What do we know about corporate social responsibility and stakeholders physical activity? A Public Health Perspective

Abstract

In the past decade and in the context of sustainable development, business organizations have been expected to partner with governments and others to address societal problems, including those pertinent to population health. Accordingly, through their corporate social responsibility (CSR) strategies and policies, companies should collaborate in health promotion efforts to modify the effects of the health determinants (including those concerning behavior change) affecting internal and external stakeholders. Although CSR strategies and policies are linked to stakeholder health and wellbeing (e.g. employee satisfaction), little is known of how these strategies affect physical activity. Thus, this perspective paper aims to contribute to the discussion of the topic by investigating what scientific evidence exists regarding the relationship between CSR and physical activity. So far there are indications that some business are implementing CSR activities targeting internal (e.g. employees) and external (e.g. consumers) stakeholders, especially in developed countries. Furthermore, among external stakeholders, CSR activities with a physical activity component targeted children, youth, the disabled, the under-privileged, and the elderly. However, there is still very little empirical evidence available using appropriate quantitative and qualitative designs. Public health and health science researchers in general should strive to advance our understanding of how CSR affects population health behavior, paving the way to develop frameworks for resilient, ethical, and sustainable health promotion.

Introduction

In the past decade and in the context of sustainable development, business organizations have been expected to partner with governments and other actors to help address societal problems, including those pertinent to population health.^1–5 In this regard, through their corporate social responsibility (CSR) strategies and policies, companies should collaborate in health promotion efforts intended to modify the effects of health determinants, including those pertaining to behavior change, ⁴ affecting internal (e.g. employees) and external (e.g. consumers, clients, the supply chain, communities, and the environment) stakeholders.^6–9 For instance, Quelch ⁸ stated that every company has a public health footprint because corporation products and policies have the potential to help-or-hurt health and wellbeing of the public through their effects on own employees, consumers, and the environment.

The CSR concept has evolved over time and been of interest to many scholars,^10–12 its definition is still a matter of ongoing debate.^13,14 Here, we define CSR as context-specific organizational actions and policies that take into account stakeholders’ expectations and the triple bottom line of economic, social, and environmental performance. ¹⁴ This means that businesses are expected to have ethical standards in their behavior toward all stakeholders as well as to help address current societal challenges. Furthermore, and through the lens of stakeholder theory, business organizations are expected to engage their stakeholders through various activities and initiatives. ¹⁵ CSR is partly based on the assumption that, at any given time, there is a social contract between an organization and society in which the organization has not only economic and legal responsibilities but also ethical responsibilities.^16,17 In the 21st century and in the context of globalization (amid constant environmental, economic, and social change), CSR has arguably become an important influence on corporate decisions, affecting both sustainability and stakeholders.^18,19 Others have noted that CSR represents a way in which companies contribute to meeting stakeholder requirements, especially concerning their role in ensuring long-term sustainability. ²⁰ However, critics of CSR argue that business organizations might engage in CSR strategies as a way to increase profitability relative to less socially committed competitors.^21,22 In recent years, there has been an attempt to disentangle the three triple bottom line areas of CSR, that is, the economic, environmental, and social areas.^23–25 The economic area of CSR has arguably evolved from the sole obligation to shareholders ²⁶ to a broader view encompassing other aspects of the organization, such as job creation, the discovery of new resources and applications, innovation, and technologies to promote progress. ²⁷ In the environmental dimension, businesses are expected to care for the environment, recognizing its crucial role in achieving sustainable development, especially its potential contribution to climate change.^23,28,29 Lastly, the social dimension of CSR concerns human resources, ²⁹ both those inside the business (i.e. internal stakeholders) and those in its environment (i.e. external stakeholders). ²³ Companies are seen as having responsibilities to their employees and to society in general, implemented through delicately balancing the interests of different stakeholders.^30,31 It is in the social dimension that we see CSR as well positioned to promote the health and wellbeing of both internal and external stakeholders

Most recently, some researchers have argued that we need a business case for improving population health through helping promote the health and wellbeing of internal and external stakeholders. ⁶ As mentioned above, business organizations are expected to promote health by tackling the social determinants of health, that is, the conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a range of health, functioning, and quality-of-life outcomes.^32–34 Health promotion targeting internal stakeholders implies the development of CSR strategies to address employee health and safety, but also to improve physical and psychological wellbeing and the work–life balance. However, in a recent review of the impact of CSR on employee health and wellbeing, Macassa et al. ³⁵ found that most studies investigated employee job satisfaction, an aspect related to organization performance. In addition, the review also noted the absence of studies investigating physical health. ³⁵

CSR is seen as providing a unique platform for business to reduce psychosocial risks in the workplace through implementing strategies to improve the psychosocial environment of the organization.^36,37 A US study by Fairlie and Svergun ³⁸ found that CSR perceptions were positively associated with work satisfaction and appeared to directly buffer both depression symptoms and turnover intentions, through mediating job satisfaction and organizational commitment. CSR strategies in the workplace are also expected to help promote wellness programs that include activities related to health behavior change (e.g. diet and physical activity) among employees. This could occur by incorporating public health literacy into strategic CSR activities to be carried out in conjunction with human resource management (HRM) actors in the organization. ³⁹ The argument here is that CSR can act as an HRM function, providing knowledge of both sustainability and health promotion (through health and public health literacies) targeting employees and their families, which in turn can spill over to external stakeholders and society at large. ³⁹

Regarding external stakeholders, CSR strategies can help to tackle “wicked” societal problems such as poverty, toxic hazards, pollution, obesity, and epidemics, which are all related to poor health outcomes in supply chains, consumers, and society at large^6,7,33 For example, Chatu ⁴⁰ demonstrated that Johnson and Johnson, through its CSR strategies in Africa, helped improve the quality of life of those with HIV/AIDS by donating its products and sponsoring programs for local communities (e.g., cause promotion, cause-related marketing, corporate philanthropy, corporate social marketing, and corporate volunteering).

For business, to influence the health and wellbeing of all their stakeholders, both internal and external, executives (e.g. CEOs) are needed who understand the societal responsibility of the organizations they lead. Responsible leaders, especially those with an integrative orientation, are expected to support their organizations in implementing policies intended to improve population health. According to Maak et al., ⁴¹ responsible leaders are more inclined to do good and avoid harm to all stakeholders, especially in the contexts where their businesses operate. Overall, organizations’ CSR strategies are expected to help improve the health of those inside and outside the organization by helping address environmental challenges (e.g. pollution, toxic hazards, and climate change), promote physical and psychosocial wellbeing, and modify the health behavior of both internal and external stakeholders, specifically physical activity, which is the subject here.

This perspective paper uses the WHO definition of physical activity, which states that physical activity is any bodily movement produced by skeletal muscles that requires energy expenditure. ⁹ Physical activity is not limited to sports but also includes, for example, walking, running, swimming, gymnastics, dancing, ball games, and martial arts. Low-, moderate-, and vigorous physical activities all improve health. ⁹ However, some argue that the focus on skeletal muscles and energy expenditure frames physical activity as a specific mechanistic act. ⁴² For example, Piggin ⁴² suggested that a new definition of physical activity was needed in order to move beyond what they called the boundaries of epidemiologic discourse or disease prevention to one acknowledging a dynamic, complex, and evolving array of reasons and emotions involved in physical activity. Therefore, they proposed an expanded definition of physical activity that involves people moving, acting and performing within culturally specific spaces and contexts, and influenced by a unique array of interests, emotions, ideas, instructions and relationships.

Physical activity plays a key role in a healthy lifestyle, so corporations should mobilize resources to promote it in society as a way to meet their social responsibilities and improve the health and wellbeing of all their stakeholders. ⁴³ Regular physical activity has been found to prevent chronic ailments such as heart disease, stroke, diabetes, and several cancers. It also helps prevent hypertension, maintain healthy body composition, and can improve mental health, quality of life, and well-being. ⁹ Physical activity has also been associated with decreased morbidity and mortality. ⁹ For example, Lear et al. ⁴⁴ found that higher recreational and non-recreational physical activity was associated with a lower risk of mortality and cardiovascular disease (CVD) events in individuals from low-, middle-, and high-income countries. In that study the authors argued that increased physical activity was a simple, widely applicable, and low-cost global strategy that could reduce deaths and CVD in middle age.

However, others suggest that an individual can meet the required physical activity guidelines still having a sedentary behavior^9,45 that has harmful effects on health independent of physical activity levels. ⁹ For instance in a systematic review and meta-analysis, Biswas et al. ⁴⁵ found that sedentary time was associated with a 30% lower relative risk for all-cause mortality among those with high levels of physical activity pooled HR, 1.16 (CI,0.84 to 1.59) as compared with those with low levels of physical activity pooled HR, 1.46 (CI, 1.22–1.75).

Moreover, Ekelund and Hosseinzadeh ⁴⁶ found that high levels of physical activity reduced the risk of death caused by prolonged sedentary behavior.

Although physical activity (unstructured movements) influence health outcomes, it is important to consider the role played by exercise.^9,47 Contrary to physical activity, exercise is defined as specific type of physical activity that is planned, structured and repeatedly done to improve or maintain physical fitness. ⁴⁷

Empirical evidence has shown that structured exercise has an impact on health outcomes across the lifespan. In a study carried out by Edwards and Hosseinzadeh ⁴⁶ found that the type, duration and intensity of structured physical activity had benefits in the prevention of type 2 diabetes.

As stated above, in the context of stakeholder theory, sustainable development, and health promotion, ⁶ companies are expected to care about the health and wellbeing of their employees and the communities they serve. Furthermore, given the unfolding pandemic of obesity across the globe, many argue that businesses might be the best partners to help address the corporate and commercial determinants of health. According to Kickbusch et al. ⁴⁸ the commercial determinants of health are the strategies and approaches used by the private sector to promote products and choices that are detrimental to health. There is agreement that corporate activities shape our environment and also somewhat determine both the availability and pricing of consumables in any society.^48–51 In addition, it is suggested that companies use tactics to promote unhealthy products and fight reforms intended to minimize their ability to harm health. ⁵² This is done through soft power, by influencing the culture, ideas, and thoughts of the public and of public health advocates, and through hard power, by building institutional and financial relationships. For example, in an Australian study, Richards et al. ⁵² examined the key characteristics of CSR as described in the corporate documents of selected “Big Food” companies; they found that of the 256 CSR activities investigated, 30% targeted the environment, 25% consumers, and 19% the community. The authors noted that the activities of these companies centered on brand image, targeted parents and children, and tried to align themselves with respected organizations in an effort to transfer their positive image attributes to their own brands. Elsewhere, there has been an attempt to relate CSR and sports social responsibility.^47,53–55 For example, Smith et al. ⁴³ argued that there was an intersection between CSR and sports social responsibility as the latter could target youth physical activity and awareness while fostering social interaction, environmental sustainability awareness, cultural understanding, and integration. Moreover, Millar ⁵⁴ noted that corporations influence health outcomes through lobbying and corporate social sustainability strategies intended to whitewash tarnished reputations and extended supply chains. Furthermore, he argued that this was achieved by using corporate social sustainability language to pursue profit above all through marketing unhealthy products as well as exploiting workers and suppliers while providing zero benefit to society. ⁵⁴

Although CSR strategies and policies have been linked to stakeholder health and wellbeing (e.g. employee satisfaction), few studies have attempted to relate how these strategies influence physical activity. Therefore, this perspective paper aims to contribute to the discussion of the topic by investigating what scientific evidence exists regarding the relationship between CSR and physical activity.

Corporate social responsibility and stakeholders physical activity: The evidence

An extensive literature search ⁵⁶ for empirical studies linking CSR and physical activity was made and found four studies.^56–59 Databases searches were carried out in Discovery, Scopus, Web of Science, and PubMed regarding the relationship between CSR and physical activity using search terms from the following combinations: “Corporate social responsibility” OR CSR AND “physical activity”; “Corporate social responsibility” OR CSR AND “internal stakeholders’ physical activity”; “Corporate social responsibility” OR CSR AND “internal stakeholders” AND “wellness”; “Corporate social responsibility” OR CSR AND “employee physical activity”; “Corporate social responsibility” OR CSR AND “employee wellness”; “Corporate social responsibility” OR CSR AND “external stakeholders” AND “physical activity”; “Corporate social responsibility” OR CSR AND adults AND “physical activity”; “Corporate social responsibility” OR CSR AND elderly AND “physical activity”; “Corporate social responsibility” OR CSR AND “older adults” AND “physical activity.” The inclusion criteria was peer-reviewed articles published in the English language that empirically investigated the relationship between CSR and physical activity for internal and external stakeholders anywhere in the world regardless of type of methodology (i.e. quantitative or qualitative). To be included, the CSR strategies had to belong to profit-driven corporations and the aim of the physical activities had to be health promotion. Articles were excluded if they were related to professional sports sponsorship activities. A total of 199 articles were identified, and after a preliminary review of titles, abstracts and duplicates, 28 articles were included for detailed full-text assessment. Of these, only four met the inclusion criteria. Reasons for excluding the other 24 were multiple and ranged from being literature reviews, papers in areas outside health promotion or public health/health sciences, conceptual papers, and opinion articles addressing theoretical discussions of CSR in professional sports organizations. We use the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline to report the flow article selection ⁵⁶ (See Figure 1).

Figure 1.

Identification, screening, and inclusion of studies for the review according to PRISMA.

In the USA, Barata Cavalcanti et al. ⁵⁹ analyzed company- and program-level findings from a pilot study of healthy community initiatives (n = 11 companies and 38 programs) performed as part of the Commitment to Healthy Communities (CHC) initiative. These initiatives concerned food access, healthy nutrition, and active lifestyles. The study found differences in the deployed strategies, which were mostly oriented toward physical activity and less toward the social and environment determinants of health. Various activities were used by the companies to promote physical activity and active lifestyles, including exercise or physical activity classes, funding youth sports leagues, and programs to increase physical activity competency among teachers.

Bason and Anagnostopoulos ⁵⁷ examined three aspects of multinational enterprises’ CSR programs centering on sport (i.e. how enterprises used sports in their CSR agendas, whether different industries had different approaches to CSR through sport, and whether it was possible to classify CSR through sport); the sample was 100 companies listed on the Financial Times Stock Exchange (FTSE) index between 2003 and 2012 (n = 1473 documents). Results indicated that corporations generally saw sport as an important context for the application of CSR. Furthermore, the same study found that CSR strategies were implemented through philanthropy (e.g. donations), sponsorships (e.g. of competition and events for mutual benefit), and personnel engagement (e.g. employees participating in sport activities to raise money, companies allowing employees to participate in sport and/or physical activity, and employees voluntarily supporting sport organizations). Moreover, the study reported that CSR activities directly benefited young people, women, the elderly, the disabled, and the under-privileged. ⁵⁷

Leone et al. ⁵⁸ investigated CSR strategies for promoting children’s physical activity in companies from different industries (n = 17) that signed a pledge as part of the UK government’s Public Health Responsibility Deal program. The results indicated that companies in the sectors related to food and beverage, sport and wellness, and food/drug retail made the most pledges concerning physical activity among children, in contrast to the restaurant sector. The CSR initiatives included sponsoring events, supporting enhanced physical education and school sport programs, and, to a lesser extent, making the built environment more conducive to physical activity and active commuting (e.g. walking to school).

Potvin Kent et al.’s ⁶⁰ cross-sectional study described the nature and targeted demographics of the physical activity and nutrition-related CSR initiatives of large food companies in Canada, comparing companies participating in the Canadian Children’s Food and Beverage Advertising Initiative (CAI) with those not participating (n = 39, including 18 CAI participants). In the 39 large food and beverage companies examined, 63 CSR initiatives related to nutrition and physical activity were identified in company websites, Facebook pages, and annual reports. Most of these initiatives were considered philanthropic or charitable activities that entailed supporting various local, provincial, and national organizations and programs, particularly those addressing short-term food insecurity or promoting physical activity among children and youth. Some companies also engaged in nutrition education by providing information on their websites, creating resources for teachers and sponsoring a national consumer education campaign.

Discussion and conclusion: Rethinking the role of business in population health behavior change in the context of sustainable development

The available empirical evidence so far indicates that corporations are already engaging in CSR activities to support internal and external stakeholders’ physical activity. However, such activities are still scarce and mostly occur in developed countries. It originated in three countries of the Organisation for Economic Co-operation and Development (OECD): the UK, the USA, and Canada. As mentioned above, previous assessments of the impact of CSR on internal and external stakeholders’ wellbeing are still scarce, specifically in areas of overall wellness (including behavior change).^35,61 To some extent, empirical evidence has often linked CSR to employee satisfaction and seldom to external stakeholder wellbeing. ⁷ For example, Bason and Anagnostopoulos ⁵⁷ found that, in the examined companies, CSR activities supported physical activity in employees (i.e. internal stakeholders) through personnel engagement. This engagement occurred through encouraging employees to participate in sport activities to raise money or through creating opportunities for them participate in sport and physical activities within the organization. ⁵⁷ In recent years, there have been calls for increased involvement of business in developing workplace wellness programs that include behavior change aspects. ³⁹ Poor workplace wellbeing (defined in terms of physical, psychological, and emotional aspects of the employee’s life) is detrimental to the long-term sustainability of business wellbeing, including profitability. ⁶² There is a suggestion that for CSR activities to be better integrated in business strategies (e.g. through wellness programs), they should be implemented in tandem with strategic human resource management (SHRM) activities within the organization.^5,39,63 This is because SHRM is responsible for attracting, retaining, and motivating workers.^15,39,63 Corporate wellness programs (i.e. organized, goal-oriented sets of plans and activities to increase the healthy behaviors of company employees to improve overall workforce health) have been linked to the prevention and management of chronic diseases, such as diabetes, obesity, heart disease, and lung disease, in the workplace. ⁶³ Furthermore, workplace wellness programs likely reduce healthcare costs, especially in the long term.^64,65

The studies identified in this perspective paper show that companies’ CSR activities were intended to develop the sport activities and physical activity of varied external stakeholders, such as children, ⁵⁸ women, young people,^57,60 the disabled, the under-privileged, and the elderly. ⁵⁷ In the evidence above, it was mostly food and beverage companies that had CSR activities targeting sports and physical activity in external stakeholders (e.g. consumer groups). However, some have argued that corporations, especially those in food and beverage industries, have contributed somewhat to the unfolding obesity epidemic.^66–69 Furthermore, others have raised concerns as to whether the CSR activities of these corporations are effective or genuine, and whether they might be only self-interested marketing or public relations stunts (e.g. to give a positive impression to consumers).^52,69–72 For example, it has been suggested that food industry campaigns tend to frame obesity as an issue of personal responsibility.^52,73,74 According to Jane and Gibson, ⁷⁵ the sponsorship of physical activity promotion can be a way for corporations to market products to children and access health-related policy development networks. They further suggested that there was a need for independent evaluation of the potential impacts of partnerships between food and beverage corporations and governments in CSR-related campaigns due to the important ethical implications of these collaborations. Nevertheless, it is important for corporations to make a business case for population health and to genuinely help address the commercial determinants of health, which somewhat contribute to obesogenic environments around the world in both low, middle, and high income countries. This can be achieved through health-promoting CSR activities intended to foster change in behavior (e.g. diet and physical activity) in different contexts (e.g. schools, workplaces, and care homes).

In the context of sustainable development and the achievement of sustainable development goals, governments need to work with other partners (e.g. other governments, public health institutions, and non-governmental organizations). The role of business will be crucial in this, although, as mentioned above, this collaboration should occur in a context of high transparency and adherence to acceptable ethical principles. McKee and Stuckler argued that corporations have the ability to define and dominate the narrative, set the rules and procedures by which society is governed, determine the living and working conditions of ordinary people, and take ownership of knowledge. Regarding the ability to define and dominate the narrative, McKee and Stuckler ⁴⁹ noted that business can, through the mass media, frame obesity, diabetes, heart disease, and other threats to health (in the context of this perspective paper insufficient physical inactivity) as individual or societal choices and responsibilities. Corporations can to some extent dictate what is or is not acceptable in the case of physical inactivity (i.e. not meeting physical activity guidelines). In relation to rule setting, corporations in general can collaborate with governments regarding regulations intended to improve consumer wellbeing. ⁴⁹ Furthermore, since corporations affect health through commodifying and controlling health-related knowledge, some argue that they are better positioned to promote physical activity as a means of disease prevention.^49,76 To this end, corporations can support communities aiming to decrease obesity. ⁴⁹ It has also been suggested that business can advance stakeholders’ rights in the political, social, and economic contexts. Here, corporations not only can influence stakeholder wellbeing through occupational health and safety programs, but, crucially, can also promote large-scale wellness campaigns involving all the stakeholders, with health behavior change (specifically physical activity) in center stage. ⁴⁹

This perspective paper identifies certain areas that merit attention from researchers, especially those in public health and health sciences. Firstly, empirical evidence of the association CSR and physical activity among internal and external stakeholders is very limited and that the topic is still in its infancy. Secondly, it is important that researchers continue conducting studies using various methodologies (but specifically, quantitative studies) to better understand the impact of corporations’ CSR activities and programs involving physical activity outcomes targeting different population groups. For example, Moher et al. ⁵⁶ noted that few companies tracked or could demonstrate the actual health impacts of their CSR activities. This is crucial if we expect business corporations to participate in inter-sectoral collaboration to help achieve sustainable development goals (and improved health at all ages). Thirdly, future research should attempt to apply Piggin et al.’s ⁴² expanded definition of physical activity, as it has implications for how successful CSR strategies and policies might influence internal and external stakeholders’ health behavior outcomes. They argued that physical activity is dynamic and can be affected by geographic (e.g. spatial), socio–cultural, emotional, and relationship contexts. Furthermore, it is also acknowledged that behavior modification (e.g. regarding diet and physical activity) is embedded in geographical, social, political, environmental, economic, and cultural realities.^9,77–79 Fourthly, there is a need to develop conceptual frameworks which clearly offer analytical pathways of the potential relationships between CSR strategies and policies with physical activity related outcomes among internal and external stakeholders. Such frameworks might help intervention researchers in areas of public health/health research to develop appropriate measures of the CSR effect on physical activity.

To succeed, CSR strategies and policies to improve stakeholders’ physical activity must consider geographical spaces as well as socio–cultural factors in the contexts in which the implementing corporations operate. This is in line with the claim that businesses should take into account the social and structural environments of stakeholders’ everyday lives. ⁶ In the context of sustainable development, there is agreement that business commitments to stakeholder’s health and wellbeing are critical and that business leaders should acknowledge, communicate, and prioritize their CSR strategies and policies (including those pertaining to physical activity) on the same level as they do for the products they deliver to society.

Public health and health scientists should advance research efforts intended to better understand how the CSR activities of businesses of any size (small, medium, and large) might influence health behavior in current and future generations. Better understanding how CSR affects population health behavior could in turn pave the way to developing frameworks for resilient, ethical, and sustainable health promotion.