Abstract
There are three main areas of social and economic policy that influence health: the welfare state, industrial organization (unions), and labor regulation. Public health literature and analysis traditionally focuses on the taxing and spending of the welfare state. This paper presents highlights from the extensive literature in political economy in order to argue that industrial relations and workplace regulation are political and crucial to public health. The routes by which they influence public health include wage inequality, workplace health and safety, political engagement and investment in human capital. The magnitude of impact can be impressive: the United Kingdom’s taxation and spending have about as much redistributive impact as that of Sweden, but that is not enough to compensate for the inequality produced by the UK’s liberal labor market. The trend across wealthy countries has been to weaker unions and less workplace regulation and we can see this as a likely cause of public health problems and health inequalities into the future.
Highlights
36 European Journal of Public HealthRacial and other equalities, the track record of all three kinds of labour market is less clear
Few who are familiar with public health scholarship will dispute the benefits to individual and public health of a strong economy, high-quality and regular employment, an egalitarian and generous welfare state and an egalitarian economic system
An article that starts out by identifying very big structural drivers of inequality will often divert into much less ambitious policies. The attractiveness of such a move stems in part from the high political stakes—to recommend what is good for public health is often to recommend what social democrats and parties of the left support
Summary
Racial and other equalities, the track record of all three kinds of labour market is less clear. Unions have often had a strong masculine bias and were an integral part of welfare systems built around male breadwinners. They often had a role in closing occupations or whole parts of the economy to nonwhites, women or ethnic minorities. This partly accounts for the relatively high employment rates for those groups in decentralized liberal economies. In some coordinated labour markets, unions and employers have seen a shared interest in greater equality. It is hard not to suspect that such a politics leads to the declining political trust and populist politics we see in many countries today
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