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Correspondence to Michael Zoorob, Department of Government, Harvard University, Cambridge, MA 02138, Massachusetts, USA; [email protected]
Key messages
What is already known about this subject?
Previous scholarship indicates that unions in the USA provide numerous workplace hazards protections through collective bargaining with employers, such as shift restrictions and safety equipment provision, along with other benefits to health such as medical insurance.
What are the new findings?
The paper demonstrates that the protective effect of unions on workplace safety at the micro level translates into large scale reductions in occupational fatalities.
I find that diminished union membership due to ‘right to work’ legislation has led to a 14.2% increase in workplace mortality.
How might this impact on policy or clinical practice in the foreseeable future?
In light of these findings, policymakers should consider the potential effects of declining unionisation and anti-union legislation on occupational health.
Introduction
Though workplace fatalities have declined substantially since the 1990s in the USA, improvement has stalled in recent years. In 2016, 5190 US workers died on the job, marking the third consecutive year of increasing occupational mortality, and reaching the highest number of workplace fatalities since 2008.1 This reversal has coincided with a recent uptick in the adoption of anti-union legislation by state legislatures. Since 2000, seven states—Oklahoma (2001), Michigan (2012), Indiana (2012), Wisconsin (2015), West Virginia (2016), Kentucky (2017) and Missouri (2017)—have enacted ‘right to work’ (RTW) laws, which prohibit contracts requiring union membership as a condition of employment. In total, 28 states have adopted RTW legislation (with 21 states doing so before 2000), while many other states are considering its adoption.2
Some scholars have argued that unions form an important part of the ‘social machinery’ that ensures public health, so their recent decline may be concerning.3 4 I analyse the effect of unionisation rates on occupational mortality, an important, if sometimes overlooked, topic in public health.5 To gain leverage on this question, I exploit variation within states over time in their union density and occupational mortality. Specifically, I use econometric two-ways ‘fixed effects’ regression modelling to account for pre-existing differences between states and trends common to all states. I successively control for two plausible time-varying confounds—a state’s general predisposition for economically regulatory policies and the...