The global health community has had almost no involvement in shaping or promoting corporate health policies within the CSR system. This is not to suggest that practitioners have ignored the rise of the global economy, CSR and workplace health. The Sustainable Development Goal 17 on partnerships reflects the recognition that many social problems are too large and complex or any one sector to solve on its own in our globalized world and the private sector has a role in the solutions. But the primary approach for engaging corporations in a global economy to address health needs has been through public-private partnerships (PPPs) . In health, PPPs are best defined as “any formal collaboration between the public sector at any level … and the non-public sector … in order to jointly regulate, finance, or implement the delivery of health services, products, equipment, research, communications, or education” . Other private sector approaches, usually with PPP elements, include such market-based ideas as franchising, vouchers, insurance, social marketing, financing and bond mechanisms .
The Global Health Community has also engaged in CSR, usually through PPPs, and considered it a form of strategic corporate philanthropy, community investment, or resource mobilization. CSR is a broad term whose definition has evolved since it was first articulated in the late 1940s with changing global business and political environments and changing views of the role business in society . Definitions focus on the integration of social and environmental concerns into business operations and the idea of doing well by doing good . A newer approach, Shared Value, which is cast as not-CSR, is similarly defined as a “management strategy focused on companies creating measurable business value by identifying and addressing social problems that intersect with their business” . Others now use the term “strategic CSR” . Most definitions incorporate the ideas of “enlightened self-interest” and “voluntariness” and link social performance with financial interest and the proverbial business case .
These notions of CSR remain valuable and relevant. But they emphasize the centrality of the individual company and business motivations without also capturing the equally significant development of new “ensemble regulatory structures”  and standard setting in what we have characterized as a CSR system. This is based on a more comprehensive definition of CSR as “processes of mutual governance between business, civil society, national governments and international organizations” in the management of business’ role in society . It is in this CSR policy sphere where global health advocates and policy-makers have been absent.
The need for CSR policy engagement on women’s and workplace health in developing countries is not an abstract concern. Most industrial or agribusiness workplaces have health infrastructures onsite that can support the expansion and improvement of health services, but are often disconnected from the public health system . Supplier factories and farms are often required by law – and certainly by occupational health practice based on the International Labor Organization’s (ILO) Occupational Health and Safety (OHS) convention – to have occupational health services and providers (health workers, nurses, paramedics, doctors) at the workplace . There is some evidence that these workplaces employ a surprisingly large share of country healthcare workforce. In the 2006 World Health Report, the WHO gave a rough estimate of between 17 percent and 37 percent, but noted the data on these workplace health providers are poor because they are classified under industries that hire them . The report noted: “Excluding them from official counts results in a substantial underestimation of the size of the health workforce and its potential to improve health” .
These health providers serve millions of women in global supply chains from Asia to Latin America and the Caribbean to Africa. The data on the number of workers in industry and agribusiness are limited as with the data on company health providers. The International Organization for Migration (IOM) estimates that 105 million people, half of which are women, leave their homes to find work in other countries . There are many more who migrate internally to urban centers to work for companies supplying products to the global economy . In Bangladesh, the garment sector employs about four million workers, mostly women . Cambodia has an estimated half a million workers in the garment industry, which employs about 25 percent of women in the country between the ages of 19 and 29 . African countries are also connected to the global standards system typically through extractive industries (e.g. mining and oil) as well as agribusiness (e.g. cut flowers, tea, coffee, cocoa and palm oil) .
Thus, across the world, millions of women have left their rural homes and social structure in search of employment usually in urban centers and across borders  and work global supply chains of agribusiness and in industry. They are low paid, often living in dormitories or with friends, under pressure to send remittances home, and often disconnected from family and public support systems. These women’s health needs are significantly different from those of men workers – and their general health can be harmed by the conditions at work and restrictive policies and practices that ignore these needs. There has been little attention paid to their need for access to general and reproductive health services and products, the poor quality of workplace infirmaries and practices of workplace health providers, and the poor sanitary conditions at work. CSR policies and business practices do not take women’s health seriously as a workplace health priority, a fundamental business interest, and a governance issue.
What would better CSR policies and practice for women’s and workplace health in developing countries look like? To start, they would not mean that every corporation and supply chain company must run a primary care facility at the workplace and offer family planning. They would mean that corporate policies and workplace practices must protect women’s health, not just safety, enable women’s access to health services, including reproductive health, and ensure the quality of care of providers and facilities on site. In poor countries, women’s health at work is compromised by a range of common operational practices. For instance, restrictions on breaks, restrooms and water can cause urinary tract infection . Lack of menstrual hygiene products and clean, private restroom can cause gynecological infections . These are issues that do not affect men and do not make the OSH list of concerns.
Access to health services, particularly reproductive health services, are critical for women workers, many of whom face what has been called “the double burden of work,” . Even if available services exist where they work or live, the long hours at work often mean women cannot access services after work – and their domestic duties further limit access. Many are young women who have need for family planning education, products and services. Company policies and de facto practices on leave directly impact their access to these health services.
Finally, very little attention is paid to the quality of workplace health facilities and staff that are usually required by law. These facilities and staff are primarily responsible for addressing workplace injuries. There is no policy expectation for these facilities to meet some level of public health standard for hygiene, confidentiality, or patient-centered care . There are equally low expectations for health care providers. The limited qualifications and skills – and expectations – of workplace nurses is common in many factories and farms. A Business for Social Responsibility (BSR) study in 10 factories in Bangladesh found 40 percent of the nurses did not have nursing diplomas. Bangladesh law and corporate code compliance requires factories to have diploma nurses. BSR found “a discernible mismatch between the training received by the nurses and the actual health needs in [garment] factories” . Nurses were under-utilized, unprepared to handle emergencies, and not trained to address the RH needs of the predominantly female workforce . Neither industry nor government has made much effort to build nursing skills or ensure qualifications relevant to the factory workforce.
These are policy issues that global health practitioners should address through the CSR System. But they have not viewed it as relevant to public health goals or system strengthening. The most active stakeholders in corporate accountability activism have come from environmental, human, or labor rights backgrounds  – and health is not their primary concern. As a result, the policies promoted by current stakeholders within the system do not address workplace health standards and practices or consider the significant health needs of women and men workers. They look to occupational safety and health conventions  to guide their thinking about health. These stakeholders view occupational health as a settled issue concerned with reducing the numerous physical dangers faced by workers, such as exposure to toxic chemicals, dangerous machinery, fire hazards and building safety. Most corporate OSH standards and related industry efforts, therefore, focus on safety issues aimed at reducing workplace injuries: adequate ventilation and lighting, fire extinguishers and exits, structural safety, and first aid supplies .
When companies comply with OSH standards, this has little effect on quality health services by health staff and worker access to quality health services onsite and offsite. OSH compliance monitoring does not address whether workplace health services meet the AAAQ (available, accessible, acceptable, appropriate and of good quality) rights framework for public health facilities and staff . There is little recognition that AAAQ might be relevant to workplaces. No one enforces basic clinical standards, such as confidentiality and privacy, knowledge and skills of health providers on health issues relevant to the workforce, or practitioner hygiene practices like handwashing or disposal of medical waste. There is very little oversight of both policies and actual practices that enable workers to seek care onsite or offsite and without retribution from managers.
Better health policies and practice at the workplace require the leadership of public health practitioners in CSR standards and governance.