© 2009 American Public Health Association DOI: 10.2105/AJPH.2008.149120
Michael Quinlan is with the School of Organization and Management, University of New South Wales, Sydney, Australia, and the Faculty of Health Sciences, University of Sydney, Sydney, Australia. Rosemary K. Sokas is with Environmental and Occupational Health Sciences, Chicago School of Public Health, University of Illinois, Chicago. Correspondence: Correspondence should be sent to Rosemary K. Sokas, MD, MOH, Division of Environmental and Occupational Health Sciences, University of Illinois at Chicago School of Public Health, 2121 West Taylor Street M/C922, Chicago, IL 60612 (e-mail: sokas{at}uic.edu). Reprints can be ordered at http://www.ajph.org by clicking on the "Reprints/Eprints" link.
The growth of contingent work (also known as precarious employment), the informal sector, and business practices that diffuse employer responsibility for worker health and safety (such as outsourcing and the development of extended national and international contracting networks [supply chains]) pose a serious threat to occupational health and safety that disproportionately affects low-wage, ethnic minority, and immigrant workers. Drawing on cases from the United States and Australia, we examine the role that community-based campaigns can play in meeting these challenges, including several successful campaigns that incorporate supply chain regulation.
THE 40 YEARS AFTER 1880 was a period of significant social reform that saw the rise of organized labor and the launch of broad community campaigns to improve living and working conditions, recognize unions, enhance the political voice of workers and women, and provide legislative protections (for example, anti-sweating leagues were established to oppose the gross exploitation of workers). This period also witnessed media exposés of inhumane working conditions and public outrage at incidents like the 1911 Triangle Shirt Waist fire, a New York factory fire that killed 146 women and girls working under sweatshop conditions; exit doors had been locked to prevent thefts. This early period of social reform was pivotal to the introduction of protective legislation providing minimum labor standards, occupational health and safety, and workers' compensation laws in Western Europe, North America, and Australasia. Almost a century later, however, as documented in recent reports prepared for the World Health Organization,1 many of these protections have failed. The implementation of neoliberal policies like downsizing, outsourcing, and privatization, and of altered business practices, such as global supply chains and lean production practices that cut labor and other costs, have resulted in the growth of job insecurity and precarious work arrangements that have had serious adverse impacts on occupational health and have produced health inequalities more generally.2–6 These policies and practices have also served to erode the social protection framework built up during most of the 20th century—an erosion process compounded by the decline of organized labor and changes to industrial relations and social security laws. A comparative overview of the interconnected historical changes just described is provided in Table 1.
The recent trends are neither inevitable nor irreversible. Just as occurred in the period from 1880 to 1920, new community alliances and campaigns have emerged to combat the occupational health and safety problems and outright exploitation and abuses that have flowed from ideologically driven neoliberal policies. There is also evidence that some of these campaigns have influenced governments to secure new forms of regulation to protect workers. In this article, we share the results of several worker and community action campaigns ranging from fundamental aspects of information sharing and worker association to examples of voluntary supply chain monitoring to actual supply chain regulation.
Work arrangements and related business strategies have undergone profound changes over the past 25 years. Outsourcing and the use of complex, multitiered national and international contracting networks to provide goods and services—networks that are now commonly referred to as supply chains—have become widespread. This and other business practices (such as downsizing and franchising) have been associated with increased use of flexible or contingent work arrangements. Contingent work (also known as precarious employment) covers a wide spectrum of working arrangements, such as temporary help, employee leasing, self-employment, contracting out, day labor, and home-based work. A substantial body of international research now links these working arrangements to poorer indexes of worker health, safety, and well-being.7,8 From a regulatory and public policy perspective, there is evidence that these work arrangements diffuse employer responsibility. At worst, they become undeclared or informal work that is completely outside formal government oversight.3 Disorganization and economic pressures on workers associated with contingent work also negatively impact record-keeping of occupational illness and injury. With the exception of acute traumatic fatalities, surveillance information in the United States systematically undercounts both occupational injuries and illnesses for all workers. Such undercounting is even more of a problem for workers in the informal sector, which limits the ability of information to inform public health interventions and further reduces the supports available to injured workers, who are often excluded from compensation benefits.9–13 Safety and health systems are broken at every level, from inadequate surveillance to absent targeting or enforcement to uninformed employers, many of whom are small contractors who sustain excess mortality themselves. These changes are occurring in the context of other workforce changes that are the result of aging population structures in developed (and some developing) countries and increasing within-country and between-country labor migration. Although mass, global movements of workers are not new, the latest (post 1980) phase can be differentiated from earlier waves in terms of absolute numbers and the number of countries involved. The number of persons who reside outside their country of birth or citizenship now increases annually at a rate that exceeds the increase in the world's population; as of 2005, there were 191 million immigrants worldwide with 60% living in developed countries and 20% in the United States.14 Most importantly, the current wave entails significant numbers of undocumented or illegal immigrants, many of whom are fleeing poverty in their home country, as well as documented temporary foreign workers. Concentrated in contingent jobs, the latter arguably represent a new international contingent workforce because they have no rights to permanent residency.15 Adverse health effects directly attributable to migration include infectious diseases caused by unaccustomed exposures and living conditions, diseases caused by social disruption, and diseases that result from neglect. Workers who have language difficulties may not understand instructions or safety training, may face overt discrimination, or may be marginalized into exploitative working arrangements. Migrant workers who lack documentation or guest workers are less likely to seek or be afforded regulatory protection. Vulnerabilities arising from migrant status are compounded by the concentration of migrant workers in contingent and unsafe working arrangements.15,16 The number of fatal occupational injuries to foreign-born workers in the United States has risen significantly since 1995, as have numbers of immigrants and rates of fatalities.17,18 Foreign-born Hispanic workers experienced a fatal occupational injury rate of 6.1 per 100 000 from 1996 through 2000, compared with rates for US-born Hispanic workers (4.5 per 100 000) and all US workers (4.6 per 100 000) that were one third less.
In Australia, as in several other countries, a range of community groups and organizations campaigned over worker health in the 1970s, including worker health action groups, workers' health centers (several still extant), women's community health centers, and migrant worker organizations and community groups. In the 1980s and 1990s, several other bodies emerged. Bereaved parents of young persons killed in workplaces founded organizations such as Advocates of Workplace Safety established by Fran Kavanagh, which mirrored similar bodies established in other countries, like Safe Communities Canada founded by Paul Kells.19 These organizations put pressure on governments by highlighting the human toll and impact of injury and death. Industry-specific bodies also emerged. For example, an alliance between Australian asbestos sufferers' groups (led by Bernie Banton) and unions ultimately thwarted efforts by the manufacturer, James Hardie, to minimize its liability to compensate victims of asbestos exposure by moving its headquarters offshore and using an underfunded scheme.20,21 Two cases highlight the influence community-based movements can exert in protecting vulnerable workers.
Home-Based Clothing Work These steps enabled a bargaining down of the price and evaded regulatory requirements with regard to pay (as little as a quarter of wages of factory-based workers), hours, occupational health and safety, and workers' compensation. By the 1990s it was estimated that there were up to 300 000 home-based clothing workers in Australia, predominantly recently arrived immigrants from Southeast Asia, including children. Gross exploitation of outworkers (home-based workers) drew attention from the Textile, Clothing, and Footwear Union (even though most of the outworkers were not unionized); churches (especially the Uniting Church); and a number of migrant bodies (like Asian Women at Work). As in Europe, a Fairwear campaign titled Behind the Label was launched that targeted major fashion houses that were using subcontracting arrangements. The campaign entailed consumer boycotts and publicity to pressure firms to sign an ethical code with the union along with lobbying state governments to amend employment laws to protect outworkers. The campaign was aided by a study funded by the National Occupational Health and Safety Commission4 that found that the home-based clothing workers experienced 3 times the number of injuries of their factory-based counterparts as well as a serious level of occupational violence at the hands of "middlemen." The study, which community groups widely publicized, found that this difference was associated with the low pay, piecework-based pay system, and resulting long hours and work intensity of home-based work. The combined community, industrial, and political campaign—and a sympathetic minister for industrial relations—resulted in legislative reforms under the rubric of the Industrial Relations (Ethical Clothing Trades) Act22 of 2001 in the state of New South Wales with matching changes to occupational health and safety and workers' compensation laws. Deeming all clothing outworkers to be employees, the legislation, including a code mandating the responsibilities of middlemen, manufacturers, and retailers; integrated minimum labor standards including wages and hours; occupational health and safety; and workers' compensation. In so doing, the legislation breached the historical separation of industrial relations, occupational health and safety, and workers' compensation laws that had existed within most developed countries for 150 years.23 Because low pay encouraged excessive hours and other hazardous practices, it was recognized that only by addressing the wages and hours of clothing outworkers could occupational health and safety protection and worker access to occupational health and safety and workers' compensation entitlements be ensured. To combat evasion via the elaborate subcontracting chain, the law focused on all commercial arrangements, not simply the one that immediately engaged workers. Contractual tracking mechanisms required transparency (the notification of and details pertaining to contracts) within the supply chain up to the very top. Thus, retailers and fashion houses had to identify and take responsibility for the parties they engaged and for the subsequent subletting of work by these parties. The law included a rebuttable presumption so that if wages were not paid by a subcontractor, this obligation would be met by the principal contractor. Further, information relating to contracts and the parties involved had to be supplied to the union, which developed tracking mechanisms to document payments and conditions at various stages. By covering every step of the subcontracting process and applying primary regulatory responsibility to those at the top of the supply chain (i.e., the retailers), the law prevented outsourcing from being used as a method of regulatory evasion. This approach provides a model for international regulation of labor standards because it focuses on commercial contracts that, unlike International Labour Organisation standards, are enforceable both in law and because of the economic power exercised by those at the pinnacle of supply chains over their subcontractors.24 The model has now been adopted by other Australian jurisdictions, including the Australian Capital Territory (which also has supply chain provisions in its industrial manslaughter legislation) and South Australia (which introduced a potentially generic regulatory protection for outworkers). Community mobilization also ensured protections that were not undermined by anti-union changes to federal industrial relations and independent contractor laws in 2004 and 2005.
Long-Haul Truck-Drivers During the late 1990s, the Australian Transport Workers Union campaigned to raise community awareness about the occupational health and safety and public safety hazards resulting from intense competition, subcontracting, and the erosion of freight and pay rates in the industry. It drew support from a community organization (Concerned Families of Australian Truckies, or CFAT) and from organizations of owners and drivers, albeit with some tensions. The campaign also targeted the New South Wales government agency responsible for vehicle crash insurance, the Motor Accidents Authority; insurers; and motorist organizations who were concerned at the mounting cost and human toll of truck-related incidents, including other road users. As in the clothing industry, the union made astute use of community and interest group disquiet and its networks within the Labor Party to pressure government. In 2000 it successfully lobbied for a wide-ranging government inquiry into trucking safety that found that pressure exerted by shippers (clients) on transport operators and the consequent use of elaborate subcontracting chains to cut costs, especially driver pay, led to poor safety outcomes for both drivers and other road users.25 This finding was reinforced by evidence from a US trucking expert, Michael Belzer, linking low pay and trip-based payment to poor safety outcomes.24 The inquiry report (2001) recommended integrated labor standards, replacement of log books with a safe driving plan signed by all key parties to a contract, and the introduction of supply chain regulation under occupational health and safety legislation (Australian occupational health and safety laws already contained general duties on suppliers as well as employers).25 In 2005 the New South Wales government introduced the Occupational Health and Safety Amendment (Long Distance Truck Driver Fatigue) Regulation, which imposed requirements on both trucking operators and those further up the supply chain, including freight brokers and clients or shippers. Thus, major transport firms had to monitor the fatigue regimens of the subcontractors they engaged and clients had to ensure that the road transport firms or owners and drivers they engaged had systems in place and were managing fatigue, including monitoring the hours of drivers arriving at warehouses or distribution centers. In sum, subcontracting could not be used to evade compliance with fatigue regulations. Because more than 80% of interstate trucking passed through New South Wales, this regulation had nationwide implications. The state's occupational health and safety agency, with a specialist enforcement team, was able to secure significant changes to fatigue management among operators and those using them. The union also mounted a simultaneous industrial, community, and political campaign to address outstanding issues, notably a claim to set a minimum safety rate for truck drivers through a remuneration level that would remove the incentive for cost cutting on maintenance, overloading, or unsafe driving behavior like speeding or excessive hours. The aim here was to set a labor cost floor that would discourage freight rates that could be met only by compromising safety. In 2008, following the 2007 election of a federal Labor government, the union secured a National Transport Commission review to evaluate the evidence linking remuneration levels and systems (such as trip-based payment) and safety and, if justified, recommend a legal framework to establish safety rates for both employee and owners and drivers of heavy vehicles. Drawing on Australian and US evidence, the review found that pay and safety were linked and recommended a regulatory regimen to set minimum rates. By 2009, the federal government was considering ways of implementing this regimen. At the global level, an alliance of the Transport Workers Union, Teamsters, and the British Transport and General Workers Union secured the endorsement of chain of responsibility by the International Transport Federation.
In the United States, examples addressing supply chain regulation have focused largely on wage and hour considerations (not without health implications), although community mobilization has been an important factor for both wage and hour and occupational safety and health concerns.29–31 In the garment industry, the Workers Rights Consortium, an independent labor rights monitoring organization, has set up a Designated Suppliers Program for establishing and enforcing university codes of conduct in purchasing apparel and textiles containing university logos. Driven by labor and activist membership, the consortium now includes over 183 affiliated colleges and universities that have agreed to specific purchasing practices to regulate source factories, including transparency and living wage provisions that are outlined in the Code of Conduct.32–34 As in Australia, this campaign includes community groups, including university students, and a union (UNITE, formerly the Union of Needletrades, Industrial and Textile Employees, now merged with the Hotel Employees and Restaurant Employees International Union to form UNITE HERE). The coalitions put pressure on large retailers and others, especially universities, to reduce the exploitation of workers producing these goods. Like its Australian counterpart, the union has also been active in monitoring contractors to counter—with some success—evasion of minimum wage laws.35 In the late 1990s, a regulatory provision of the Fair Labor Standards Act was used by the US Department of Labor to develop performance-based enforcement agreements that set agreed upon compliance targets with the garment industry. These agreements used the blunt instrument of an embargo of goods not meeting wage standards to motivate manufacturers to enhance monitoring. This suggests a legal base for supply chain regulation in the United States to protect the health, safety, and well-being of outsourced workers.30 Similarly, in US trucking, there is a growing recognition among unions and academic researchers of the need to deal with supply chain issues. Researchers and driver representatives have called for a "chain of responsibility" in safety legislation.26,27 At the same time, the Teamsters (Clean Trucks Campaign) have combined with environmentalists and immigrant groups (the Coalition for Clean and Safe Ports) in a campaign for basic environmental, labor, and national security standards in relation to trucks using port facilities in Los Angeles and Long Beach, California. The agreed on reduction in diesel emissions from trucks will not only involve government-subsidized retrofitting of vehicles but also the conversion of numerous owners and drivers currently being used to employee-drivers operating in a more regulated fashion, both institutionally and legally.35 In effect, this would address the supply chain issue, and the Teamsters Union hopes to extend this to other ports. This case demonstrates that a community campaign that uses the leverage of concerns about health and security can oblige government and its agencies, in this case Harbor Commissions, to act. In the United States, support for the legislative, judicial, and political framework lags behind that in Australia, although the importance of community participation has been recognized by unions, researchers, and some policymakers as essential to the development of effective public health interventions broadly and has been integrated into several research activities.36 Community and worker participation in health and safety research projects has driven the development of more accurate research into exposure–disease etiologic relations by providing access to information that is difficult to obtain without the robust cooperation of study participants. Furthermore, because of the urgent need for change felt by affected community members and workers, their active participation intrinsically requires researchers to integrate intervention effectiveness into the research enterprise.37 As the Australian examples demonstrate, worker and community access to information is critical to effective supply chain regulation. However, there is also a need to recognize the complex challenges posed by a combination of contingent work, including a growing global contingent workforce, and hazardous substance exposures. Two areas where community mobilizations to protect vulnerable workers in the United States may specifically set the stage for supply chain regulation include the implementation of community and worker right-to-know legislation and regulation, and the emergence of worker centers addressing the needs of the informal work sector. Both these movements have been based in the active engagement and empowerment of affected individuals through community action.
Community and Worker Right to Know Utilization was initially promoted by federally funded worker training projects based on popular education methods that engage and empower adult learners.38 Primarily union-based, these programs demonstrated that active participation in problem identification and problem solving produced measurable improvements in hazard recognition and reduction and, in some instances, in reduced injury outcomes, as documented in a series of peer-reviewed studies.39–44 These studies addressed the impact of training on unionized workers who typically enjoy enhanced job security and coworker support. The activism of family survivors of workplace fatalities has continued to spur increased attention to the quality and completeness of workplace hazard communication specifically and the ineffectiveness of federal agencies in investigating and ultimately preventing workplace deaths generally.45,46
US Attempts to Regulate Multiemployer Worksites Similar to these attempts to clarify responsibility for hazard communication training for all workers on a worksite in general industry, the Occupational Safety and Health Administration developed guidance to address the safety and health needs of employees working on multiemployer worksites in construction. Although the use of subcontractors on construction sites involves smaller entities and has a much longer history than does the use of extensive supply chains in industries other than trucking, it typically entails a complex network of multitiered subcontracting that can fragment and obscure clear responsibility for the implementation of safety procedures at a given worksite. Multitiered subcontracting in construction and elsewhere has proved problematic in many countries, even countries such as Australia and Great Britain, where wide-ranging general duty provisions in occupational health and safety legislation and associated regulations explicitly impose legal responsibilities on all the parties involved and court rulings make it clear that responsibilities for occupational health and safety cannot be outsourced.48 In the United States, a series of letters of interpretation of the standard to enforce construction safety and health regulations on large multiemployer construction sites attempted to introduce some aspects of Great Britain's Construction Design and Management program.49 However, because the term "subcontractor" does not appear in the Occupational Safety and Health Act, the construction-related interpretations of the standard developed under the act were overturned by the Occupational Safety and Health Review Commission on April 27, 2007, a decision that, in the words of a dissenting commissioner, "reversed over 30 years of Commission precedent."50 This interpretation has not yet affected hazard communications enforcement, but it was challenged in a series of court cases and has now been remanded for revision. The initial Review Commission decision nevertheless raised grave concerns about the already difficult status of subcontracted workers, not to mention those in the informal sector, and shows both the fragility of current workplace enforcement efforts and the vigilance required to maintain them.
Worker Centers On the whole, the workers accessing these centers are very much focused on their own ability to generate income and on issues of discrimination, wage fraud, fairness, justice, and related issues. The worker centers focus on action-oriented or intervention responses. The centers identify worker strengths, build a community of support, assist in accessing governmental agencies, and use empowerment educational models. As such, the centers may substitute in part for the more formally organized worker representation or the management engagement seen in successful safety and health training interventions. At the least, the centers may help workers negotiate the absence of appropriate workplace supports. The approach generally used by these centers appears to include developing interventions at multiple levels from intrapersonal skill-building to interpersonal leadership training to direct action at the workplace level to community and organizational engagement to policy changes.56 In a related approach, implemented in California by the Maintenance Cooperation Trust Fund, worker-investigators identified labor abuses in large retail chains that contracted with janitorial services that failed to comply with labor laws and then developed legal cases against the janitorial services, winning over $26 million in back pay for these workers over a 3-year period. Businesses that comply with the law have an interest in leveling the playing field with competitors who undercut them by failing to pay minimum wage or otherwise avoiding legal responsibility. These honest business organizations have added their support, as have labor unions. A recent California labor commissioner ruling also held a large contracting entity responsible for a violation by a subcontractor, enforcing a supply chain approach.57 As with clothing outworkers in Australia, worker centers have the potential to build the networks and broader community support essential to pressure government and their agencies.
The community mobilizations over occupational health that we have described are by no means exhaustive but illustrate some key points. First, the cases illustrate that community mobilizations to improve worker and public health can be a potent force for addressing the serious challenges to health we initially identified. Second, as demonstrated by the clothing worker and trucking examples, such campaigns take time to build momentum but can gain leverage by exploiting divisions within an industry, whether between retailers and manufacturers, between employers and insurers, between large and small operators, or between different elements of government. Third, as illustrated by the campaign on the West Coast docks, community, industrial, and political campaigns are not alternatives but are synergistic. Fourth, the initiatives recognize a need to bridge the historically distinct realms of industrial relations, occupational health and safety, and workers' compensation laws. Fifth, we believe that the globalization of labor requires that successes and lessons learned need to be transmitted internationally. The policy challenges are global even if countries may need to shape responses to their own context, and some remedies require global action. The cases discussed illustrate a broader pattern of community opposition to the impact of neoliberal policies on vulnerable workers. Evidence of parallel challenges can be found in Europe1 and in developing countries like Brazil where informal workers have sought to organize with the help of community groups and there have also been regional mobilizations to secure basic access to workers' compensation and income support.1 History also provides important lessons about the capacity of substantial social reforms to grow from apparently small changes won from community agitation. In 1896 the (then) Australian colony of Victoria responded to antisweating campaigns by introducing minimum wages for 6 vulnerable occupations, including female clothing workers. Within 15 years, minimum wage provisions applied to the vast bulk of the workforce throughout Australia and New Zealand, thus serving as a model for developments in other countries. A similar scenario is possible regarding developments like supply chain regulation, especially because alternative remedies, such as corporate social responsibility, show no sign of securing the coverage or impact to address these problems.1 Without integration of employment standards and regulation of contractual arrangements, supply chains will remain a conduit for expanding contingent work and resultant poorer health outcomes.
Approval was not required because the writing of this article did not involve human research participants.
Peer Reviewed M. Quinlan contributed examples from Australia and R. K. Sokas contributed examples from the United States. Both authors contributed to the overall content and conclusions. Accepted for publication October 16, 2008.
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