- Email: [email protected]
Integrating health impact assessment into the triple bottom line concept
Environmental Impact Assessment Review 24 (2004) 151 – 160 www.elsevier.com/locate/eiar
Integrating health impact assessment into the triple bottom line concept Mary Mahoney *, Jenny-Lynn Potter School of Health Sciences, Deakin University, 221 Burwooh Highway, Burwood, Victoria 3125, Australia
Abstract This theoretical study explores the links between the Triple Bottom Line (TBL) concept and the principles of HIA and considers the potential role of HIA to provide a mechanism for integrating health concerns within a broader agenda of government and business. TBL is a framework linked to the broader sustainability agenda that underpins and reviews environmental, economic and social performance of organizations. In its simplest form, TBL acts as a tool for reporting to stakeholders/shareholders organizational performance and the nature of the impacts on the community. The links to HIA are clear as both seek to determine the impact (potential and actual) on the health and well-being of the population. The study found that TBL can operate at four levels within organizations ranging from reporting through to full integration with the organization’s goals and practices. Health is narrowly defined and there are tensions about how to undertake the social accountability functions. The study shows the potential role for HIA within the broader policy and accountability agenda. As health is one of the main outcomes of an organization’s activities it needs to be taken into account at all levels of activity. D 2003 Elsevier Inc. All rights reserved. Keywords: Triple bottom line; Health impact assessment; Accountability
1. Australia’s current commitment to HIA In Australia, increasing attention has been paid to HIA in recent years with work being funded by the Commonwealth Government through both the enHealth Council and the Population Health Division. The Environmental Health
* Corresponding author. E-mail address: [email protected] (M. Mahoney). 0195-9255/$ – see front matter D 2003 Elsevier Inc. All rights reserved. doi:10.1016/j.eiar.2003.10.005
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Strategy published in 2001 recommended the strengthening of HIA processes within environmental health requirements and guidelines for legislating its use have been drafted. The report, ‘HIA: a tool for policy development in Australia’ (Mahoney and Durham, 2002), recommended a broader application of HIA to policies, strategies and programs affecting population health and inequalities in health. Several states are exploring formal and informal applications. A national study on the development of a framework for equity-focused HIA is currently underway. It is not surprising therefore, that some consideration should be given to the connections between HIA and the broader sustainability agenda, which is driving developments in business and government. Triple Bottom Line (TBL) is a term used to describe a strategy to operationalise the planning, monitoring, measurement and reporting of sustainable development. It encompasses the values, issues and processes that need to be addressed to minimize harm resulting from actions. TBL demonstrates concern for economic, social and environmental values (Allen Consulting Group, 2002, Elkington, 1998). It is a framework that underpins and reviews the environmental, economic and social performance of organizations (City of Melbourne, 2002). The term TBL was coined by Elkington (1998) in Cannibals with Forks: the Triple Bottom Line of 21st Century Business, and is linked to Corporate Citizenship, Social and Ethical Accounting and Corporate Social Responsibility. Many state governments in Australia now use TBL as it is an important area for consideration.
2. Methods A report, submitted to the Commonwealth Department of Health, showed that the links between TBL and HIA, nor more general links of TBL to health, had ever been explored. Qualitative interviews with 14 key policymakers and researchers and an extensive literature review and three case studies of organizations using TBL were undertaken. There was also correspondence with national and international experts in one or more of TBL, HIA, policy, corporate citizenship, social and ethical accounting, and health and equity. The views outlined in the interviews and literature form the basis of the discussion in this paper. 2.1. The TBL concept The drivers for TBL are argued to arise out of concern for ecological sustainability, recognition of power and responsibility of all organizations, corporate advantage or good business sense, a desire for accountability and transparency, pressure from communities who demand a say, and shareholder pressure linked to globally competitive markets (British Standards Institution, 2001).
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Sustainable development serves as an overarching driver for TBL. Sustainable development involves a broad rethinking of society and its development to integrate environmental, economic and social goals (Government of Western Australia, 2001). An understanding of sustainable development recognises a particular philosophy and specific principles as guiding human activity and developments to ensure that the three dimensions are addressed in both the short and long term. Another driver is the concern for the ‘global environment’ within which corporations are now seen to be more powerful than governments. This concern raises issues about transparency and accountability in decision-making. The traditional relationship between business and society is seen as being reshaped and understanding of organizations’ responsibilities is altering. Changes in societal expectations and attitudes towards democracy underpin these demands. ‘‘Companies are now being asked by their stakeholders for more information about their impacts on the environment, the economy and society, and to attest to ethical conduct and sound governance of their businesses’’ (Allen Consulting Group, 2002). From a government perspective, Wiseman (2002) attributes the introduction of TBL to a shift from an emphasis on addressing economic priorities first and then compensating the losers and repairing the environment to a way of thinking and doing business which respects the integrity and interdependence of economic, social and environmental values. The origins of TBL can be attributed to ‘‘the recognition that economic measures are not by themselves the best measures of broad progress and wellbeing, that policies stressing growth in economic output can bring negative social and environmental effects, and finally, that all three are essential but interdependent elements of good policy, and of just and sustainable societies’’ (Salvaris personal communication). Wiseman (2001) in The Report on International Policy Trends also identifies as crucial: innovation and investment in human, social, natural and physical capital; sustainable and productive resource usage; linking growth to better services and reducing inequalities; and engaging citizens, communities and stakeholders. The need for organizations to communicate, to implement difficult choices about policy priorities and to base policy making on evidence was also acknowledged as important. The development of new measures of reporting progress and well-being also drives TBL in both business and government. Guidelines and tools have been developed to assist organizations to incorporate TBL into their everyday operations. The Global Reporting Initiative (2000) Sustainability Reporting Guidelines now serve as a basis for the development of further guidelines. These set out criteria and key performance indicators that should be used by organizations. Concerns have been expressed that, while reporting remains voluntary, it will never be consistent or widespread (Yencken, 2001). If attention is focused on standardised reporting requirements then TBL will be
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seen as a commercial imperative, but attention may be diverted from true integration to measurement and reporting. The Global Reporting Initiative (2000) Guidelines define the three dimensions of sustainability as:
Economic: including, but not limited to, financial information, wages and benefits, labour productivity, job creation, expenditure on outsourcing, expenditure on research and development, and investment in training and other forms of human capital. Environmental: including such things as impacts of processes, products, and services on air, water, land, biodiversity and human health. Social: including workplace health and safety, employee retention rates, labour rights, human rights, wages and working conditions at outsourced operations and address interactions between the organization and its community. Under TBL, economic environmental and social impacts are regarded as being of equal importance. The three dimensions are interdependent and mutually reinforcing (Allen Consulting Group, 2002, p. 30). Success is attained through the achievement of overall organizational objectives without compromising the balance of the relationship between the three dimensions. Businesses are motivated to adopt TBL for different reasons including— defending their reputation against stakeholders; making immediate and tangible financial gains from sustainable business actions (the traditional business case); incorporating sustainable business management into a broader strategic approach and better long-term business performance. The literature reveals that the primary goals of TBL are:
Transparency and effectiveness: allowing people to assess or ensure that organizations are doing the right thing in terms of their core business, Accountability: allowing organizations to take responsibility for their actions and to report this honestly to their stakeholders, Consultation and responsiveness: enabling organizations to ensure positive relationships both internally and externally and responding to the feedback from stakeholders through informed and appropriate decision-making, Impact assessment: allowing organizations to identify the nature and scope of impact of the actions they take particularly across and between the three dimensions, Information and communication (including PR function): enabling organizations to use the results of their processes for future decision making and to convey, as and when appropriate, these results to the public.
TBL assumes that within their context and capabilities, organizations are accountable to their stakeholders for their contribution to sustainable devel-
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opment (Suggett, 2000). An organization builds stakeholder confidence by increasing transparency and creates a basis for effective engagement with them. The organization moves beyond general performance reporting to consideration of the important issues for itself and its stakeholders (VicWater, 2002). Forming partnerships with stakeholders and involving them in decision making involves inclusivity and partnership. This is based on a recognition of the added value that interaction with both internal and external stakeholders brings to organizational outcomes. The Allen Consulting Group (2002) study found that very few Australian companies have produced substantial environmental or social reports. Of the top 50 listed companies in Australia, only 10 have produced environmental reports and only six have produced social reports. 2.2. HIA explored Kemm (2000) identified two types of HIA ‘tight focused’ and ‘broad focused’. In Australia, these two types tend to arise from two different perspectives and traditions. One has a strong environmental base and is linked to EIA while the other has strong health connections. The first is used to determine the effects of developments on the environment and specifically on the health of people who form part of that environment. It involves the identification and quantification of risk, is generally applied to development projects involving some sort of physical change to the environment and uses a biomedical model of health. The second is driven by public health, is based on a social model of health and is grounded in the determinants of health. It acknowledges the potential impact of policies on population health and on inequalities in health. It is essentially Strategic Health Assessment. Considerable confusion and uncertainty exists about the different approaches and some concern that there could be unhelpful competition between them. Extensive international work on the development of Strategic Environmental Assessment (including HIA) and on integrated human or sustainability impact assessment will assist in blending the two approaches to HIA. It is clear that all approaches to HIA either separately or in combination have potential to be useful to the corporate sector in determining the impacts of their actions. 2.3. Links between HIA and TBL HIA and TBL have similarities both in their broad-based ideology and in their practical approaches to measuring and reporting. The two concepts are not identical and seek to achieve different goals, but there are clear areas of mutual benefit. The following section will focus on why it is useful to integrate HIA and TBL and how this integration could be achieved.
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At the broad ideological level there are three broad connections between TBL and HIA. 1. There is a common concern with impact. 2. There is a common commitment to health (defined in the broadest way), with sustainability, equity and diversity, to obtaining evidence of outcome, (kinds of evidence needed, methods of obtaining it, determining relative weight and importance) and to increasing participatory approaches to policy-making. 3. There is common agreement on the importance of ‘joined up’ thinking within organizations. ‘‘Society depends on the economy and the economy depends on the global ecosystem, the health of which represents the ultimate bottom line’’ (VicWater, 2002). The TBL approach is based on rethinking the priorities of organizations and this requires them to identify the impacts of their actions on stakeholders and the community. The three dimensions of TBL provide a platform for checking, measuring and reporting on the nature, extent, depth and consequences of this impact including consideration of differential aspects linked to equity and diversity. Health was felt to be one of the core values underpinning the application of TBL—the health of the economy, the environment and the people linked broadly to the organization and its actions. TBL provides a ‘tag’, ‘umbrella’ or way of thinking about, and accounting for, health and sustainability. Additionally, HIA provides a tested mechanism or set of tools that can be used to assist in the identification of impacts specifically within the environmental and social elements of TBL. A tension that remains unresolved in TBL is the connection between and across each of the three dimensions. HIA can help TBL to unite the elements through a common focus on health, providing a cross-cutting connection or link. Within the environmental dimension, HIA can provide a specific mechanism through the application of standard impact assessment tools for identifying impacts on the environment and, in particular, on human health. Within the social dimension HIA can provide a mechanism for determining the impacts of policies on people’s health and well-being. As health is essentially about social outcomes, it is the concept that underpins the reason for reporting on the social dimensions of an organization’s actions. The question ‘‘Do our activities impact on people socially?’’ really means ‘‘Is their health affected, and if so how and what can be done about it?’’ and ‘‘Are people better or worse off because of our policies or practices?’’ Similarly, equity in each dimension may be affected by all actions. Policymaking involves a constant trade-off between health, environmental and economic costs. HIA can offer a way of checking whether equity will be achieved and what trade-offs will be needed.
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At the broad end TBL acts as an ethical mind-set that serves to realign the goals of an organization to take account of aspects broader than simply economic prosperity. At the ‘bottom’ or reporting end it acts as a barometer of the effectiveness of the organization in respect to each of the three dimensions. The broad aims of HIA are to determine impacts of policies and actions on population and individual health so that modifications can be made to maximize gains and minimize negative impacts. The two activities are therefore compatible at both levels. Core tensions between HIA and TBL that need to be resolved include: how health is defined, how stakeholders are defined, and issues of power in every aspect of the process. Another crucial aspect that would need to be addressed is the area of key performance indicators. The Global Reporting Initiative (2000) uses social indicators, which are generally ‘internally’ focused towards such aspects as employee safety and job satisfaction levels. Measures, which examine the social impacts of a company on its local and wider community, would need to be added. TBL is, or has the potential to be, applied at four different levels within organizations.
TBL TBL TBL TBL
as reporting mechanism; within planning and reporting; embedded in the planning process; underpinning the organization.
As each level is driven by a different organizational agenda, the ways in which HIA can be integrated will vary with level. The greatest level of activity is occurring at the first of these levels with a subsequent reduction at each of the successive levels. Many companies have started with the reporting processes as this produces the quickest and most obvious results. Unless an organization understands how to account for and report on each dimension separately, it will be very difficult to produce an integrated report. The next section suggests how HIA could be integrated at each level. 2.4. TBL as a reporting mechanism This level of application of TBL involves the reporting of the nature, range and scope of activities and the impacts that the organization’s activities have on each of the three dimensions. The focus is primarily on reporting and there is little accountability, consultation or stakeholder input. What is reported is important in making stakeholders aware of particular issues. Some attention is paid to environmental dimensions in the economic reporting. There is a clear role for HIA within this level as it can provide appropriate and proven tools for collecting data for the key performance indicators. For example impacts on public health resulting from changes in a water treatment process
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could be identified. At this level existing EHIA and EIA approaches would be combined with health-specific impact assessment tools to identify the health impacts of new developments or ongoing activities. Additionally health inequalities or equity-focused HIA tools could be applied to identify whether the actions were likely to compound disadvantage amongst stakeholders. For instance, do the company’s employment practices create inequalities within the community or amongst its workforce? 2.5. TBL within planning and reporting At this level, organizations are beginning to embed TBL principles into their planning processes as well as their reporting processes. However, the three dimensions are still fragmented and seen as separate from the main organizational objectives. Equal weighting is not necessarily given to each dimension. A commitment to the concept of sustainable development is present in parts of the organization but the mechanisms for achieving it in an integrated way are not present. HIA would be integrated in two ways. There would be a gradual acceptance of the importance of assessing actions for their impacts (i.e. the beginnings of strategic placement of HIA in the decision-making processes) and the use of HIA to inform key performance indicators in the reporting processes. The strategic integration of HIA would be achieved by persuading high level decision-makers and organizational planners to screen policies for unintended consequences. This process would be closely aligned to the long-term planning goals of the organization. Many HIAs have been undertaken on this basis. Knowing the long-term implications of a policy for the future development of an organization is just as important as identifying impacts of specific actions on health. The potential link between HIA and TBL, the two concepts, is illustrated for example in a recent HIA which assessed how transport impacts on health in London (Watkiss et al, 2000). 2.6. TBL embedded in the planning processes In this level, the three dimensions are seen as equally important and all the activities of the organization are geared towards balancing the relation between them. The three dimensions are not conceived as separate entities and reporting is fully integrated. An integrated perspective also emerges as a logical part of the planning processes. HIA, or perhaps Integrated Impact Assessment would be fully applied as in levels 1 and 2 but there would be a clear commitment to determining the impacts of actions using an integrated approach. For instance, an integrated application of HIA with other impact assessment approaches might include some or all of the following: use in strategic decision-making; comprehensive impact assessments
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when needed; rapid appraisals when evidence was available; routine use of checklists or audits whenever a new or changed action was proposed. At this level, application of HIA would be prospective whereas applications at levels 1 and 2 tend to be retrospective. 2.7. TBL underpinning the organization The fourth level of application sees a commitment to sustainable development and human health throughout the entire organization. These are embedded in the vision, values and philosophy. Specialist TBL reporting processes would not be needed because TBL would be linked to higher level goals and have emerged through strategic planning. Health and sustainability would be the priorities that drive the organization, and HIA would become replaced with a synthesized approach to impact assessment. Many would argue that at this level TBL would amount to Quadruple Bottom Line as cultural aspects would also be embedded. In a legislative climate of minimal regulation, it may be many decades before this level is achieved.
3. Conclusion At present TBL reporting tends to be viewed as a luxury or novelty and in some contexts it essentially serves as a PR device. Knowing the health impacts of actions is becoming increasingly important. For governments, understanding how policies, programs and projects impact on human health may be as crucial as understanding the environmental and economic costs. For business, knowing the impacts (and thus the potential costs) of their actions on human health is vital to their reputation and long-term viability. In the long-term it may even be in the interest of government to require organizations to include health impacts as part of their formal reporting. In the short term, it may be sufficient to note the benefits to health that could come from engaging with and reporting on TBL. From the practitioner perspective, much work is needed to explore the possible applications of HIA to each level of TBL. Liaison between HIA practitioners and those engaged in corporate citizenship and TBL to discuss how corporate policies and actions impact on health might be suggested. HIA practitioners might collaborate with organizations interested in TBL. Guidelines for the potential integration of HIA principles within TBL and for integrating health and social indicators might be developed.
Acknowledgements This paper reports on a project funded by the Commonwealth Department of Health and Ageing, Population Health Division in Canberra Australia as part of
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the first round of the Public Health Education Research Program (PHERP) Innovations Grants. Additionally, we would like to acknowledge the input from all key informants and to thank Dr. Martin Birley, and Ms. Padmaja Jha who commented on the draft report.
References Allen Consulting Group. Triple bottom line. Canberra: Commonwealth of Australia; 2002. British Standards Institution. Sustainability: integrated guidelines for management, the Sigma Project. Forum for the future and accountability. London: British Standards Institution; 2001. http:// www.projectsigma.com/. City of Melbourne. Triple bottom line toolkit [http://www.iclei.org/anz/tbl/tbltools/businesscase.pdf]. Elkington J. Cannibals with forks: the triple bottom line of 21st century business. London: New Society Publishers; 1998. Global Reporting Initiative. Sustainability reporting guidelines: on economic, environmental and social performance. Amsterdam: Global Reporting Initiative; 2000. www.globalreporting.org. Government of Western Australia. Focus on the future: opportunities for sustainability in Western Australia, a consultation paper for the state sustainability strategy for Western Australia [www.sustainability.dpc.wa.gov.au/speeches/consultationpaer.pdf]. Kemm JR. Can health impact assessment fulfil the expectations it raises? Public Health 2000;114:431. Mahoney M, Durham G. Health Impact Assessment: a tool for policy development in Australia, report for the Commonwealth Department of Health and Ageing. Melbourne: Deakin University; 2002. Suggett D. Sustainability in government: triple bottom line in Australian governments, business leaders forum on sustainability. Victoria: Parliament House; 2000. VicWater. Triple bottom line reporting guidelines. Melbourne, Victoria: Victorian Water Industry Association; 2002. Watkiss P, Brand P, Hurley F, Pilkington A, Mindell J, Joffe M, et al. On the move: informing traffic health impact assessment in London. London: NHS Executive; 2000. www.londonshealth.gov.uk/ pdf/onthemove.pdf. Wiseman J. Report on international policy tends. Learning about innovation and balance: improving the productivity, sustainability and fairness of knowledge economies and societies. Melbourne: Victorian Department of Premier and Cabinet, Victorian Government; 2001. Wiseman J. Growing Victoria together: towards a triple bottom line work plan for government. Melbourne: Department of Natural Resources and Catchment Management Authority Forum; 2002. June 25. Yencken D. Where are we going: comprehensive social, cultural, environmental and economic reporting. Sydney: The Australian Collaboration; 2001.
Integrating health impact assessment into the triple bottom line concept Mary Mahoney *, Jenny-Lynn Potter School of Health Sciences, Deakin University, 221 Burwooh Highway, Burwood, Victoria 3125, Australia
Abstract This theoretical study explores the links between the Triple Bottom Line (TBL) concept and the principles of HIA and considers the potential role of HIA to provide a mechanism for integrating health concerns within a broader agenda of government and business. TBL is a framework linked to the broader sustainability agenda that underpins and reviews environmental, economic and social performance of organizations. In its simplest form, TBL acts as a tool for reporting to stakeholders/shareholders organizational performance and the nature of the impacts on the community. The links to HIA are clear as both seek to determine the impact (potential and actual) on the health and well-being of the population. The study found that TBL can operate at four levels within organizations ranging from reporting through to full integration with the organization’s goals and practices. Health is narrowly defined and there are tensions about how to undertake the social accountability functions. The study shows the potential role for HIA within the broader policy and accountability agenda. As health is one of the main outcomes of an organization’s activities it needs to be taken into account at all levels of activity. D 2003 Elsevier Inc. All rights reserved. Keywords: Triple bottom line; Health impact assessment; Accountability
1. Australia’s current commitment to HIA In Australia, increasing attention has been paid to HIA in recent years with work being funded by the Commonwealth Government through both the enHealth Council and the Population Health Division. The Environmental Health
* Corresponding author. E-mail address: [email protected] (M. Mahoney). 0195-9255/$ – see front matter D 2003 Elsevier Inc. All rights reserved. doi:10.1016/j.eiar.2003.10.005
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Strategy published in 2001 recommended the strengthening of HIA processes within environmental health requirements and guidelines for legislating its use have been drafted. The report, ‘HIA: a tool for policy development in Australia’ (Mahoney and Durham, 2002), recommended a broader application of HIA to policies, strategies and programs affecting population health and inequalities in health. Several states are exploring formal and informal applications. A national study on the development of a framework for equity-focused HIA is currently underway. It is not surprising therefore, that some consideration should be given to the connections between HIA and the broader sustainability agenda, which is driving developments in business and government. Triple Bottom Line (TBL) is a term used to describe a strategy to operationalise the planning, monitoring, measurement and reporting of sustainable development. It encompasses the values, issues and processes that need to be addressed to minimize harm resulting from actions. TBL demonstrates concern for economic, social and environmental values (Allen Consulting Group, 2002, Elkington, 1998). It is a framework that underpins and reviews the environmental, economic and social performance of organizations (City of Melbourne, 2002). The term TBL was coined by Elkington (1998) in Cannibals with Forks: the Triple Bottom Line of 21st Century Business, and is linked to Corporate Citizenship, Social and Ethical Accounting and Corporate Social Responsibility. Many state governments in Australia now use TBL as it is an important area for consideration.
2. Methods A report, submitted to the Commonwealth Department of Health, showed that the links between TBL and HIA, nor more general links of TBL to health, had ever been explored. Qualitative interviews with 14 key policymakers and researchers and an extensive literature review and three case studies of organizations using TBL were undertaken. There was also correspondence with national and international experts in one or more of TBL, HIA, policy, corporate citizenship, social and ethical accounting, and health and equity. The views outlined in the interviews and literature form the basis of the discussion in this paper. 2.1. The TBL concept The drivers for TBL are argued to arise out of concern for ecological sustainability, recognition of power and responsibility of all organizations, corporate advantage or good business sense, a desire for accountability and transparency, pressure from communities who demand a say, and shareholder pressure linked to globally competitive markets (British Standards Institution, 2001).
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Sustainable development serves as an overarching driver for TBL. Sustainable development involves a broad rethinking of society and its development to integrate environmental, economic and social goals (Government of Western Australia, 2001). An understanding of sustainable development recognises a particular philosophy and specific principles as guiding human activity and developments to ensure that the three dimensions are addressed in both the short and long term. Another driver is the concern for the ‘global environment’ within which corporations are now seen to be more powerful than governments. This concern raises issues about transparency and accountability in decision-making. The traditional relationship between business and society is seen as being reshaped and understanding of organizations’ responsibilities is altering. Changes in societal expectations and attitudes towards democracy underpin these demands. ‘‘Companies are now being asked by their stakeholders for more information about their impacts on the environment, the economy and society, and to attest to ethical conduct and sound governance of their businesses’’ (Allen Consulting Group, 2002). From a government perspective, Wiseman (2002) attributes the introduction of TBL to a shift from an emphasis on addressing economic priorities first and then compensating the losers and repairing the environment to a way of thinking and doing business which respects the integrity and interdependence of economic, social and environmental values. The origins of TBL can be attributed to ‘‘the recognition that economic measures are not by themselves the best measures of broad progress and wellbeing, that policies stressing growth in economic output can bring negative social and environmental effects, and finally, that all three are essential but interdependent elements of good policy, and of just and sustainable societies’’ (Salvaris personal communication). Wiseman (2001) in The Report on International Policy Trends also identifies as crucial: innovation and investment in human, social, natural and physical capital; sustainable and productive resource usage; linking growth to better services and reducing inequalities; and engaging citizens, communities and stakeholders. The need for organizations to communicate, to implement difficult choices about policy priorities and to base policy making on evidence was also acknowledged as important. The development of new measures of reporting progress and well-being also drives TBL in both business and government. Guidelines and tools have been developed to assist organizations to incorporate TBL into their everyday operations. The Global Reporting Initiative (2000) Sustainability Reporting Guidelines now serve as a basis for the development of further guidelines. These set out criteria and key performance indicators that should be used by organizations. Concerns have been expressed that, while reporting remains voluntary, it will never be consistent or widespread (Yencken, 2001). If attention is focused on standardised reporting requirements then TBL will be
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seen as a commercial imperative, but attention may be diverted from true integration to measurement and reporting. The Global Reporting Initiative (2000) Guidelines define the three dimensions of sustainability as:
Economic: including, but not limited to, financial information, wages and benefits, labour productivity, job creation, expenditure on outsourcing, expenditure on research and development, and investment in training and other forms of human capital. Environmental: including such things as impacts of processes, products, and services on air, water, land, biodiversity and human health. Social: including workplace health and safety, employee retention rates, labour rights, human rights, wages and working conditions at outsourced operations and address interactions between the organization and its community. Under TBL, economic environmental and social impacts are regarded as being of equal importance. The three dimensions are interdependent and mutually reinforcing (Allen Consulting Group, 2002, p. 30). Success is attained through the achievement of overall organizational objectives without compromising the balance of the relationship between the three dimensions. Businesses are motivated to adopt TBL for different reasons including— defending their reputation against stakeholders; making immediate and tangible financial gains from sustainable business actions (the traditional business case); incorporating sustainable business management into a broader strategic approach and better long-term business performance. The literature reveals that the primary goals of TBL are:
Transparency and effectiveness: allowing people to assess or ensure that organizations are doing the right thing in terms of their core business, Accountability: allowing organizations to take responsibility for their actions and to report this honestly to their stakeholders, Consultation and responsiveness: enabling organizations to ensure positive relationships both internally and externally and responding to the feedback from stakeholders through informed and appropriate decision-making, Impact assessment: allowing organizations to identify the nature and scope of impact of the actions they take particularly across and between the three dimensions, Information and communication (including PR function): enabling organizations to use the results of their processes for future decision making and to convey, as and when appropriate, these results to the public.
TBL assumes that within their context and capabilities, organizations are accountable to their stakeholders for their contribution to sustainable devel-
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opment (Suggett, 2000). An organization builds stakeholder confidence by increasing transparency and creates a basis for effective engagement with them. The organization moves beyond general performance reporting to consideration of the important issues for itself and its stakeholders (VicWater, 2002). Forming partnerships with stakeholders and involving them in decision making involves inclusivity and partnership. This is based on a recognition of the added value that interaction with both internal and external stakeholders brings to organizational outcomes. The Allen Consulting Group (2002) study found that very few Australian companies have produced substantial environmental or social reports. Of the top 50 listed companies in Australia, only 10 have produced environmental reports and only six have produced social reports. 2.2. HIA explored Kemm (2000) identified two types of HIA ‘tight focused’ and ‘broad focused’. In Australia, these two types tend to arise from two different perspectives and traditions. One has a strong environmental base and is linked to EIA while the other has strong health connections. The first is used to determine the effects of developments on the environment and specifically on the health of people who form part of that environment. It involves the identification and quantification of risk, is generally applied to development projects involving some sort of physical change to the environment and uses a biomedical model of health. The second is driven by public health, is based on a social model of health and is grounded in the determinants of health. It acknowledges the potential impact of policies on population health and on inequalities in health. It is essentially Strategic Health Assessment. Considerable confusion and uncertainty exists about the different approaches and some concern that there could be unhelpful competition between them. Extensive international work on the development of Strategic Environmental Assessment (including HIA) and on integrated human or sustainability impact assessment will assist in blending the two approaches to HIA. It is clear that all approaches to HIA either separately or in combination have potential to be useful to the corporate sector in determining the impacts of their actions. 2.3. Links between HIA and TBL HIA and TBL have similarities both in their broad-based ideology and in their practical approaches to measuring and reporting. The two concepts are not identical and seek to achieve different goals, but there are clear areas of mutual benefit. The following section will focus on why it is useful to integrate HIA and TBL and how this integration could be achieved.
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At the broad ideological level there are three broad connections between TBL and HIA. 1. There is a common concern with impact. 2. There is a common commitment to health (defined in the broadest way), with sustainability, equity and diversity, to obtaining evidence of outcome, (kinds of evidence needed, methods of obtaining it, determining relative weight and importance) and to increasing participatory approaches to policy-making. 3. There is common agreement on the importance of ‘joined up’ thinking within organizations. ‘‘Society depends on the economy and the economy depends on the global ecosystem, the health of which represents the ultimate bottom line’’ (VicWater, 2002). The TBL approach is based on rethinking the priorities of organizations and this requires them to identify the impacts of their actions on stakeholders and the community. The three dimensions of TBL provide a platform for checking, measuring and reporting on the nature, extent, depth and consequences of this impact including consideration of differential aspects linked to equity and diversity. Health was felt to be one of the core values underpinning the application of TBL—the health of the economy, the environment and the people linked broadly to the organization and its actions. TBL provides a ‘tag’, ‘umbrella’ or way of thinking about, and accounting for, health and sustainability. Additionally, HIA provides a tested mechanism or set of tools that can be used to assist in the identification of impacts specifically within the environmental and social elements of TBL. A tension that remains unresolved in TBL is the connection between and across each of the three dimensions. HIA can help TBL to unite the elements through a common focus on health, providing a cross-cutting connection or link. Within the environmental dimension, HIA can provide a specific mechanism through the application of standard impact assessment tools for identifying impacts on the environment and, in particular, on human health. Within the social dimension HIA can provide a mechanism for determining the impacts of policies on people’s health and well-being. As health is essentially about social outcomes, it is the concept that underpins the reason for reporting on the social dimensions of an organization’s actions. The question ‘‘Do our activities impact on people socially?’’ really means ‘‘Is their health affected, and if so how and what can be done about it?’’ and ‘‘Are people better or worse off because of our policies or practices?’’ Similarly, equity in each dimension may be affected by all actions. Policymaking involves a constant trade-off between health, environmental and economic costs. HIA can offer a way of checking whether equity will be achieved and what trade-offs will be needed.
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At the broad end TBL acts as an ethical mind-set that serves to realign the goals of an organization to take account of aspects broader than simply economic prosperity. At the ‘bottom’ or reporting end it acts as a barometer of the effectiveness of the organization in respect to each of the three dimensions. The broad aims of HIA are to determine impacts of policies and actions on population and individual health so that modifications can be made to maximize gains and minimize negative impacts. The two activities are therefore compatible at both levels. Core tensions between HIA and TBL that need to be resolved include: how health is defined, how stakeholders are defined, and issues of power in every aspect of the process. Another crucial aspect that would need to be addressed is the area of key performance indicators. The Global Reporting Initiative (2000) uses social indicators, which are generally ‘internally’ focused towards such aspects as employee safety and job satisfaction levels. Measures, which examine the social impacts of a company on its local and wider community, would need to be added. TBL is, or has the potential to be, applied at four different levels within organizations.
TBL TBL TBL TBL
as reporting mechanism; within planning and reporting; embedded in the planning process; underpinning the organization.
As each level is driven by a different organizational agenda, the ways in which HIA can be integrated will vary with level. The greatest level of activity is occurring at the first of these levels with a subsequent reduction at each of the successive levels. Many companies have started with the reporting processes as this produces the quickest and most obvious results. Unless an organization understands how to account for and report on each dimension separately, it will be very difficult to produce an integrated report. The next section suggests how HIA could be integrated at each level. 2.4. TBL as a reporting mechanism This level of application of TBL involves the reporting of the nature, range and scope of activities and the impacts that the organization’s activities have on each of the three dimensions. The focus is primarily on reporting and there is little accountability, consultation or stakeholder input. What is reported is important in making stakeholders aware of particular issues. Some attention is paid to environmental dimensions in the economic reporting. There is a clear role for HIA within this level as it can provide appropriate and proven tools for collecting data for the key performance indicators. For example impacts on public health resulting from changes in a water treatment process
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could be identified. At this level existing EHIA and EIA approaches would be combined with health-specific impact assessment tools to identify the health impacts of new developments or ongoing activities. Additionally health inequalities or equity-focused HIA tools could be applied to identify whether the actions were likely to compound disadvantage amongst stakeholders. For instance, do the company’s employment practices create inequalities within the community or amongst its workforce? 2.5. TBL within planning and reporting At this level, organizations are beginning to embed TBL principles into their planning processes as well as their reporting processes. However, the three dimensions are still fragmented and seen as separate from the main organizational objectives. Equal weighting is not necessarily given to each dimension. A commitment to the concept of sustainable development is present in parts of the organization but the mechanisms for achieving it in an integrated way are not present. HIA would be integrated in two ways. There would be a gradual acceptance of the importance of assessing actions for their impacts (i.e. the beginnings of strategic placement of HIA in the decision-making processes) and the use of HIA to inform key performance indicators in the reporting processes. The strategic integration of HIA would be achieved by persuading high level decision-makers and organizational planners to screen policies for unintended consequences. This process would be closely aligned to the long-term planning goals of the organization. Many HIAs have been undertaken on this basis. Knowing the long-term implications of a policy for the future development of an organization is just as important as identifying impacts of specific actions on health. The potential link between HIA and TBL, the two concepts, is illustrated for example in a recent HIA which assessed how transport impacts on health in London (Watkiss et al, 2000). 2.6. TBL embedded in the planning processes In this level, the three dimensions are seen as equally important and all the activities of the organization are geared towards balancing the relation between them. The three dimensions are not conceived as separate entities and reporting is fully integrated. An integrated perspective also emerges as a logical part of the planning processes. HIA, or perhaps Integrated Impact Assessment would be fully applied as in levels 1 and 2 but there would be a clear commitment to determining the impacts of actions using an integrated approach. For instance, an integrated application of HIA with other impact assessment approaches might include some or all of the following: use in strategic decision-making; comprehensive impact assessments
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when needed; rapid appraisals when evidence was available; routine use of checklists or audits whenever a new or changed action was proposed. At this level, application of HIA would be prospective whereas applications at levels 1 and 2 tend to be retrospective. 2.7. TBL underpinning the organization The fourth level of application sees a commitment to sustainable development and human health throughout the entire organization. These are embedded in the vision, values and philosophy. Specialist TBL reporting processes would not be needed because TBL would be linked to higher level goals and have emerged through strategic planning. Health and sustainability would be the priorities that drive the organization, and HIA would become replaced with a synthesized approach to impact assessment. Many would argue that at this level TBL would amount to Quadruple Bottom Line as cultural aspects would also be embedded. In a legislative climate of minimal regulation, it may be many decades before this level is achieved.
3. Conclusion At present TBL reporting tends to be viewed as a luxury or novelty and in some contexts it essentially serves as a PR device. Knowing the health impacts of actions is becoming increasingly important. For governments, understanding how policies, programs and projects impact on human health may be as crucial as understanding the environmental and economic costs. For business, knowing the impacts (and thus the potential costs) of their actions on human health is vital to their reputation and long-term viability. In the long-term it may even be in the interest of government to require organizations to include health impacts as part of their formal reporting. In the short term, it may be sufficient to note the benefits to health that could come from engaging with and reporting on TBL. From the practitioner perspective, much work is needed to explore the possible applications of HIA to each level of TBL. Liaison between HIA practitioners and those engaged in corporate citizenship and TBL to discuss how corporate policies and actions impact on health might be suggested. HIA practitioners might collaborate with organizations interested in TBL. Guidelines for the potential integration of HIA principles within TBL and for integrating health and social indicators might be developed.
Acknowledgements This paper reports on a project funded by the Commonwealth Department of Health and Ageing, Population Health Division in Canberra Australia as part of
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the first round of the Public Health Education Research Program (PHERP) Innovations Grants. Additionally, we would like to acknowledge the input from all key informants and to thank Dr. Martin Birley, and Ms. Padmaja Jha who commented on the draft report.
References Allen Consulting Group. Triple bottom line. Canberra: Commonwealth of Australia; 2002. British Standards Institution. Sustainability: integrated guidelines for management, the Sigma Project. Forum for the future and accountability. London: British Standards Institution; 2001. http:// www.projectsigma.com/. City of Melbourne. Triple bottom line toolkit [http://www.iclei.org/anz/tbl/tbltools/businesscase.pdf]. Elkington J. Cannibals with forks: the triple bottom line of 21st century business. London: New Society Publishers; 1998. Global Reporting Initiative. Sustainability reporting guidelines: on economic, environmental and social performance. Amsterdam: Global Reporting Initiative; 2000. www.globalreporting.org. Government of Western Australia. Focus on the future: opportunities for sustainability in Western Australia, a consultation paper for the state sustainability strategy for Western Australia [www.sustainability.dpc.wa.gov.au/speeches/consultationpaer.pdf]. Kemm JR. Can health impact assessment fulfil the expectations it raises? Public Health 2000;114:431. Mahoney M, Durham G. Health Impact Assessment: a tool for policy development in Australia, report for the Commonwealth Department of Health and Ageing. Melbourne: Deakin University; 2002. Suggett D. Sustainability in government: triple bottom line in Australian governments, business leaders forum on sustainability. Victoria: Parliament House; 2000. VicWater. Triple bottom line reporting guidelines. Melbourne, Victoria: Victorian Water Industry Association; 2002. Watkiss P, Brand P, Hurley F, Pilkington A, Mindell J, Joffe M, et al. On the move: informing traffic health impact assessment in London. London: NHS Executive; 2000. www.londonshealth.gov.uk/ pdf/onthemove.pdf. Wiseman J. Report on international policy tends. Learning about innovation and balance: improving the productivity, sustainability and fairness of knowledge economies and societies. Melbourne: Victorian Department of Premier and Cabinet, Victorian Government; 2001. Wiseman J. Growing Victoria together: towards a triple bottom line work plan for government. Melbourne: Department of Natural Resources and Catchment Management Authority Forum; 2002. June 25. Yencken D. Where are we going: comprehensive social, cultural, environmental and economic reporting. Sydney: The Australian Collaboration; 2001.