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

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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.

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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

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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.

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Cost savings. Assessing unintended community health effects at an early stage of a project helps

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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.

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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.

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Risk management. Risk management is a core business activity for many industries—and

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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,

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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).

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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. •

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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.

•

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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.

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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.

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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”.

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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”.

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Some have called the opportunity to promote population health “the next frontier of CSR”

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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.

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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.

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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.

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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?

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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.

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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.

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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

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•

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?

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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.

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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.

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Useful questions to consider

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•

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?

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Noise Excessive noise in or adjacent to communities can lead to annoyance and adverse health impacts.

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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.”

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Exposure to noise is also associated with interference with

oral and written communication, sleep disturbance, cardiovascular disease, and cognitive impairment in children.

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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.

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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.

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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.

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Useful questions to consider

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•

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?

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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.

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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.

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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.

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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.

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Useful questions to consider

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•

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.

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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

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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?

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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

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•

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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