Labor Unions: A Public Health Institution

Abstract

Using a social-ecological framework, we drew on a targeted literature review and historical and contemporary cases from the US labor movement to illustrate how unions address physical and psychosocial conditions of work and the underlying inequalities and social determinants of health. We reviewed labor involvement in tobacco cessation, hypertension control, and asthma, limiting articles to those in English published in peer-reviewed public health or medical journals from 1970 to 2013. More rigorous research is needed on potential pathways from union membership to health outcomes and the facilitators of and barriers to union-public health collaboration. Despite occasional challenges, public health professionals should increase their efforts to engage with unions as critical partners.

Same‐level fall injuries in US workplaces by age group, gender, and industry

“…Differences in injury incidence could also reflect the distribution and effectiveness of safety programs and practices in a given industrial sector. Sectors might value and practice safety differently, on average, if targeted regulatory enforcement, differential insurance premiums, safety climate, average establishment size, or labor union involvement in occupational safety are strong enough incentives to influence sector‐wide safety practices. It is possible that industries, including manufacturing, with a history of readily apparent hazards likely to cause premature death have, over time, developed hazard mitigation strategies that include same‐level fall prevention.…”

Respectable Gentlemen and Street-Savvy Men: HIV Vulnerability in Sri Lanka

“…Two workers said they had friends employed at pharmacies who provided information about what condoms to buy. Malinowski et al (2015) have analyzed labor unions as a public health institution and explored the role of unions in initiating public health policies. In the same vein, several scholars have noted how the decline of unions is a threat to public health (Wright 2016).…”

Solidarity and disparity: Declining labor union density and changing racial and educational mortality inequities in the United States

“…One such structural factor—declining labor union density—has precipitated burgeoning income inequity . Unionism's disproportionate decline among racialized, less‐educated, and blue‐collar workers, and the well‐documented relationship between unions and wages, benefits, occupational safety, and protective policies suggests a connection with growing mortality inequities . Thus, in this state‐level study, we analyzed union density's relationship with all‐cause mortality and overdose/suicide mortality, and tested whether declining union density has exacerbated racial and educational mortality inequities.…”

“…Unions may also protect health and reduce health inequities. At the workplace level, by regulating the balance of power between workers and management, unionization may reduce exposure to material deprivation (eg, inadequate wage and nonwage benefits, including access to health insurance and drug treatment), occupational hazards (eg, toxic chemicals), and stressors (eg, job instability or a lack of job autonomy), which can cause chronic disease and occupational injury, as well as mental illness, drug use, and their sequelae, like suicide and fatal overdose . For example, Hagedorn et al found that collectively bargained, legally binding union contracts tend to contain provisions promoting workers’ income, benefits, working‐time arrangements, safety, and decision‐making power .…”

“…The workplace‐level health benefits of unionization may be stronger for less‐educated, racialized, and otherwise marginalized workers, a finding demonstrated for economic outcomes like the union wage premium . Similarly, at the societal level, by regulating the balance of power between the working class and owning class, unionism may improve working‐class health by advancing economy‐wide compensation norms, labor rights, and progressive social protections and public‐health programs, reducing material deprivation and psychosocial stressors throughout the working class, union membership aside . For example, Feigenbaum et al found that state‐level right to work laws, which can weaken unions by allowing workers in unionized businesses to opt out of paying union dues, reduce state‐level policy progressivism, such as the strength of redistributive social programs.…”