The democratic road to health for all : the trade union movement as a public health actor

Abstract

'Public health is the science and art of preventing disease, prolonging life, and promoting health through the organized efforts of society' (Acheson 1988 cited in Detels et al., 2009: 3). This continues to be the 'widely accepted' definition of public health (Detels et al., 2009: 3) and speaks to the active nature of public health, which is as much a social, economic and political pursuit as it is a medical practice or academic discipline.

The broader public health constituency encompasses a variety of practitioners and scholars ranging from medicine to the social sciences, yet 'public health cannot succeed without the support and active involvement of the community' (Detels et al.,2009: 4). This dissertation argues that the trade union movement (as a mass social movement representing the social, economic and political aspirations of working people around the globe) is an important public health actor actively involved - though not necessarily consciously or explicitly - in working towards the World Health Organisation (WHO) goal of Health for All. Empirical research begins with an historical study of the health activism of the peak Australian trade union organisation. The study finds that through a variety of strategies - including: improving wages and working conditions; advancing the social and political status and power of working people; promoting a culture of individual and collective human rights, including the right to health; and strengthening democracy and thus social and political stability - Australian unions have contributed to a variety of public health and human development gains. The current priorities and activities of the international trade union movement are then scrutinised through in-depth interviews with key informants from international trade union organisations, the International Labour Organisation (lLO) and World Health Organisation (WHO), in order to assess the global relevance of the Australian findings. The breadth of health-related activism carried out by international trade union organisations is presented, from their global activism with intergovernmental organisations such as the ILO and WHO, to solidarity activities supporting trade union development in low income countries. Factors that constrain the trade union pursuit of Health for All, along with examples of how trade unions address and overcome these challenges, are also discussed. Whether in Australia or internationally, the main priority of unions is organising: that is, increasing the membership, strength and capacity of their organisations. Organising strength is used to pursue, fight for and defend, a large array of socially determined contributors to health, including: wages and working conditions, traditional and emerging occupational health and safety concerns, and community health concerns like HIV/ AIDS and environmental sustainability. The dissertation concludes by discussing the empirical findings in light of the emerging public health literature that expounds the importance of democracy to public health practice. This pursuit is manifest in campaigns to improve determinants of well-being including UNESCO's Education for All, and WHO's Human Resources for Health and Health for All. These aspirations are complemented by the trade union movement's own visions for worker well-being, embodied in the ILO's objective for Decent Work. The long-standing goal of WHO, Health for All, cannot solely be achieved by any of these sectors working alone. Together, however, much progress can be made. Show more