities that were described. Businesses can pull many levers as a force for good, he said. He raised the issue of relying on voluntary action by businesses that choose to engage in population health. Baxter asked which levers could be pulled and what progress could be made, and whether they were adhering to a code of conduct or were motivated by the threat of regulation or other forces or if all businesses were conscious that they are a part of, not separate from, society? Baxter suggested that sharing success stories such as Detroit is a way to educate others about what the possibilities are with an ambitious agenda to engage people, businesses, the public sector, and others to take on the challenges of improving population health.

Suggested Citation:"7 Reflections on the Day." National Academies of Sciences, Engineering, and Medicine. 2016. Applying a Health Lens to Business Practices, Policies, and Investments: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21842.
×
Page 75
Suggested Citation:"7 Reflections on the Day." National Academies of Sciences, Engineering, and Medicine. 2016. Applying a Health Lens to Business Practices, Policies, and Investments: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21842.
×
Page 76
Suggested Citation:"7 Reflections on the Day." National Academies of Sciences, Engineering, and Medicine. 2016. Applying a Health Lens to Business Practices, Policies, and Investments: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21842.
×
Page 77
Suggested Citation:"7 Reflections on the Day." National Academies of Sciences, Engineering, and Medicine. 2016. Applying a Health Lens to Business Practices, Policies, and Investments: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21842.
×
Page 78
Suggested Citation:"7 Reflections on the Day." National Academies of Sciences, Engineering, and Medicine. 2016. Applying a Health Lens to Business Practices, Policies, and Investments: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21842.
×
Page 79
Suggested Citation:"7 Reflections on the Day." National Academies of Sciences, Engineering, and Medicine. 2016. Applying a Health Lens to Business Practices, Policies, and Investments: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21842.
×
Page 80
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In 2013 the Institute of Medicine (IOM) Roundtable on Population Health Improvement organized a workshop to discuss opportunities to foster a health in all policies approach in non-health sectors such as housing, transportation, defense, education, and others. Much of the discussion focused on public-sector organizations, and roundtable members saw the need for further discussion of the role of the private sector, both as stakeholder and partner.

On June 4, 2015, the roundtable convened a follow-up workshop focused on applying a health lens to the role and potential of businesses in improving economic well-being and community health outcomes. Participants explored what businesses can offer the movement to improve population health and areas of potential, as well as models for how businesses can impact the determinants of health, and developed a platform for discussing how to promote and support health in all business practices, policies, and investments. This report summarizes the presentations and discussions from the workshop.

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