Belonging to a union is good for your health DENNIS RAPHAEL AND JESSICA MULLER Dr. Dennis Raphael is a professor of health policy and management at York University. Jessica Muller is an MA student in the graduate program of health policy and equity at York University. Living and working conditions are the primary factors that shape whether individuals stay healthy or become ill; they are much more important than biological markers or behavioural choices. This truism applies to just about every physical, mental or social affliction that one may encounter. The term social determinants of health (SDOH) has come to stand for these living and working conditions that include income, housing, food security, unemployment, job security and working conditions, as well as thehealth care system and the social safety net, among others. The health care, public health and civil society sectors all accept this conclusion. Yet even amongst those who have come to accept the concept and work to see it implemented through public policy action, there is a significant blind spot that requires attention: the roles unionization and collective agreements play in shaping the quality and equitable distribution of health outcomes. This is surprising as unionization and working under collective agreements influence many societal health factors, such as income through wages and benefits, job security and working conditions. At a societal level, income inequality is a decisive predictor of our collective health, be it physical, mental, or social, which is why unionization and collective agreements have important impacts upon health. We have brought together clear evidence that greater unionization in wealthy nations of the Organisation for Economic Cooperation and Development (OECD) is related to lower poverty rates, fewer low-waged workers, less income inequality and lower rates of infant mortality and low birthweight. Canada’s unionization rates are amongst the lowest of many wealthy nations, with just 31 per cent of workers belonging to unions, most of them in the public sector. By contrast, unionization rates are 65 per cent in Finland,
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67 per cent in Denmark and 67 per cent in Sweden. And in these nations, union agreements are extended to those who may not be unionized, so that collective employment agreements cover 89 per cent of workers in Finland, 84 per cent in Denmark and 90 per cent in Sweden. In Canada, this extension of agreements simply does not occur. Canada’s poverty rates and income inequality rates are above the OECD average, and its infant mortality and low birthweight rates are also above the OECD average. In Canada, belonging to a union is related to higher wages, better benefits and greater job security, all of which also have a positive influence on health. Union members are paid more per hour than nonunion members, with women and youth seeing the biggest differential. Unionization brings more bargaining power, which allows for higher wages. Higher income offers greater access to housing, food security and quality childcare. Health benefits are more likely in unionized workplaces, with benefits such as pension plans, dental care, vision care, sick pay and disability insurance commonly offered to union members. Unions push toward better health by creating a standard of higher wages and benefits for not only unionized workers but the broader public. By bringing up lower wages, unions reduce levels of income inequality and poverty. Health benefits also allow for greater access to drug and dental plans, employment training and mental health services. For those concerned with promoting health and reducing illness, a focus on making it easier to unionize a workplace seems a pressing issue. Yet, despite these benefits for the average Canadian, Canada’s labour movement has weakened in the past 40 years, with rates of union membership declining from 38 per cent in 1981 to 31 per cent in 2020. Several factors contributed to this decline. Reduced union membership is in part a result of Canada’s response to globalization, which allows companies to easily move abroad in response to labour disputes with unions. CONT’D ON PAGE 14
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