Exploring a Culture of Health in the Auto Industry

Abstract

The Culture of Health framework includes four pillars of societal health and well-being influenced by business, namely: consumers; employees and workers in the supply chain; the community, and the environment. The Auto industry was an ideal crucible in which to explore the interface of public health with business given the confluence of the different domains in this sector. The substantial benefits of mobility, especially for the under-resourced, sit alongside negative impacts from emissions, accidents, products and services. Through interviews with 65 senior executives from seven major automakers, corporate actions reflecting health as a strategic agenda were mapped to the Culture of Health model. While most of the companies did not use the language of health explicitly in their strategy, key examples were present across all four pillars. Given the future of mobility relies on the interface of human experience with technology, it is a population-level challenge demanding system-level changes. Ostensibly, a framework for sustainability, the Culture of Health model could help the Auto industry navigate the disruption caused by the global megatrends and changing societal expectations of business in society and transition successfully to a new mobility economy.

Full text

sustainability
Article
Exploring a Culture of Health in the Auto Industry
Wendy M. Purcell 1,* , Brian S. Feldman 2, Molly Finn 1and John D. Spengler 1


Citation: Purcell, W.M.; Feldman,
B.S.; Finn, M.; Spengler, J.D.
Exploring a Culture of Health in the
Auto Industry. Sustainability 2021,13,
3924. https://doi.org/10.3390/
su13073924
Academic Editor: Manfred
Max Bergman
Received: 27 February 2021
Accepted: 29 March 2021
Published: 1 April 2021
Publisher’s Note: MDPI stays neutral
with regard to jurisdictional claims in
published maps and institutional affil-
iations.
Copyright: © 2021 by the authors.
Licensee MDPI, Basel, Switzerland.
This article is an open access article
distributed under the terms and
conditions of the Creative Commons
Attribution (CC BY) license (https://
creativecommons.org/licenses/by/
4.0/).
1Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA 02215, USA;
mfinn@hsph.harvard.edu (M.F.); jack_spengler@harvard.edu (J.D.S.)
2
Harvard Kennedy School, Harvard University, Cambridge, MA 02138, USA; brianfeldman@hks.harvard.edu
*Correspondence: wpurcell@hsph.harvard.edu; Tel.: +1-617-717-4053
Abstract:
The Culture of Health framework includes four pillars of societal health and well-being
influenced by business, namely: consumers; employees and workers in the supply chain; the
community, and the environment. The Auto industry was an ideal crucible in which to explore the
interface of public health with business given the confluence of the different domains in this sector.
The substantial benefits of mobility, especially for the under-resourced, sit alongside negative impacts
from emissions, accidents, products and services. Through interviews with 65 senior executives from
seven major automakers, corporate actions reflecting health as a strategic agenda were mapped to the
Culture of Health model. While most of the companies did not use the language of health explicitly
in their strategy, key examples were present across all four pillars. Given the future of mobility relies
on the interface of human experience with technology, it is a population-level challenge demanding
system-level changes. Ostensibly, a framework for sustainability, the Culture of Health model could
help the Auto industry navigate the disruption caused by the global megatrends and changing
societal expectations of business in society and transition successfully to a new mobility economy.
Keywords: Auto industry; Culture of Health; mobility solutions; equity; sustainability
1. Introduction
In 2016, the Harvard Business School and the Harvard T.H. Chan School of Public
Health embarked on a joint research venture to investigate whether companies embraced
the concepts imbued in the vision of a Culture of Health (COH) that, “Every company,
knowingly or unknowingly, impacts public health
. . .
”[
1
]. The COH framework includes four
main ways that business influences society’s health and well-being:
•Through the products/services business delivers to consumers (Consumer Health).
•In how it treats its employees and supply chain workers (Employee Health).
•By how much it invests in the health of its communities (Community Health).
•Through its impacts on the environment (Environmental Health).
Since the articulation of these four areas, and with the advent of the COVID-19
pandemic and the Black Lives Matter movement, the agenda has increasingly focused
on an underlying element critical to attaining a COH, namely societal equity, i.e., the
impact business needs to make in stemming the tide of increasing inequity in society [
2
].
In addition to the suffering inequity causes to the individuals whose relative position in
society is lower, it also negatively affects societal health [
3
] and undermines global economic
growth and prosperity [
4
]. Relevant to the COH framework, the Business Roundtable’s
revised ‘Statement on the Purpose of a Corporation’ [
5
] redefines corporate purpose as
serving society and all of its stakeholders—a radical departure from shareholder primacy.
The World Economic Forum’s Davos Manifesto 2020 also includes a similar list of goals
and stakeholders that business must serve [
6
]. As such, the COH aligns closely with the
sustainability agenda in business and environmental, social, and corporate governance
(ESG) metrics, connecting as it does people, prosperity, and planet.
Sustainability 2021,13, 3924. https://doi.org/10.3390/su13073924 https://www.mdpi.com/journal/sustainability

Sustainability 2021,13, 3924 2 of 18
Some connections between the Corporate Social Responsibility (CSR) agenda [
7
], and
that of the COH framework can be drawn in terms of a company looking beyond its own
business interests to create social and economic value through engagement with their
communities and beyond. However, we consider there are important differences. For
example, there is an intentionality towards CSR initiatives that relate to a company seeking
to be viewed as a good corporate actor with many CSR projects separate from core business.
In contrast, the COH framework is a strategic lens through which a company can view
its collective efforts across the four domains of the model when they place health as a
strategic driver. In this way, health connects the emergent possibilities relating to value
creation. Of course, some CSR projects may seek to engage in community or other efforts
that relate to advancing health and/or well-being. However, the distinction we draw
here with CSR is the focus on health from the consumer, employee/worker, community
and/or environmental perspective integrated with corporate strategy. The shared value
model [
8
], which “involves creating economic value in a way that also creates value for
society by addressing its needs and challenges” also brings relevant insights to dialogue
concerning adopting a COH in business. The strategic shift from CSR to Corporate Social
Innovation (CSI) [
9
] perhaps brings more to this debate, in that it seeks to align with company
strategy–-albeit, its focus will reach beyond health as defined in the COH framing.
The Automobile (Auto) industry was selected as the business sector in which the four
different, but interconnected and hyper-dependent, pillars of a COH could be explored to
develop a deep understanding of the contextual factors influencing a COH in business. The
Auto industry has an outsized impact on societal health, in both positive and negative ways.
Its positive contribution to the movement of people and goods throughout the United States
of America (U.S.) is profound, being a key factor in the growth of the middle class. Indeed,
the prosperity of the U.S. economy can be linked with the rise of the Auto sector as the
founder of the first Auto company, Henry Ford, held “
. . .
freedom of movement drives human
progress” [
10
]. Perhaps less widely appreciated is the influence freedom of movement
through individual car ownership has on equity. One of the executives interviewed in the
present study captured this sentiment, “Mobility equals access
. . .
without being able to move,
you can’t get anywhere on so many levels . . . you can’t access better jobs, a better life”.
Indeed, for those with the least socio-economic status, owning a car consistently
increases economic stability and overall prosperity. The negative economic consequences
of not being able to afford a car are known [
11
], with the connection between car ownership
and improved accessibility of the under-resourced to all elements of society including
jobs [
12
], with the authors noting “
. . .
vehicles, in most of the United States {are in themselves}
essential infrastructure”. It has even been suggested that those who have the least in society
should be given priority and supported to have cars over those of higher socio-economic
status who lack a commensurate need, given the environmental concerns of increasing
numbers of gas-powered cars on the road overall [13].
Cars are particularly important for those in rural areas, especially those designated as
‘medically underserved’ [
14
], with some 30 million Americans lacking timely ambulance
transport to a trauma center [
15
]. Car ownership has been associated with better health
compliance, given easier access to doctor appointments yielding better outcomes [
16
]. It
helps combat both food insecurity and food deserts [
17
–
19
] by extending grocery options
and shopping patterns. It enables people to relocate more easily to low-crime neigh-
borhoods [
20
–
22
], supports children’s participation in school activities linked to higher
educational attainment, and is associated with a greater likelihood of gaining employment
in adulthood [
23
]. As many of these issues disproportionately affect low-income U.S.
communities, vehicle ownership can help advance social equity. One study commented,
“Families with access to cars found housing in neighborhoods where environmental and social
quality consistently exceeded that of the neighborhoods of households without cars” [
24
]. When
low-income individuals obtain a vehicle, they are more likely to secure employment and
enjoy better job security [
25
–
28
], with car usage linked to economic mobility beyond that
of reliable and affordable public transportation [24,29].

Sustainability 2021,13, 3924 3 of 18
There are also substantial negative costs to car ownership; vehicles can increase carbon
dioxide (CO
2
) emissions, compound traffic congestion, and exacerbate urban sprawl
with substantial impact on environmental degradation (including climate change, air
quality, and pollution from manufacturing), as well as fatalities and injuries that incur high
social costs [
30
–
32
]. The use of personal vehicles contributes two-thirds of the 30% of all
U.S. greenhouse gas (GHG) emissions produced by all modes of transportation [
33
,
34
].
Indeed, exposure to particulate matter (PM) from fossil fuel emissions accounted for
almost one in five (18%) of total global deaths in 2018, with 10.2 million premature deaths
annually attributable to the fossil-fuel component of PM
2.5
[
35
]. Moreover, the burden
of air pollution is not evenly shared, with poor people and some groups facing higher
exposure to pollutants. One study estimated that minority communities incur around
twice as much of the impacts from transportation as they cause [
36
]. The Global Burden of
Diseases, Injuries, and Risk Factors Study 2015 [
37
] identified ambient air pollution as a
leading cause of the global disease burden, especially in low-income and middle-income
countries [35].
Electric mobility, driverless cars, automated factories, and ridesharing are just a few
of the major disruptions the Auto industry faced even before the COVID-19 crisis [
38
].
Technological advances in electric (EV) and autonomous (AV) vehicles raise new possi-
bilities to both address environmental concerns and offer new mobility solutions. For
example, an aging population with co-morbidities, distracted drivers, inequitable access
to private and public transportation, urbanization, and the growth of mega-cities would
support a focus on a COH as a strategic agenda. Adopting the COH framework may help
the Auto industry navigate the disruptions and changing societal expectations about the
contribution business should make to impact positively society’s challenges, with the four
pillars guiding the sector’s strategic initiatives.
The Auto industry is an important economic force in the U.S. with approximately
seven million people employed overall: two million in manufacturing vehicles, parts, and
wholesale trade; 3.8 million in retail trade, and another million in repair and maintenance
jobs [
39
]. As such, the industry influences the health of its employees, workers in its global
supply chain, as well as in communities near its factories and roads almost everywhere.
There are some 1.4 billion cars in operation worldwide, with growth in passenger vehicles
doubling every 20 years. Older vehicles affect the environment more than newer ones,
given poorer fuel efficiency with greater GHG, nitrogen oxides (NOx), volatile organic
hydrocarbons and particulates emitted along with brake and tire wear emissions. With
approximately 40 million used cars sold per annum versus approximately 17 million new
ones in 2018 [
40
]—with an average of 6.75 years per transaction [
41
]—older vehicles failing
environmental standards in one country are often exported to countries where standards
are lower to the detriment of the global environment [42].
The present study uses the COH framework to explore how Auto industry leaders
considered their company’s role in promoting a healthy, sustainable, and equitable society
as part of their company’s business strategy. The focus was to explore how the initiatives
of the Auto industry connected with the COH framework. The methodology centered
on engagement with the top companies in the sector through interviews with C-suite,
senior level executives, and managers. The aim was to understand the pathway to progress
a COH in a business sector working at the confluence of the four pillars. Does a COH
influence the thinking of top executives in an important sector of the economy? If so, how
does this affect strategy and actions? Is a COH a path to value creation and sustainability?
2. Materials and Methods
To date, in-depth interviews have been undertaken with 65 leaders (C-Suite, senior
executives, and managers) across seven major Auto companies (see Table 1) using an
interview guide (Appendix A). Visits were also made to all the company headquarters. The
aim was to understand the specific ways the company strategy considers a COH, with a
focus on equity. The methodology for securing engagement with Auto industry executives

Sustainability 2021,13, 3924 4 of 18
was effective given this industry rarely joins such efforts. Added to this is the context of
the industry, experiencing major disruption in the market, as well as recent emissions and
financial scandals in some companies.
Table 1. Culture of health: auto industry companies interviewed.
Auto Company Interviewed Location 1
Bavaria Motor Works (BMW) Yes Munich, Germany
Ford Motor Company Yes Dearborn, MI, USA
General Motors Company (GM) Yes Detroit, MI, USA
Hyundai Motor America Yes Fountain Valley, CA, USA
Nissan North America Yes Franklin, TN, USA
Tesla Inc. Yes Palo Alto & Freemont, CA &Reno, NV, USA
Toyota Motor North America Yes Plano, TX, USA
1Headquarters and key facility locations visited by the researchers to conduct interviews.
Collectively, the Auto companies studied offered both a broad and deep look into the
sector as a whole and the sample included:
•
Two of the original ‘Detroit 3
0
U.S.-based Auto manufacturers (GM, Ford), as well as
the newest major technology company and market disruptor, Tesla.
•
Two of the top three global automakers, by volume of vehicles sold globally, Toyota
and the Renault-Nissan-Mitsubishi Alliance represented by Nissan.
•
Broad participation from companies in the three most important global Auto man-
ufacturing regions of the world, the U.S. (GM, Ford, Tesla), Asia (Hyundai), and
Europe (BMW).
•
The first (Tesla) and second (Toyota) ranked Auto manufacturers by market capitalization.
The first step in securing engagement of a target Auto company was to identify and
secure the interest of an executive leader of appropriate rank who was able to obtain the full
commitment of the company as a corporate entity, a prerequisite for inclusion in the project.
Connections were made through Harvard faculty contacts, by direct ‘cold’ calls to company
headquarters, and via invitations on LinkedIn professional networks. At least four-six
interviewees were required per company. Interviews, typically 60-min duration (range
30-min to over an hour), were conducted between April 2018 and July 2020; most of the
interviews were recorded and transcribed, and contemporaneous notes were always taken.
Using the interview guide (Appendix A), and flexing to accommodate the interviewee’s role
and responsibilities as appropriate, the discussion explored the different dimensions of the
COH framework. To foster the frank sharing of information, confidentiality was assured
with a Non-disclosure Agreement in place for one company. Accordingly, executives
interviewed for the study are not identified, nor are any quotes attributed to a particular
company. Data was reviewed thematically, drawing out key examples as they relate to
each of the four pillars of a COH. Given the timeframe of interviews, the study effectively
had pre-COVID-19 data as well as that secured while the pandemic was at its peak in the
U.S.; where relevant this context is reflected in the narrative.
3. Results
The study sought to explore the COH framework in the Auto industry and map
a range of specific initiatives and projects against one or more of the COH domains in
order to illustrate how they connect with the COH model. To date, 65 interviews across
seven Auto companies (see Table 2) have been completed. By level, the executives inter-
viewed included 35 C-suite executives (including two Chief Executive Officers; CEOs),
24 Senior Executives
, and six Management level staff. By functional area, the interviewees
included representatives from General Management, Product Development, Operations,
Manufacturing and Labor Affairs, Purchasing, Human Resources, Sustainability, Com-
munications, Marketing, Information Technology, Government Relations, Community

Sustainability 2021,13, 3924 5 of 18
Affairs, and new Limited Liability Companies (LLCs) started by corporations to pilot new
technologies/business models.
Table 2. Culture of health: auto industry interviewees.
Auto Company Interviewees 1
Bavaria Motor Works (BMW) N = 6: 4C; 2SE
Ford Motor Company N = 10: 7C; 3SE
General Motors Company N = 13: 8C; 3SE; 2M
Hyundai Motor America N = 6: 1C; 3SE; 2M
Nissan North America N = 6: 5C; 1SE
Tesla Inc. N = 14: 5C; 7SE; 2M
Toyota Motor North America N = 10: 5C; 5SE
1C = C-suite; SE = Senior Executive; M = Management.
In discussing the COH framework with Auto executives, the terminology typically needed
to be reframed in language that resonated within the industry, with interviewees responding:
“Well, I’m not sure we’re the kind of company you’re looking for
. . .
we don’t cure
illnesses, we aren’t medical people . . . ”
“We don’t really see ourselves as a health company . . . ”
However, some C-suite executives resonated immediately with the framework, noting
how their company affected the health and well-being of society:
“I don’t know what you are referring to by a culture of health exactly, but if you are
asking whether we are trying to make people’s lives better, whether we care about how
our business is affecting society, whether we want to improve society, then the answer is
yes, we definitely do. Our CEO is on record saying this many times. Our top goals and
objectives are aligned to this. We are out front on this”.
“So, first, I want to maybe redefine what health means in the context of what we do or what
we can do
. . .
in the communities.
. . .
health also includes things like hunger, education,
youth development, and the well-being of underserved communities
. . .
social innovation,
it’s how we are delivering impact in underserved communities or communities where we
work and live”.
The Auto companies described technology and societal changes affecting their core
business as opportunities, but also as pressure to make wise decisions about strategic
investment to ensure the long-term viability of their business:
“So, the future is, on the one hand, uncertain, on the other hand, exciting, because of
technological change and the pace at which this change is happening. The world will
not look the same two years from now or five years [from] now as it does today, and the
challenge for companies like ours and every Automaker is to stay ahead of the curve, stay
relevant, always push the boundaries of innovation
. . .
making society work better and
lifting all boats at the same time, improving everyone’s lives”.
A majority of the C-suite and senior executives expressed sincere interest in making
decisions that improved people’s lives in all dimensions:
“We have developed some very promising pilot programs that have great social impact
. . .
innovation in partnering
. . .
anchoring our understanding of the best use cases for
electrified and autonomous vehicles which will address health directly, but also lead to
less congestion on the road and more effective transportation for people who really need
it . . . ”.

Sustainability 2021,13, 3924 6 of 18
Detailed thematic analysis of the results revealed key areas where the Auto companies’
work mapped easily to the COH framework (Figure 1). These included means to advance
equity among consumers, promote well-being among their employees, ways to create
social and economic connections within their communities in the manner of an anchor
institution, and actions to reduce their negative environment impact. Across the four pillars,
we selected 12 examples (Table 3) informed by the interviews with company executives
and illustrated by publicly available company press releases, company reports, and news
articles featuring at least one of the seven automakers. The basis of selection included two
key criteria: that the case illustrated one of more of the COH pillars in practice, and that
the activity advanced equity. In calling out a particular example in one company should
not be read as absence of such in another company.
Figure 1. Culture of health: key thematic issues in the auto industry.
Table 3. Culture of health: auto company examples of activities advancing equity.
COH Pillars Examples Automotive Companies
Consumers
Financial Literacy & Inclusive Financing Ford, GM, Toyota
Generational Ergonomics Ford, Toyota
Childhood Safety Toyota
Employees &
Supply Chain
Organizational Well-being BMW, Ford, GM
Mental Health Support Ford, Toyota
Supply Chain Resilience & Inclusion Ford, Hyundai
Community
Economic Anchors & Place-making Ford, Hyundai
Minority-Owned Dealerships GM, Hyundai, Toyota
Talent Pipeline Development Tesla
Environment
Eco-Innovation Ford, Hyundai
Electric Vehicles GM, Tesla, Toyota
Green Manufacturing Processes Nissan, Toyota

Sustainability 2021,13, 3924 7 of 18
3.1. Consumer
All the Auto companies prioritize customer care, but operationalize this in different
ways. Against the COH framework, it ranged from ensuring safety technology was
standard across their product range, to enabling dealerships to educate consumers on
health-related driving features. Here, three examples that reflect COH tailored to key
customer segments are described. To be sure, declining U.S. interest rates and stagnant
consumer demand for vehicles may partly explain the companies’ programs. Yet, these
initiatives have helped consumers take advantage of the benefits of car ownership [
29
], such
as empowering them to build more expansive social and economic ties, gain employment,
increase their earnings, and more easily gain access to medical care.
3.1.1. Financial Literacy and Inclusive Financing
Auto companies have sought to make the financing process more equitable and inclu-
sive, lowering the barriers to car ownership. Several of the Auto companies improve access
to car ownership among under-resourced groups by collaborating with local organizations.
For example, GM Financials ‘KEYS’ program is a free education resource that equips car
buyers with personal finance information with videos and articles that seek to clarify
credit, budget, and leasing terms to support consumers’ financial literacy [
43
]. A Toyota
senior manager outlined their company’s involvement in an ‘On the Road Lending’ (OTRL)
program scheme, noting “Reliable, affordable means of transportation can transform lives
. . .
so
we’ve been supporting [OTRL] with Toyota Production System thinking and with cash”. Toyota
was testing a program on financing used fleet vehicles for single mothers in economically
disadvantaged areas near the company’s headquarters, targeting those who could not
get financing on their own, yet whose ability to earn a stable income most often required
having a car. Auto companies were especially attentive to financial inclusion during the
height of the COVID-19 pandemic, standing up programs to help prevent loan defaults.
For example, through its Ford Credit subsidiary, the Detroit automaker formed a payment
deferral program ‘Built to Lend a Hand’ while GM allowed consumers to defer monthly
payments for up to 120 days, and offered interest-free financing for up to seven years on
certain vehicles.
3.1.2. Generational Ergonomics
Auto ergonomics are being adapted to better address age-related physiological de-
clines and health conditions so that customers 65-years-and-older—a group with weaker
perceptual, motor, auditory, and visual skills who disproportionately suffer from age-
related ailments—are enabled to continue driving safely [
44
]. For example, Ford designers
and engineers created the ‘Third Age Suit’, a device that can simulate vision-related and
nervous system impairments, and used the information to redesign the interior spaces
of its cars. Toyota integrated consumer health into its automobile design process. For
example, its in-vehicle cardiac measurement systems to reduce the risk of heart-related
vehicle accidents [
45
]. AV are an ultimate solution to those with impairments that might
affect safe driving. One senior executive at Tesla cited the company is leading efforts in
AV as the reason they joined the company, given the life-changing impact this technology
could have on a close family member suffering from a neurodegenerative condition.
3.1.3. Childhood Safety
Car manufacturers have worked to reduce the number of vehicular accidents and
deaths involving children, directing critical resources to improving youth consumer
safety [
46
]. While regulation and market demands compel automakers to engineer a
safe riding experience, Toyota’s commitment to childhood accident reduction targets safety
education for under-resourced communities. Since 2004, the automaker has partnered with
the Cincinnati Children’s Hospital to educate more than 100,000 people nationwide about
the importance of car seat installation. By detailing age- and weight-specific car seat guide-
lines, as well as specifics about adaptive car seats for children with special needs, Toyota

Sustainability 2021,13, 3924 8 of 18
has encouraged caregivers to drive safely. Toyota also has a commitment to eliminating
vehicle-related deaths among children, developing local partnerships in approximately
200 cities
specifically focusing on under-resourced communities. For example, its ‘Buckle
Up for Life Safety Lab’ in Austin, TX, USA offered one-on-one car seat installation in-
struction, knowledge about Texas’s childhood passenger safety laws, and free car seats to
families in need. The Lab reached individuals who may otherwise have lacked the ability
to receive guidance on the importance of childhood injury prevention and reduction.
3.2. Employee Health
All the companies were fully conversant with standard employee metrics, including
retention, satisfaction, and engagement, with most focused on increasing diversity, inclu-
sion, and belonging. Health and safety were a strategic consideration given the link with
creating a competitive business advantage [
47
]. Speaking to GM and BMW in follow-up
discussions amid the pandemic revealed that well-being was now higher up on the agenda,
as they recognized the differential impact of COVID-19 on people, whether through social
determinants of health and/or the presence of co-morbidities.
3.2.1. Organizational Well-Being
Carmakers are transforming their organizational cultures to better support the physi-
cal, emotional, and social health of their employees. Clearly, companies are incentivized to
invest in their employees; healthier workforces boost profitability, raise worker produc-
tivity, and combat absenteeism. Nevertheless, automakers have defined employee health
as more than just a topline budget item. As BMW’S ‘Health Initiative’ notes, “Health is
our most valuable asset as human beings. We regard it as the basis for individual performance and
personal enjoyment of life” [
48
]. This goes beyond occupational safety, occupational medicine,
and ergonomics to champion four new areas: exercise, nutrition, mental health, and ad-
diction prevention. From employee welfare programs, to installing wood flooring in their
factories rather than concrete to reduce musculoskeletal strain, these all speak to BMW’s
commitment to advancing a COH and philosophy that integrates personal well-being with
job performance.
At Tesla, well-being is infused from the design phase of new vehicles, with factory
health and safety experts drawn in to ensure the well-being of employees who make the
vehicle is fully considered. Ford has developed a health-monitoring system based on
wearable technology for employees at 15 manufacturing plants in seven countries. GM,
spurred by the COVID-19 crisis, drew its Chief Medical Officer into a strategic role with
the company’s injury prevention focus transitioning to prioritize well-being.
3.2.2. Mental Health Support
With the COVID-19 pandemic, many Auto companies expanded or introduced new
mental health programs to support their employees during this challenging period. For
example, BMW stressed the importance of cultivating psychological and emotional well-
being, advising workers to prioritize self-care. Similarly, Toyota bolstered its Employee
Assistance Program, which offers personalized help from professional counselors via voice
or video, to provide “one-on-one help for employees to deal with their fear regarding health and safety,
loss of control and uncertainty, loneliness due to isolation and social distancing, or frustration and distress
due to changed routines”. Toyota has taken steps to improve the health of those populations
disproportionately affected by the pandemic, noting, “Minority populations—including those in
the LGBTQ + community—are at increased risk during a pandemic”. The company is working
with nonprofit partners to disburse grants, specifically related to providing mental health
services, and has supported minority organizations’ transition to a telehealth platform to
ensure healthcare needs are met during the pandemic.

Sustainability 2021,13, 3924 9 of 18
3.2.3. Supply Chain Resilience and Inclusion
Automakers recognize the importance of adopting a ‘healthy’ supply chain built on a
relational and collaborative basis, noting as one senior executive interviewed said, “For
every one Auto job, there are ten in the supply chain. The question is, how to benefit everybody?”
Relevant to COH and equity, the COVID-19 pandemic saw many of the Auto companies
in this study make their expertise available in support of the health crisis. For example,
GM mobilized first for ventilators, working in partnership with Ventec Life Systems,
reconfiguring its manufacturing facility in Indiana to scale up production with a federal
contract to produce 30,000 ventilators [
49
]. Ford forged a collaboration with one of its
suppliers, Joyson Safety Systems, for airbag materials and Beaumont Health for design,
to manufacture reusable medical gowns [
50
] and worked with GE Healthcare to produce
thousands of ventilators.
Tesla’s in-house vertical integration model has helped it imbue its culture into its
workforce worldwide. Hyundai noted in its 2019 Sustainability Report [
51
] it has sought
to create “
. . .
a virtuous cycle whereby we support growth in our value chain, and then share
the value generated with our suppliers”. Ford has been in intentional in purchasing from
veteran-, minority-, and women-owned suppliers, spending over U.S. $10 billion purchas-
ing from under-represented enterprises in 2018, and creating a robust and sustainable
procurement network.
3.3. Community
Several of the Auto companies cited work in the communities near their headquarters
and/or major manufacturing facilities that went beyond efforts to be a ‘good neighbor’.
Indeed, many had moved away from an approach based on corporate social responsibility
(CSR) or philanthropy to one focused on corporate social innovation and collaboration
with community non-profits, especially those working in economically depressed areas.
Adopting a shared value model ranged from targeting issues relating to food deserts, lack
of adequate medical facilities, poor transportation infrastructure, and limited adult training
opportunities. In so doing, companies spoke of how this work was co-terminus with their
human capital and sustainability agendas, with some companies expanding their view of
community from where they have operations to everywhere their products were on the
road in the world.
3.3.1. Economic Anchors and Place-Making
The role of the Auto industry in economic development and place-making is im-
portant [
52
]. For example, Ford is leading a cultural revitalization effort in Corktown, a
traditionally low-income neighborhood in Detroit, MI, USA. Through redevelopment of
Michigan Central Station and adjoining properties in this historically under-resourced area,
its ‘Innovation Hub’ plans to help “preserve the cultural heritage of existing neighborhoods, while
creating modern, sustainable mixed-use spaces that foster innovation and community engagement”.
As part of the project, Ford is providing home repair grants for local homeowners, target-
ing lifelong residents or low-income individuals given redevelopment can often lead to
uneven economic gains and displace long-time community members. Its goal of relocating
company staff into the city aims to increase economic support to the community, but in
ways that minimize gentrification.
Hyundai has used creative place-making to help enhance the lives of local community
members. For example, its ‘Culture Station’ campaign saw it transform abandoned gas
stations into public spaces, prompting a dialogue about how to transition from gas to
electric or hydrogen fuel cell vehicles, with art murals of endangered Korean birds in Seoul’s
public parks raising attention about biodiversity; both initiatives developed recreational
spaces in support of well-being. Additionally, through its IONIQ Forest program, Hyundai
planted 30,000 trees, specifically zelkova and pine trees that help absorb fine dust, at the
Incheon metropolitan landfill. The effort helped combat land degradation, absorbing more
than 500 kg/year of fine dust and sequestering more than 130,000 kg/year of CO2.

Sustainability 2021,13, 3924 10 of 18
3.3.2. Minority-Owned Dealerships
While minorities purchase some 30% of new vehicles, only 5% of dealerships are
minority-owned [
53
]. As such, carmakers have provided capital and entrepreneurial re-
sources to help minority individuals own and operate car dealerships. These efforts build
business capacity among minority groups, who historically have suffered from discrim-
inatory financial lending laws. GM, for example, through its Minority Dealer Advisory
Council (MDAC) works to develop Black, Asian, Hispanic, and Native American business
leaders, providing educational programming around customer acquisition and dealership
profitability. It also offers access to GM leadership to voice feedback about the dealership
experience, supporting communities traditionally excluded from founding dealerships.
In an interview with a senior executive, they discussed the carmaker’s outreach
in Atlanta, GA, USA. Referring to the region as “the cultural epicenter of Black America,”
the executive discussed how creating a Black history exhibit and partnering with local
minority organizations helped increase minority representation among the dealer body.
Likewise, Toyota initiated outreach efforts by partnering with the National Association
of Minority Automobile Dealers, “combatting the inequalities and obstacles that historically
stifle opportunity”. To help mitigate these inequitable circumstances, the company’s Toyota
Dealer Investment Group provides operational, capital, and managerial support to qualified
minority-owned dealerships and help communities flourish economically. Hyundai has
also taken a long-term approach to placing dealerships in African American neighborhoods.
3.3.3. Talent Pipeline Development
Carmakers, long associated with apprenticeship programs, have expanded their efforts
to support technical education programs and create career pathways. For example, Tesla
has three programs that help make the recruiting process more equitable for individuals
without a four-year college degree. Through its Manufacturing Development Program,
recent high school graduates from schools near its major North America manufacturing
facilities can start as a Production Associate and simultaneously enroll in a community
college to learn robotics. This program expands opportunity pathways and increases equity
in the hiring process. As one executive in an interview noted, talent schemes make “a real
difference . . . because we have so many students going right from high school into the workforce”.
To date, over 100 high school graduates have entered the program. Similarly, Tesla’s
‘Student Automotive Technical Program’ (START) partnered with local community and
technical colleges to provide an intensive training program to equip students with the
skills needed to work as Automotive Technicians. Over 300 individuals have been hired,
and the carmaker has helped achieve a 90% placement rate every cycle of the program.
This initiative has widened opportunity for traditionally under-resourced individuals
and created a skills pipeline between local educational institutions and employers. Tesla
has helped promote technical skill development through its ‘Tool & Die Apprenticeship’
initiative, noting, “The vehicle manufacturing industry faces a critical shortage of tool and die
makers, with only 2% of the industry being under the age of 35”. The program brings together
academic learning with on-the-job training and is hosted at Tesla’s Fremont Factory; it has
since expanded to other locations.
3.4. Environment
In terms of decreasing vehicle GHG and particulate emissions, all the companies fo-
cused on investing in potential solutions, but the approach chosen and the level of strategic
investment varied. Some had developed and produced at least one EV model, others
had no EVs in production at the time of interview, and some were investing in multiple
options. Some defended gas-powered engines, highlighting dramatic improvements with
the combustion engine, while others had publicly committed to an all-electric future. Many
of the companies were working with cities on software to improve traffic flow, developing
AVs, multi-passenger vehicles and ‘last-mile’ solutions.

Sustainability 2021,13, 3924 11 of 18
3.4.1. Eco-Innovation
Automakers are developing innovative materials that are more biodegradable, sustain-
able, and durable. For example, through its research into the use of tomato skin, bamboo,
and agave fiber, Ford implemented a tree-based cellulose hybrid material for use in the
interior consoles. Since this material is 24% lighter than traditional materials, it has al-
lowed for a less intensive manufacturing process that in turn has reduced GHG emissions
and cut costs by 13%. The automaker also found that natural-fiber-reinforced materials
could improve fuel economy and sequester carbon. Hyundai likewise has applied an
eco-friendly approach to its materials design process. The carmaker noted that plant-based
artificial leather, bioplastics, and plant-based paints “offer our customers better air quality
inside their vehicles, greater durability, [and] improved safety”. For example, the seat foam in
many Hyundai vehicles uses cardanol oil, a byproduct from cashew nuts. The automaker
claims that this biomaterial increases interior hygiene by 99.9%, and is less energy-intensive
to manufacture than a synthetic alternative. In partnership with the Rhode Island School
of Design, RI, USA., the carmaker has developed a concept for a symbiotic bio-engine
that is more environmentally friendly, and conceived of engineering designs for improved
in-vehicle air filtration.
3.4.2. Electric Vehicles
Automakers have introduced into their product lineup EVs, which help combat
environmental degradation, lower fuel costs, and mitigate the harmful effects of climate
change. By replacing the internal combustion engine (ICE) with an electrically charged
battery, carmakers are significantly reducing the CO
2
emissions that contribute to rising
global temperatures and increased pollution. While the environmental consequences of
EVs are known, recent studies point to profound public health benefits that would support
a policy of rapid replacement of current gasoline and diesel cars and light-duty trucks
with EVs [
54
]. With EVs becoming more available, and a tax credit of up to U.S. $7500
per vehicle [
55
], sales have grown but still represent a small percentage of global vehicles.
Taking all the parameters into account, the social cost of carbon benefits was U.S. $10,400
per 150,000 miles with implications for environmental justice.
Tesla noted that in 2019 its vehicles resulted in savings of over 4 million metric tons
of CO
2
, stating, “This is the equivalent of saving emissions from being released into the
environment from over 500,000 ICE vehicles with a fuel economy of 22 miles per gallon”.
Given affordability as an equity issue, Tesla has committed to drive down battery costs
and produce a model priced for wider accessibility. Likewise, other car companies have
committed to electrifying their vehicle fleet. GM pledged in January 2021 to eliminate
all tailpipe emissions from light-duty vehicles by 2035, offering 30 EV models by mid-
decade [
56
]. Given its vehicle emissions account for some 75% of the company’s overall
carbon footprint, the automaker’s planned shift to EVs will help address climate change.
Additionally, Toyota has committed to producing 70% of its vehicles as electric models by
2030. Building on its identity as one of the earliest companies to commercialize hybrid
vehicles, this effort will magnify the automaker’s removal of over 38 million tons of GHG
globally. Low-income communities and communities of color disproportionately feel the
impacts of vehicle pollution and can benefit the most from the clean air and cost-saving
benefits of EVs [57].
3.4.3. Green Manufacturing Processes
Making efforts to reduce the environmental impact of their products, and improve the
sustainability of their manufacturing operations, carmakers are mitigating carbon emissions
and water waste. For example, Nissan committed itself to reducing CO
2
emissions by 30%
compared to its 2005 fiscal-year levels. To achieve this goal, the company developed a new
water-based paint that no longer requires energy-intensive, high-temperatures reducing
carbon emissions by 25% and using dry painting booths that allows it to collect 100% of
the residual airborne paint. This approach, which emphasizes resource conservation and

Sustainability 2021,13, 3924 12 of 18
manufacturing innovation, helps reduce the company’s carbon footprint. Nissan has also
reduced its CO
2
emissions by 30,000 tons by improving its shipping and logistics processes.
Similarly, Toyota has worked to advance environmentally friendly manufacturing policies.
For example, reducing the procurement of plastic packaging by 25% compared to fiscal-year
2018, and working with a third-party vendor to implement habitat management policies at
its major worksites to help protect biodiversity as part of its sustainability strategy.
4. Discussion
This study explored for the first time the COH within the Auto industry, examining
the inter-dependence of health and business. It sought to illustrate where initiatives of
the Auto industry could be connected to the COH framework. While it might appear
oxymoronic to place the Auto industry within a COH, doing so offered a crucible [
58
] in
which to examine the confluence of the four pillars. While all the companies had active CSR
agendas in play, health was an important consideration for the Auto companies’ current
and future business strategy. However, the industry did not regard its efforts in this domain
as a ‘health strategy’ per se. At first hearing, the COH framework was typically received as
being about health as individual disease and disability and, with the exception of concern
for employee health and safety, out of place with their purview. However, upon deeper
exploration, leaders talked about how their work focused on improving the quality of
life for people and the planet. As such, the COH terminology needed to be reframed in
language that better resonated for Auto leaders to engage fully with the agenda. Having
done so, it was clear all of the seven Auto companies studied were engaged at a strategic
level in advancing a COH, with a strong heritage or mission guiding them to “do the right
thing”. At the conceptual level, they understood that part of their role as an Auto company
was to improve people’s lives, with executives displaying a clear sense of purpose to serve
society through mobility solutions.
This study presents an opportunity to examine strategy and actions through the lens of
health, from wide-scale negative impacts on human and environmental health to extensive
positive benefits associated with mobility, especially for the under-served [
13
,
26
–
29
]. Auto
was a good choice because it deeply affects everyone in the U.S. and beyond, for better
or worse through whom it does and does not serve. Specifically, its negative impact on
climate, air quality, and health; its impact on workers and communities throughout the
global supply chain and where its vehicles are produced and on the road, as well the
communities in which they are produced; and connections between car ownership and
economic advantage and resilience. With strategic pivots to confront its responsibility for
climate change and GHG emissions, with poor air quality in urban areas and along mega-
highways disproportionately affecting the health of under-resourced people, the Auto
sector is experiencing major disruption and transformation from principally manufacturing
vehicles to developing broad-based mobility solutions. A COH can help guide their efforts.
For example, by integrating COH-related thinking into its design process, Ford en-
sured that elderly customers could still drive safely, helping make roads and highways safer
for all. Likewise, Toyota’s focus on detecting heart-health metrics while driving focused
on consumers’ health. A greater emphasis on employees’ health, including mental health,
went beyond occupational and workplace safety into supporting well-being. Adopting a
relational approach with their supply chain workers supported corporate resilience, while
a focus drawing vendors from all sectors of society was a way of promoting equity. This
extended into the efforts automakers are making to invest in their local communities’ and
enhance quality of life and opportunity for all by investing in education and job creation.
All the automakers were paying close attention to building a greener, more energy-secure
and more environmentally friendly future, recognizing these changes help under-resourced
communities, who are affected disproportionately by transportation-related pollution. Ini-
tiatives to pivot to EV will help combat environmental degradation and climate change
and yield material public health benefits.

Sustainability 2021,13, 3924 13 of 18
Simply re-framing COH as a strategic intent moves it to a top-line imperative. All
of the seven Auto companies demonstrated a strong understanding of the general expec-
tations of them to contribute more to societal health and well-being and to minimize the
negative impacts of their business operations. All the companies had active CSR agendas
in place [
59
], but none had adopted health as a strategic lens through which they viewed
their corporate actions. No one company had strengths across every COH pillar, but none
showed uniform weakness either and there was a general understanding that doing good
for society was expected of them. How a company was doing at the time of the interview
(vis-a-vis traditional business metrics such as its stock price, profitability, or the perception
of it by Wall Street), did not appear to be the fundamental driver of how the companies
viewed their ability to make strategic moves related to a COH. Rather, many executives
spoke eloquently about how their product affects people’s lives and society through allow-
ing greater freedom and mobility. Indeed, the importance of access to a reliable car to their
customers’ overall quality of life, well-being, and economic stability was understood at a
visceral level.
All the companies had embarked on initiatives that could be related to a COH using
an equity lens, from increasing access to car ownership, approaching vehicle emissions
and safety features, and developing mobility solutions that address the isolation of socio-
economically disadvantaged communities directly. Recognizing that those least able to
afford cars benefit most from having them—for example, by increasing people’s ability to
secure and keep better paying jobs [
12
]—the companies had made various efforts to enable
affordable ownership. Likewise, there was full acknowledgement that environmental
impact affects economically disadvantaged communities who are more often located close
to highways with consequent higher rates of serious health conditions [
60
,
61
]. Making
safety features standard, especially on economy models, was also a way in which equity was
supported, ensuring those who are poorer are not forced to decide between affordability
and safety.
As we demand more from business, now is the time for business to take a lead role in
promoting societal well-being and embrace a COH as the framework joins sustainability
with equity. As one executive commented at interview, “In our minds sustainability isn’t just
about the environment or our employees. It’s about social responsibility very broadly. It’s about
what are the basic human rights and what should we be doing to make them available to everybody?
We want to have a positive net impact. We want to help put more freedom back into the cities”.
Consumers, employees, suppliers, communities, and investors are all looking to companies
to generate positive social returns as well as financial returns, paying all due attention
to reducing negative environment impact and a move to restorative approaches. Amid
the COVID-19 pandemic, business leaders at all levels recognized health as an agenda for
business. The Auto industry is ripe for health-accelerated change through the confluence
of it being disrupted by the ‘experience economy’, as well as the impact of COVID-19 on
mobility trends. Rather than market-based evolution, which optimizes commerce at the
expense of the well-being of people and planet, the focus will be how leaders progress
mobility solutions that reflect an ecology of people, cities, and the natural environment
based on equity, community, and well-being.
The Auto company executives interviewed agreed on the sector’s core areas that
affect health: access to mobility, environmental sustainability, and driver safety. However,
the relative priority of these areas and thereby the degree of corporate attention given to
each, including to social inequities that may amplify overall health impacts, varied by
company. Furthermore, some companies defined additional goals or targets that reflected
their company culture and business strategy, such as adopting the Sustainable Development
Goals, prioritizing social investments in the communities in which they do business, or
investing in their workforce development beyond traditional health and safety protections,
such as skills training.

Sustainability 2021,13, 3924 14 of 18
The majority of Auto company executives interviewed were involved to a greater or
lesser extent in actively refining their corporate strategy, being intentional in their consider-
ation of their future role, risk appetite, and reputation. Trust in the Auto industry has been
challenged, with concerns arising from emissions scandals and cover up along with product
defects, job losses, factory closures and loss of life due to accidents, diminishing air quality
and being complicit in efforts to roll back fuel efficiency standards. Tesla’s disruptive
influence is changing the Auto industry for the better, reflected in the recent announcement
by GM [
56
] to be carbon neutral and new that automakers are dropping their opposition to
California’s climate rules [62]. Uncertainty is high given the technological transformation
of the industry with still many unknowns in battery power, artificial intelligence, and
consumer adoption of shared mobility and integrated transportation and energy systems.
The COH framework offers much in bringing together health with business, sustainability
with equity, and offering insights into the hyper-connected and inter-dependent nature of
these agendas.
The future of mobility [
38
,
63
] relies on the interface of human experience with tech-
nology; it is a population-level challenge demanding system-level changes. Rather than
seeking to atomize the problem, adopting the COH framework can help promote work at
both a strategic level and a community/system level. Pioneers, innovators, and activists are
building the field, moving beyond technological determinism to transformational impact,
to partnerships defined by inclusion, learning and self-organizing communities. With the
impending downturn of the industry, leaders are seeking a future path to profitability
with ongoing exploration of EV and AV, as well as shared mobility and connectivity. With
original equipment manufacturers (OEM) deciding where to focus, disruption continues
apace with interest in data monetization from connected networks.
However, these mobility trends may pause as more people choose to own a car and/or
drive more because of concerns about COVID-19, ride-sharing, and public transport, and
seek car ownership due to an all-time low on oil prices. At the same time, economic
pressures may see new car sales decrease further, with more older and uninsured vehicles
on the road because of unemployment, missed payments, and policy lapses. While working
from home for some will reduce the commute, this is not applicable across all social groups,
with under-resourced populations challenged by the move to technology-enabled work
itself an issue of equity. The lived experiences of the pandemic will however serve to
reinforce the connections between health and business. From needing to make the case for
health, perceived as a cost to business, we now have the opportunity to position health
across the four COH pillars as a business asset. Adopting a COH framework can help Auto
company leaders make change in and through their companies to survive and thrive in a
post-COVID-19 world.
As the World Economic Forum noted “Mobility is a fundamental human need, and an
essential enable of prosperity. But the current mobility paradigm is not sustainable” [
64
].
Adopting a COH at a strategic level could make an important contribution to the massive
transformation underway in the global mobility systems, and in defining a new social
contract with the Auto industry. Interactions between organizational practices and socio-
ecological systems relies upon a deep understanding of equity and opportunities for
shared value creation. The Auto industry is a suitable vessel in which to explore such
questions and in which to pilot evidence-based interventions that bend the arc of the curve
toward health justice. Ahead, there are fulsome opportunities for the Auto industry—and
business in general—to embrace fully Quelch’s foresight that “Every company, knowingly
or unknowingly, impacts public health . .. ” [1].

Sustainability 2021,13, 3924 15 of 18
Author Contributions:
Conceptualization, W.M.P.; methodology, W.M.P., M.F.; formal analysis,
W.M.P. and B.S.F.; investigation, W.M.P., M.F. and J.D.S.; resources, J.D.S.; data curation, W.M.P. and
M.F.; writing—original draft preparation, W.M.P. and B.S.F.; writing—review and editing, W.M.P.,
B.S.F., M.F. and J.D.S.; visualization, B.S.F.; supervision, W.M.P. and J.D.S.; project administration,
W.M.P.; funding acquisition, J.D.S. All authors have read and agreed to the published version of
the manuscript.
Funding:
This research was funded by the Robert Wood Johnson Foundation under the grant No.
74275 ‘Building a Culture of Health: A Business Leadership Imperative’ and is a joint initiative
between the Harvard Chan School of Public Health and the Harvard Business School. The opinions
expressed in this Article represent the researchers’ personal views and do not reflect the beliefs of
Harvard University. Any reference to a business, product, or service does not represent endorsement.
Institutional Review Board Statement: Not applicable.
Informed Consent Statement: Not applicable.
Data Availability Statement:
The data are not publicly available as a Non-disclosure Statement is in
place given privacy and commercial in confidence issues.
Acknowledgments:
The authors acknowledge the early project formulation and investigative partic-
ipation of Eileen McNeely, and the addition support of Andi Gordon, Heloisa Jardim, and Katrina
Rothstein. The authors are grateful to the Auto company leaders and senior managers who gave
generously of their time and whose insights inform our research.
Conflicts of Interest:
The authors declare no conflict of interest. The funders had no role in the design
of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or
in the decision to publish the results.
Appendix A. Standard Interview Guide
1.
How does {company}’s overall business strategy incorporate improving people’s lives,
health, and well-being? Does the {company} have a ‘health strategy’? What language
do you use (both internally and externally) to describe the company’s impact on
people’s lives, health, and well-being?
2.
How do you view the area you lead/work in as contributing to the {company}’s
progress in making people’s lives better and improving their health and well-being?
Specifically, what are the initiatives that the {company} has undertaken to impact the
following four areas, and how do you measure this impact for each area? (Feel free to
focus on the area[s] most impacted by your work):
•Communities
•Consumers
•Employees (including supply chain)
•Environment
3.
How much or little does regulation drive the {company}’s goals and objectives in
improving people’s lives across the four areas listed above? Where it is not regulation,
what does drive the company to undertake initiatives aimed at improving people’s
quality of life? How do you measure the impact your initiatives have?
4.
What do you think the {company}’s strongest contribution to improving people’s
lives is now, and what will it be 5–10 years out? How does the {company} measure
its impact on people’s lives, and what areas do you think the company will need
new ways to measure in the future given the major transformation the industry is
experiencing through both advances in technology and changing business models?
5.
What are your views on how the auto industry overall is impacting society’s health
and well-being today, and what could it do better moving forward?
6.
What targets do you think the industry as a whole should aim for in the future (5, 10,
20 years)? What kinds of measurements do you think are needed to show progress
against them?

Sustainability 2021,13, 3924 16 of 18
References
1.
Quelch, J.A.; Boudreau, E.C. Building a Culture of Health: A New Imperative for Business, 1st ed.; Springer International Publishing:
Berlin, Germany, 2016.
2.
Inequality in the United States: Understanding Inequality with Data. Available online: https://inequality.stanford.edu/sites/
default/files/Inequality_SlideDeck.pdf (accessed on 25 January 2021).
3.
Sanger-Katz, M. Income Inequality: It’s Also Bad for Your Health. The New York Times. 30 March 2015. Available online: https:
//www.nytimes.com/2015/03/31/upshot/income-inequality- its-also-bad- for-your-health.html (accessed on
25 January 2021
).
4.
Cingano, F. Trends in Income Inequality and Its Impact on Economic Growth; OECD Social, Employment and Migration Working
Papers; OECD Publishing: Paris, France, 2014; Volume 163, pp. 1–64. [CrossRef]
5.
Business Roundtable. Business Roundtable Redefines the Purpose of a Corporation to Promote ‘An Economy That Serves
All Americans’. Available online: https://www.businessroundtable.org/business-roundtable-redefines-the-purpose-of- a-
corporation-to-promote-an-economy-that-serves-all-americans (accessed on 7 February 2021).
6.
Schwab, K. Davos Manifesto 2020: The Universal Purpose of a Company in the Fourth Industrial Revolution. Available on-
line: https://www.weforum.org/agenda/2019/12/davos-manifesto-2020-the- universal-purpose-of- a-company-in-the-fourth-
industrial-revolution/ (accessed on 7 February 2021).
7.
Masoud, N. How to win the battle of ideas in corporate social responsibility: The International Pyramid Model of CSR. Int. J.
Corp. Soc. Responsib. 2017,2, 4. [CrossRef]
8.
Porter, M.E.; Kramer, M.R. Creating shared value. How to reinvent capitalism and unleash a wave of innovation and growth.
Harv. Bus. Rev. 2011,89, 62–77.
9.
Mirvis, P.; Herrera, M.E.B.; Googins, B.; Albareda, L. Corporate social innovation: How firms learn to innovate for the greater
good. J. Bus. Res. 2016,69, 5014–5021. [CrossRef]
10.
Ford on Why Smart Mobility Is Essential for Smart Cities. Available online: https://www.automotiveworld.com/articles/ford-
smart-mobility-essential-smart- cities/ (accessed on 7 February 2021).
11.
Tomer, A.; Kane, J.W. Cars Remain King and Barrier to Economic Opportunity. Available online: https://www.brookings.edu/
blog/the-avenue/2014/10/23/cars-remain-king-and-barrier-to-economic-opportunity/ (accessed on 13 February 2021).
12.
King, D.A.; Smart, M.J.; Manville, M. The poverty of the carless: Toward universal auto access. J. Plan. Educ. Res.
2019
, 739456.
[CrossRef]
13.
Bliss, L. As the Planet Warms, Who Should Get to Drive? Available online: https://www.bloomberg.com/news/articles/2019-0
2-08/access-to-cars- could-help-the- poor-but- hurt-the-planet (accessed on 8 January 2021).
14.
Health Care Deserts: Nearly 80 Percent of Rural, U.S. Designated as ‘Medically Underserved’. Available online: https://khn.org/
morning-breakout/health-care-deserts-nearly-80-percent-of-rural-u-s-designated-as- medically-underserved/ (accessed on
4 February 2021).
15.
Rural Emergency Medical Services (EMS) and Trauma Introduction. Available online: https://www.ruralhealthinfo.org/topics/
emergency-medical-services (accessed on 4 February 2021).
16.
Syed, S.T.; Gerber, B.S.; Sharp, L.K. Traveling towards disease: Transportation barriers to health care access. J. Community Health
2013,38, 976–993. [CrossRef] [PubMed]
17.
Clifton, K.J. Mobility strategies and food shopping for low-income families: A case study. J. Plan. Educ. Res.
2004
,23, 402–413.
[CrossRef]
18.
Widener, M.J. Comparing measures of accessibility to urban supermarkets for transit and auto users. Prof. Geogr.
2017
,69,
362–371. [CrossRef]
19.
Fitzpatrick, K.; Ver Ploeg, M. On the Road to Food Security? Vehicle Ownership and Access to Food; Survey Research Center, Institute
for Social Research, University of Michigan: Ann Arbor, MI, USA, 2010; pp. 1–41.
20.
Bastiaanssen, J.; Johnson, D.; Luca, K. Does transport help people gain employment? A systematic review and meta-analysis of
the empirical evidence. Transp. Rev. 2020,40, 607–628. [CrossRef]
21.
Dawkins, C.; Jeon, J.S.; Pendall, R. Vehicle access and exposure to neighborhood poverty: Evidence from the Moving to
Opportunity Program. J. Reg. Sci. 2015,55, 687–707. [CrossRef]
22.
Jeon, J.S.; Dawkins, C.; Pendall, R. How vehicle access enables low-income households to ive in better neighborhoods. Hous.
Policy Debate 2018,28, 920–939. [CrossRef]
23.
Ralph, K.M. Childhood car access: Long-term consequences for education, employment, and earnings. J. Plan. Educ. Res.
2018
,
0739456X1879845. [CrossRef]
24.
Pendall, R.; Hayes, C.; George, A.; McDade, Z.; Dawkins, C.; Jeon, J.S.; Knaap, E.; Blumenberg, E.; Pierce, G.; Smart, M. Driving
to Opportunity: Understanding the Links among Transportation Access, Residential Outcomes, and Economic Opportunity for Housing
Voucher Recipients; The Urban Institute: Washington, DC, USA, 2014; pp. 1–75.
25. Baum, C.L. The effects of vehicle ownership on employment. J. Urban Econ. 2009,66, 151–163. [CrossRef]
26.
Blumenberg, E.; Pierce, G. Car Access and Long-Term Poverty Exposure: Evidence from the Moving to Opportunity (MTO)
Experiment. J. Transp. Geogr. 2017,65, 92–100. [CrossRef]
27.
Blumenberg, E.; Pierce, G. The Drive to Work: The Relationship between Transportation Access, Housing Assistance, and
Employment among Participants in the Welfare to Work Voucher Program. J. Plan. Educ. Res. 2017,37, 66–82. [CrossRef]

Sustainability 2021,13, 3924 17 of 18
28.
Smart, M.J.; Klein, N.J. Disentangling the role of cars and transit in employment and labor earnings. Transportation
2020
,47,
1275–1309. [CrossRef]
29.
Klein, N.J. Subsidizing car ownership for low-income individuals and households. J. Plan. Educ. Res.
2020
, 0739456X2095042.
[CrossRef]
30.
National Highway Traffic Safety Administration. 2018 Fatal Motor Vehicle Crashes: Overview; Traffic Safety Facts; NHTSA’s
National Center for Statistics and Analysis: Washington, DC, USA, 2019; pp. 1–10.
31.
Blincoe, L.J.; Miller, T.R.; Zaloshnja, E.; Lawrence, B.A. The Economic and Societal Impact of Motor Vehicle Crashes, 2010 (Revised);
National Highway Traffic Safety Administration: Washington, DC, USA, 2015; pp. 1–300.
32.
Centers for Disease Control and Prevention. Older Adult Drivers. Available online: https://www.cdc.gov/transportationsafety/
older_adult_drivers/index.html (accessed on 4 February 2021).
33.
Union of Concerned Scientists. Car Emissions & Global Warming. Available online: https://www.ucsusa.org/resources/car-
emissions-global-warming (accessed on 2 February 2020).
34.
Union of Concerned Scientists. Vehicles, Air Pollution & Human Health. Available online: https://www.ucsusa.org/resources/
vehicles-air-pollution-human-health (accessed on 2 February 2020).
35.
Vohra, K.; Vodonos, A.; Schwartz, J.; Marais, E.A.; Sulprizio, M.P.; Mickley, L.J. Global mortality from outdoor fine particle
pollution generated by fossil fuel combustion: Results from GEOS-Chem. Environ. Res. 2021,195, 110754. [CrossRef]
36.
Tessum, C.W.; Apte, J.S.; Goodkind, A.L.; Muller, N.Z.; Mullins, K.A.; Paolella, D.A.; Polasky, S.; Springer, N.P.; Thakrar, S.K.;
Marshall, J.D.; et al. Inequity in consumption of goods and services adds to racial–ethnic disparities in air pollution exposure.
Proc. Natl. Acad. Sci. USA 2019,116, 6001–6006. [CrossRef]
37.
Forouzanfar, M.H.; Afshin, A.; Alexander, L.T.; Anderson, H.R.; Bhutta, Z.A.; Biryukov, S.; Brauer, M.; Burnett, R.;
Cercy, K.
;
Charlson, F.J.; et al. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational,
and metabolic risks or clusters of risks, 1990–2015: A systematic analysis for the Global Burden of Disease Study 2015. Lancet
2016,388, 1659–1724. [CrossRef]
38.
Hofstätter, T.; Krawina, M.; Mühlreiter, B.; Pöhler, S.; Tschiesner, A. Reimagining the Auto Industry’s Future: It’s Now or
Never. Available online: https://www.mckinsey.com/industries/automotive-and-assembly/our-insights/reimagining-the-
auto-industrys-future-its-now-or-never (accessed on 11 January 2021).
39.
U.S. Bureau of Labor Statistics. Automotive Industry: Employment, Earnings, and Hours. Available online: https://www.bls.
gov/iag/tgs/iagauto.htm (accessed on 2 February 2020).
40.
Wagner, I.U.S. New and Used Car Sales 2019. Available online: https://www.statista.com/statistics/183713/value-of-us-
passenger-cas-sales-and-leases-since-1990/ (accessed on 2 February 2020).
41.
Muller, D. Carvana Sees Enormous Upside for Used-Car Market. Available online: https://www.autonews.com/used-cars/
carvana-sees-enormous-upside- used-car-market (accessed on 4 February 2021).
42.
Mbugua, S. Is Africa Becoming the World’s Dumping Ground for Dirty Diesel Vehicles? Available online: https://www.dw.com/
en/is-africa-becoming-the- worlds-dumping-ground-for-dirty-diesel-vehicles/a-44833036 (accessed on 1 February 2020).
43.
GM Financial. Available online: https://www.gmfinancial.com/en-us/financial-resources/articles.html (accessed on
26 February 2021
).
44.
The Insurance Institute for Highway Safety. Older Drivers. Available online: https://www.iihs.org/topics/older-drivers
(accessed on 5 February 2021).
45.
Making Roads Safer by Detecting Heart Health. Available online: https://pressroom.toyota.com/making-roads-safer-by-
detecting-driver-heart-anomalies/ (accessed on 26 February 2021).
46.
Centers for Disease Control and Prevention. Child Passenger Safety. Available online: https://www.cdc.gov/transportationsafety/
child_passenger_safety/cps-factsheet.html (accessed on 5 February 2021).
47.
Gunther, C.E.; Peddicord, V.; Kozlowski, J.; Li, Y.; Menture, D.; Fabius, R.; Frazee, S.G.; Nigro, P.J. Building a Culture of Health
and Well-Being at Merck. Popul. Health Manag. 2019,22, 449–456. [CrossRef]
48.
BMW Group. Available online: https://www.bmwgroup.com/en/company/bmw-group-news/artikel/health-at-bmw-group.
html (accessed on 26 February 2021).
49.
General Motors. Ventec Life Systems and GM Partner to Mass Produce Critical Care Ventilators in Response to COVID-19
Pandemic. Available online: https://media.gm.com/media/us/en/gm/news.detail.html/content/Pages/news/us/en/2020
/mar/0327-coronavirus-update-6-kokomo.html (accessed on 14 June 2020).
50.
Dasgupta, S. Ford Is Using Airbag Material to Make Reusable Hospital Gowns to Fight COVID-19. Available online:
https://auto.hindustantimes.com/auto/news/coronavirus-ford-is-using-airbag-material-to-make-reusable-hospital-gowns-
41586924049818.html (accessed on 14 June 2020).
51.
Road to Sustainability 2019. Available online: https://www.hyundai.com/content/hyundai/ww/data/csr/data/0000000030
/attach/english/hmc-2019-sustainability-report-v3-en.pdf (accessed on 26 February 2021).
52.
Harvard, T.H. Chan School of Public Health. How Health Organizations Can Help ‘Anchor’ Communities. Available on-
line: https://www.hsph.harvard.edu/news/features/how-health-organizations-can-help-anchor-communities/ (accessed on
5 February 2021).
53.
Byrd, J. National Association of Minority Automobile Dealers Celebrates 35 Years. Available online: https://michiganchronicle.
com/2015/02/11/national-association-of-minority- automobile-dealers-celebrates- 35-years/ (accessed on 27 January 2021).

Sustainability 2021,13, 3924 18 of 18
54.
Choma, E.F.; Evans, J.S.; Hammitt, J.K.; Gómez-Ibáñez, J.A.; Spengler, J.D. Assessing the health impacts of electric vehicles
through air pollution in the United States. Environ. Int. 2020,144, 106015. [CrossRef] [PubMed]
55.
Oak Ridge National Laboratory; U.S. Environmental Protection Agency. Federal Tax Credits for Electric and Plug-in Hybrid Cars.
Available online: https://www.fueleconomy.gov/feg/taxevb.shtml (accessed on 2 February 2021).
56.
General Motors. General Motors, the Largest U.S. Automaker, Plans to Be Carbon Neutral by 2040. Available online: https:
//media.gm.com/media/us/en/gm/home.detail.html/content/Pages/news/us/en/2021/jan/0128-carbon.html (accessed on
2 February 2021).
57.
The Greenlining Institute. Electric Vehicles for All: An Equity Toolkit. Available online: https://greenlining.org/resources/
electric-vehicles-for-all/ (accessed on 8 February 2021).
58. Warren, G.; Thomas, R. Crucibles of Leadership. Harv. Bus. Rev. 2002,80, 39–124.
59.
Deloitte. Accelerated Transformation of Automotive Business CSR and Brand Strategies. Available online: https://www2.deloitte.
com/cn/en/pages/consumer-business/articles/consumer-ncp- auto-csr-brand-strategy.html (accessed on 27 March 2021).
60.
Parvini, S. Breathing Uneasy: Living Along the 710 Freeway Corridor. Available online: https://www.kcet.org/shows/
departures/breathing-uneasy-living- along-the-710-freeway-corridor (accessed on 2 February 2020).
61.
Semuels, A. The Role of Highways in American Poverty. Available online: https://www.theatlantic.com/business/archive/2016
/03/role-of-highways-in-american-poverty/474282/ (accessed on 8 February 2021).
62.
Automakers Drop Efforts to Derail California Climate Rules. Available online: https://www.nytimes.com/2021/02/02/climate/
automakers-climate-change.html (accessed on 26 February 2021).
63.
Hannon, E.; McKerracher, C.; Orlandi, I.; Kamkumar, S. An Integrated Perspective on the Future of Mobility.
Available online
:
https://www.mckinsey.com/business-functions/sustainability/our-insights/an-integrated-perspective-on-the- future-of-
mobility (accessed on 11 February 2021).
64.
World Economic Forum, Strategic Intelligence, Future of Mobility. Available online: https://intelligence.weforum.org/topics/a1
Gb00000038poVEAQ?tab=publications (accessed on 26 February 2021).