Trade Unions Are the Frontline of Public Health

Victories for unionised cleaners and porters in hospitals across the country prove that trade unions aren't just essential for workers' terms and conditions – they are leading the fight for public health.

The contract change won by workers at Barts Health means a pay rise of up to fifteen percent, worth £2,800 per year. (Unite the union)

Last month, workers at one of the UK’s largest NHS trusts, Barts Health, won a spectacular victory that will see almost two thousand taken off substandard outsourced Serco contracts and onto in-house NHS ones. To make ends meet, many of the outsourced workers—cleaners, porters, security guards—had been working double shifts or second jobs, exhausting themselves just to put food on the table for themselves and their families. As well as improvements to conditions and treatment, the contract change means a pay rise of up to fifteen percent, worth £2,800 per year.

We know that trade unions promote economic equality and build worker power, but this victory was a reminder of a fact that became clear during the pandemic: unions are also key for protecting health. That applies to both those they represent and the wider public—most of us would prefer to be treated in a hospital cleaned by staff members who are properly paid and well supported while doing it, after all—and to workplaces both inside and outside the healthcare sector.

Some of the earliest and most famous battles in the history of Britain’s labour movement have centred on the issue of occupational health. In the late 1800s, young girls and women working in London’s Bryant and May match factory suffered regularly from a condition known as ‘phossy jaw’, a result of exposure to the white phosphorus used in match manufacturing. One of their 1888 strike’s key victories was the right to eat their meals in a separate room, away from the dangerous chemicals.

At the end of last year, in the same city, tube drivers began a series of strikes against roster changes that would have given them insufficient rest time between shifts, meaning fatigue and possible accidents on the dangerous railways. Since 2020, DVLA workers in Swansea have been involved in an ongoing dispute over their employer’s failure to put in place decent infection mitigation measures during the pandemic. The National Union of Education was at the forefront of efforts to get the government to take Covid transmission in schools seriously last year.

Each of these disputes are examples that back up the growing body of evidence tying trade unions to public health. Where workers can act collectively, they can fight for enhanced safety measures, better wages, and paid sick time—all of which are crucial to keeping our society fit and well.

In the Workplace, In the Community

The relationship between work and health functions in different ways. The conditions of our work are also the conditions in which our health is formed: for example, long working hours led to more than 700,000 early deaths from heart attacks and strokes worldwide in 2016. The same is true for mental wellbeing: if we face victimisation or bullying in the workplace, the emotional state it produces in us doesn’t stay on the shop floor. As Colette Shade has written in Tribune, one study from the US found that higher union density is associated with lower rates of suicide.

But our work also affects the outside world. Covid proved how closely economic security and public health are tied together. New ONS data released just last week showed that avoidable deaths are consistently more likely in Britain’s more deprived areas, with the price of social inequality sometimes worth as much as a decade of life. By fighting for higher wages, not least in the middle of a cost of living crisis that’s already making us sick, trade unions are on the frontline of the struggle to close the gap.

When those in low-paid and precarious work are disproportionately women and people of colour, that struggle applies to other forms on inequality, too. A fighting trade union movement key to challenging health inequality in its various forms.

The Problem

The problem is that our government and the ruling class it represents has proved that it cares little about public health, and less about workers’ rights, evidenced by the fact that it’s currently pushing through brand new anti-union measures. Covid saw the government abandon workers to risk their lives without vital protective equipment (while handing over public money for that protective equipment to their mates), and without access to paid sick leave. When workers have spoken up about health and safety concerns, they have been fired. Clearly, a system that allows this dynamic to exist must be completely overhauled.

In making that change, we need to build a politics that recognises that the treatment of workers in the workplace is a model for the health of our society. The recent win for cleaners and porters at Croydon Hospital, which has resulted in a twenty-four percent pay rise, is an example of how work, the community, and public health intersect: the cleanliness and safety of the hospital ensures the wellbeing of those who work, learn, and are treated in it, which by extension means the wellbeing of local families and the community at large. The rights of healthcare workers are the conditions in which the rest of us receive healthcare, just as the rights of workers in public spaces or on public transport determine the conditions in which the rest of us travel, work, rest, and play.

For public health scholars, practitioners, and institutions, that means protecting and encouraging the rights of workers to unionise and bargain collectively across industries. In partnership, the public health community and trade unions can promote health research, better understand the social determinants of health, and take steps to decrease disparities. A failure to work in tandem, particularly in light of the steady growth of trade union membership, is public health’s loss: a powerful trade union revival is a big opportunity in our search for better health for all.