Labor union involvement in occupational safety and health, 1957-1987

Right-to-know policies and related market-oriented occupational health policies require an institutionalized means through which workers can interpret and act on information about quality differences among jobs. In principle, labor unions could play this role. However, union coverage has been declining since the 1950s, and the decline has accelerated in recent years. This paper documents the growth in occupational health and safety activities in unionized workplaces from 1957 to 1987 and the decline in union representation in hazardous workplaces from 1971 to 1986. It also analyzes the relationship between right-to-know and right-to-refuse-hazardous-work guarantees under industrial relations and occupational health law.     

Immigrant workers: health, law, and public policy

Immigrant workers are a large segment of the lower echelon of the U.S. labor force, and as many as 3.6 to 6 million of these workers and their families are living in the U.S. illegally. This paper examines who the recent immigrants are: explains why their current situation in the U.S. is an important public health matter; discusses the ethical and policy issues stemming from their health needs and from illegal status; and concludes with a brief look at some implications of the Simpson-Mazzoli Immigration and Reform Act, currently before Congress. The paper suggests that the illegal status of undocumented workers intensifies their health risks; that the immigrants' responsibility for budget short-falls in public services is not as clearcut as frequently assumed; and that legislation aimed at regulating the status of immigrant workers in the U.S. is unlikely to solve many of the central problems.     

The political and economic context of mental health care in the United States

Since the mid-1970s, the mental health treatment system in the U.S. has faced budgetary famine. This is in stark contrast to the growing cornucopia of fiscal resources enjoyed by the overall health care system. This paper explores the complex reasons for this disproportionate allocation in health spending. On the one hand, mental health may suffer from the perception that its diagnoses are largely "subjective" and its treatments do not fit the traditional "medical model" that can be defined precisely and paid for by third-party insurers. But more importantly, the death of mental health resources can be attributed to the peculiar nature and characteristics inherent in American politics. This paper describes the American political environment, from both a historical and a contemporary perspective, to give some insight into the development of policies affecting the mental health system in the U.S. Given the current climate of fiscal conservatism in this country toward any increases in social spending, it is likely that the profound mismatch in need and spending for mental health programs will continue indefinitely.     

Challenging custom: rethinking national population surveillance policy in a global public health age

This article examines the current state of disease surveillance and reporting in the United States and seeks to answer two central questions: first, whether the increasing emphasis on the global importance of public health policies compels a fundamental reexamination of the long-standing deferential approach to state power where matters of population health surveillance are concerned and, second, how the nation's long-standing deferential legal customs might be modified to address the growing emphasis on global public health policy that is undergirded by technological advances. We examine the International Health Regulations, or IHR (2005), and suggest that these regulations offer a powerful impetus for reevaluating U.S. legal custom concerning the policy and practice of population health surveillance, not only as a matter of U.S. law but also as a core dimension of U.S. legal obligations to other nations, as embodied in international agreements and treaties. We find that if the political will exists to change the domestic disease surveillance and reporting system, the federal government has the power to act. Questions remain, however, about whether the public health and legislative communities are willing to challenge current customs or even if they desire to do so.     

Technological, economic, and political feasibility in OSHA's Air Contaminants Standard

In 1989, after almost two decades of substance-by-substance standard setting, the Occupational Safety and Health Administration (OSHA) promulgated its Air Contaminants Standard, imposing new exposure limits for 376 toxic substances encountered in U.S. industry. In marked contrast to earlier regulations, the Air Contaminants Standard has generated relatively little industry opposition. This paper analyzes the standard in the context of the twenty-year debate over the appropriate role for technological feasibility and economic compliance costs in occupational health policy. The political feasibility of the new standard is traced to OSHA's abandonment of "technology forcing" in favor of reliance on "off-the-shelf" technologies already in use in major firms. While important as an embodiment of OSHA's new "generic" approach to regulation, the Air Contaminants Standard cannot serve as a model for future occupational health policy, due to its reliance on informal, closed-door mechanisms for establishing regulatory priorities and permissible exposure limits.     

Contesting anticompetitive actions taken in the name of the state: state action immunity and health care markets

The so-called state action doctrine is a judicially created formula for resolving conflicts between federal antitrust policy and state policies that seem to authorize conduct that antitrust law would prohibit. Against the background of recent commentaries by the federal antitrust agencies, this article reviews the doctrine and discusses its application in the health care sector, focusing on the ability of states to immunize anticompetitive actions by state licensing and regulatory boards, hospital medical staffs, and public hospitals, as well as anticompetitive mergers and agreements. Although states are free, as sovereign governments, to restrict competition, the state action doctrine requires that "the state itself" make the decision to do so. Partly on the basis of problems in the political environment, the article criticizes courts for using a mere "foreseeability" test to decide whether a state legislature sufficiently authorized competitors to act in contravention of clear federal policy: "Few things are more foreseeable than that a trade or profession empowered to regulate itself will produce anticompetitive regulations."     

The labor impacts of policy change in health care: how federal policy transformed home health organizations and their labor practices

Health care organizations are highly labor-intensive; policies designed to stimulate organizational change are likely to have labor impacts. This paper examines the labor effects of policy change in home health care. Major federal home care policy trends since 1980 have spurred the evolution of the typical home care provider toward greater organizational and market rationality. Greater managerial sophistication has introduced changes in management/labor relations. Survey data from the 1986 DRG Impact Study are used to show how the pressure of cost-containment policies has pushed agencies to cut labor costs by increasing workloads, managerial supervision, and control of the work process. Research on the effects of recent policy change in health care has to date focused primarily on potential client effects. Labor impacts are rarely examined and are poorly understood at the time that policy is made. Findings in this article suggest that these issues deserve greater, more systematic attention, because unanticipated labor impacts may prove to be significant impediments to the realization of intended policy goals.     

The Americans with Disabilities Act as risk regulation.

Much disability based discrimination occurs because of fears that hiring or serving people with disabilities will pose a safety risk. Disability rights laws such as the ADA strictly regulate such risk-motivated discrimination. Many disability rights advocates and academic defenders of the ADA laud such laws as applying a "scientific" approach to risk rather than the "irrational" approach generally adopted by the public at large. That position is doubly strange: It stands in remarkable tension with disability rights advocates' general suspicion of "experts," and applies a technocratic approach to risk regulation-an approach that usually has politically conservative implications-to achieve the distinctly nonconservative goal of promoting the full integration of people with disabilities into our nation's economic and civic life. In this essay, Professor Bagenstos uses the problem of risk-motivated disability discrimination as a lens through which to examine the politics of risk regulation scholarship. He argues that the easy association of technocratic approaches with political conservatism-and of democratic approaches with political liberalism or progressivism-ignores the complex ways in which technocratic and democratic institutions may serve or disserve particular political interests.     

Breaking gridlock: the determinants of health policy change in Congress

Prior to the 2010 health care reforms, scholars often commented that health policy making in Congress was mired in political gridlock, that reforms were far more likely to fail than to succeed, and that the path forward was unclear. In light of recent events, new narratives are being advanced. In formulating these assessments, scholars of health politics tend to analyze individual major reform proposals to determine why they succeeded or failed and what lessons could be drawn for the future. Taking a different approach, we examine all health policies proposed in the U.S. House of Representatives between 1973 and 2002. We analyze these bills' fates and the effectiveness of their sponsors in guiding these proposals through Congress. Setting these proposed policies against a baseline of policy advancements in other areas, we demonstrate that health policy making has indeed been far more gridlocked than policy making in most other areas. We then isolate some of the causes of this gridlock, as well as some of the conditions that have helped to bring about health policy change.     

Organizational factors that contribute to police deadly force liability

Police use of deadly force is a significant concern for municipal policymakers and law enforcement agencies. Following U.S. Supreme Court case law, police agencies and municipal entities may be held civilly liable under Section 1983 for force that is not objectively reasonable; for failure to train; and for policies, customs, and practices that cause constitutional injury. This article analyzes eighty-six cases from the U.S. District Courts and the U.S. Courts of Appeals on Section 1983 liability regarding police use of deadly force. The article focuses specifically on police firearm use in deadly force situations, highlighting how managerial disorganization and administrative breakdown impacts departmental decision making. Principles of management, such as division of labor, hierarchy of authority, span of control, unity of command, and communication are used to explain bad shootings that lead to potential police liability.     

Regulatory Analysis in Corporate Law

Drawing on recent experiences in the US, UK, and EU, this article suggests that regulatory analysis of corporate law policies, as currently understood and applied, suffers from severe weaknesses. The effects of proposed corporate law policies are often difficult to predict and even more difficult to quantify, which negatively impacts analytical reliability. Moreover, given its nature and strong intersections with economic, societal and political issues, corporate law is less amenable to technocratic assessments than other areas of law. Based on three case studies, the article explores these problems. It outlines a revised ‘procedural’ view, suggesting that regulatory analysis in corporate law should be understood as a process for enhancing information, transparency, and monitoring, independently of specific normative criteria. This leads to several implications. In short, regulatory analysis should combine quantified analysis with leeway for regulatory judgment and focus on increased consultation, critical engagement, review, and transparency as the dominant guiding factors.     

Halfway competitive markets and ineffective regulation: the American health care system

Since the late 1960s the U.S. has attempted to develop a strategy for controlling the rate of growth of health care spending. During the 1970s this strategy relied heavily on various forms of regulation. Some regulatory programs were partially successful in moderating spending increases, but they generated significant opposition--particularly from powerful provider groups, who successfully convinced Congress and the states to dismantle most of the regulatory structure and to substitute various forms of competitive approaches to controlling spending. Some of these competitive strategies have been successful in increasing the efficiency of subsections of our health system. But they too have produced "losers," and the government has been pressured to enter the system to minimize their losses. The net result has been a political stalemate between halfway competitive markets and ineffective regulation. With the rate of health care spending growth near historic levels, it is likely that the 1990s will bring a return to a stronger role for government regulation. But it is unlikely that we are any more willing to tolerate the negative fallout from regulation today than we were in the 1970s, and therefore we predict that the proportion of GNP going to health care will continue to grow throughout the remainder of this century.     

The politics of health care regulation: the case of the National Health Planning and Resources Development Act

This paper examines the political and bureautic dynamics of health regulation under the National Health Planning and Resources Development Act and, to a lesser extent, the Carter Cost Proposal now before Congress. A number of underlying issues that affect the day-to-day exercise of health planning are considered, including the contest between state and local and federal government for program control, jurisdictional conflict between state and local planning agencies, and the unsettled roles to be played by professional planners, consumers, and providers. When we assess regulatory policy in health, these complicating factors must be added to the long list of handicaps that already exist. One important finding is that local planning agencies have embraced the task of health regulation somewhat more fully than had generally been expected. A number of explanations for this are offered. In short, the controlling factors in health planning are political, not technical, and there is more occurring at the state and local levels than many had predicted, although any impact is not likely to be dramatic.     

Beyond Technocratic Governance: The Case of Biotechnology

Decision-making processes within the European Union are often held to be technocratic in nature. This article challenges this assumption upon conceptual and empirical grounds. Whilst in the European regulatory field of biotechnology, politicians often seek to define political issues as technical questions and so may successfully evade necessary but time-consuming legislative processes through the means of Comitology; the diverse mixture of national, supranational, technocratic and political interests within the Commission, Council, Parliament and committees, determines that social and ethical criteria do play a role in European regulation. Relating such specific findings to the broader question of European governance, it might thus be argued that the European Union is more than a technocratic regime, and does more than promote negative integration. However, the 'political' within European decision-making needs nonetheless to be strengthened to ensure the necessary and continued inclusion within such regulatory processes of social and ethical rationalities to complement the economic rationality of the internal market.     

The Response of Business to Social Regulation in England and Wales: An Enforcement Perspective*

This paper considers business adaptation to legal regulation from an enforcement perspective. It is argued that regulatory agencies and business have a reflexive relationship in which there is a continual process of adaptation and readaptation by one party and then the other. This reflexivity and its implications are discussed with reference to socio-legal research into the regulation of occupational health and safety and environmental pollution in England and Wales.     

Frontline Safety: Understanding the Workplace as a Site of Regulatory Engagement

The concept of frontline safety encapsulates an approach to occupational health and safety that emphasizes the “other side of the regulatory relationship”—the ways in which safety culture, individual responsibility, organizational citizenship, trust, and compliance are interpreted and experienced at the local level. By exploring theoretical tensions concerning the most appropriate way of conceptualizing and framing frontline regulatory engagement, we can better identify the ways in which conceptions of individuals (as rational, responsible, economic actors) are constructed and maintained through workplace interactions and decision making as part of the fulfillment of the ideological and constitutive needs of neoliberal labor markets.     

The changing process and politics of health policy in Korea

Korea recently introduced three major health care reforms: in financing (1999), pharmaceuticals (2000), and provider payment (2001). In these three reforms, new government policies merged more than 350 health insurance societies into a single payer, separated drug prescribing by physicians from dispensing by pharmacists, and attempted to introduce a new prospective payment system. This essay compares the three reforms in Korea and draws important lessons about the country's changing process and politics of health care policy. The change of government, the president's keen interest in health policy, and democratization in the public policy process toward a more pluralist context opened a policy window for reform. Civic groups played an active role in the policy process by shaping the proposals for reform-a major change from the previous policy process that was dominated by government bureaucrats. The three reforms also showed important differences in the role of interest groups. Strong support by the rural population and labor unions contributed to the financing reform. In the pharmaceutical reform, which was a big threat to physician income, the president and civic groups succeeded in quickly setting the reform agenda; the medical profession was unable to block the adoption of the reform but their strikes influenced the content of the reform during implementation. Physician strikes also helped block the implementation of the payment reform. Future reform efforts in Korea will need to consider the political management of vested interest groups and the design of strategies for both scope and sequencing of policy reforms.     

Hidden convergence: toward a historical comparison of U.S. and U.K. health policy

The social science literature on the comparative history of the welfare state offers conflicting accounts of the relationship between the United States and the United Kingdom. At first blush, the comparative history of health care policy in the United States and the United Kingdom seems to affirm the dominant view that the U.S. and U.K. welfare states have diverged substantially during the twentieth century. A comparison of U.S. and U.K. health policy, however, suggests that there are more parallels and points of tangency between the two systems than are readily apparent. The comparative history of health policy over the past century reveals common political and policy challenges and frequent interchanges of policy ideas, and helps uncover the political dynamics behind the development of health policy in the two countries, which can, in turn, help illuminate the contemporary politics of reform in both countries.     

The Dangers of Hanging Baskets: 'Regulatory Myths' and Media Representations of Health and Safety Regulation

The successful enforcement of health and safety regulation is reliant upon the ability of regulatory agencies to demonstrate the legitimacy of the system of regulatory controls. While 'big cases' are central to this process, there are also significant legitimatory implications associated with 'minor' cases, including media-reported tales of pettiness and heavy-handedness in the interpretation and enforcement of the law. The popular media regularly report stories of 'regulatory unreasonableness', and they can pass quickly into mainstream public knowledge. A story's appeal becomes more important than its factual veracity; they are a form of 'regulatory myth'. This paper discusses the implications of regulatory myths for health and safety regulators, and analyses their challenges for regulators, paying particular attention to the Health and Safety Executive (HSE) which has made concerted efforts to address regulatory myths attaching to its activities. It will be shown that such stories constitute sustained normative challenges to the legitimacy of the regulator, and political challenges to the burgeoning regulatory state, because they reflect some of the key concerns of late-modern society.     

Research ethics across the 49th parallel: the potential value of pilot testing "equivalent protections" in Canadian research institutions

Canada and the United States share the world's largest trade partnership and an increasing concern about divergent regulatory approaches to common industries. Canadian research institutes receive more research funding from the U.S. National Institutes of Health than any other country, much of it to fund multi-centre and collaborative research between the two countries. Because of these close economic and research ties, and the extensive similarities between the two countries in the review and oversight of ethics in human subjects research, we propose that Canada would be an ideal country for a pilot-test of the feasibility of "equivalent protections," a U.S. regulation that permits comparison of protections for human subjects between institutions in the two countries. The "equivalent protections" has been advocated by various bodies in the United States as a potentially beneficial mechanism for improving oversight of foreign trials. As well, we argue that "equivalent protections" could prove to be valuable for Canada in five specific ways: (1) by potentially reducing administrative burden on Canadian research institutions administering U.S. federal research funding; (2) by creating symbolic value of an explicit recognition by the United States that procedures normally followed for the protection of human subjects in Canadian research institutions are at least equivalent to those provided by the U.S. regulations; (3) by lowering the opportunity cost of investing in research in Canada; (4) by affording Canada an opportunity to enhance its leadership role in international research by offering an alternative to the U.S. regulatory model for the protection of human subjects; and (5) by providing a model for how the idea of equivalent protections might be addressed for research funded by Canadian agencies but conducted in other countries.