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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.

The French and American medical professions share similar historical bases for strong political and economic market positions. As professions, the attributes of common education, ethics, and mission tend to keep physicians together in their political organization. But the medical professions in both France and the United States are also subject to intraprofessional forces of division, such as the conflicts which often oppose generalists to specialists. Although organized medicine in France and the United States shares these commonalities, there is a very important difference between the two countries. The French profession tends toward organizational particularism, both ideologically and nonideologically, which serves to splinter it in ways inimical to the interests of the medical profession. By contrast, the American medical profession tends to organize universally-that is, its organizational base is much more often one of unity and accommodation toward the divergent interests of physicians. Thus, organized medicine in the United States has more easily fought off political and economic pressures coming from government and the private sector-but by no means with total success. On the other hand, highly fragmented organized medicine in France has experienced an almost linear decline in the face of pressures coming from a determined and strong state.

During the second half of the 1970s, the practice of the closed shop became widespread in some parts of the British public sector, but was resisted in others. This paper examines the issue in relation to the National Health Service, where trade unionists made frequent demands for the closed shop and where many managers were apparently not unwilling to concede it. Yet very few closed shops actually resulted. The paper examines the origin and patterns of these demands, health authority policies towards them, and their outcomes in terms both of the operation of the closed shops which were agreed, and the reasons for failure to agree. The conclusion is that although NHS industrial relations had apparently matured very rapidly between 1973 and 1977, the trade unions were neither strong enough nor united enough to enforce the closed shop; nor were industrial relations so far developed as to make the practice a natural next step.

UNLIKE EMPLOYEES IN OTHER SECTORS OF THE ECONOMY, HEALTH CARE WORKERS ARE DIRECTED TOWARD ONE ULTIMATE GOAL: making people well and keeping them healthy. The development of collective bargaining and union activities during this century has had a great impact on all industries in the United States and the western world. However, only in recent years have workers in the health care sector been affected by the organized labor movement. The history of collective bargaining and strikes among physicians, the key decision-makers in the health care sector, is even more recent. Because of their central position, physicians' collective activity has had and will continue to have tremendous implications for the viability of the present health care system and the quality of patient care. Even though most physicians continue to function as individual, entrepreneurial service providers and "professionals," physicians as a group are more frequently being seen as members of a utility like industry. Their importance to individuals and society as a whole, it can be argued, is second to none; if physicians refuse to work there can be no worse set of outcomes. To estimate the potential future impact of growing collective action on the part of physicians, this article explores the general historical developments.

In this article, the development of nursing in Canada is described in terms of three major time periods: the emergence of lay nursing, including organization and registration, 1870-1930; the move to the hospital, 1930-1950; and unionization and the routinization of health care, 1950 to the present. This development is viewed in the light of the orienting concepts of professionalization, proletarianization, and medical dominance (and gender analysis). This historical trajectory of nursing shows an increasing occupational autonomy but continuing struggles over control of the labor process. Nursing is now using theory, organizational changes in health care, and credentialism to help make nursing "separate from but equal to" medicine and to gain control over the day-to-day work of the nurse. Nursing can thus be viewed as undergoing processes of both professionalization and proletarianization. As nursing seeks to control the labor process, its occupational conflicts are joined to the class struggle of white-collar workers in general. Analysis of nursing indicates the problems involved in sorting out the meaning of concepts that are relevant to occupational or class analysis but which focus on the same empirical phenomenon.

The history of union organizing efforts in the hospital field is discussed in this article, along with the factors judged necessary for successful union organizing. The role played by labor legislation in the unionization of hospital workers is shown, and the influences of the National Labor Relations Act, the Taft-Hartley amendments, and labor legislation at the local level are described. Management has largely resisted unionization because of the social nature of hospitals. Competitive market forces do not confront the not-for-profit hospitals, which are dependent upon third-party reimbursement. While strikes are an integral and essential part of collective bargaining in industry, they are, in fact, detrimental to hospitals because of these institutions' concern with human life. Despite laws and assurances from labor leaders that strikes will not occur, strikes have been used as a method for resolving disputes, through they are basically inconsistent with the economic characteristics and objectives of the hospital. The authors conclude that arbitration awards should be made by arbitrators appointed from outside of the local region of the hospital involved, ant that, because of the catastrophic effect of strikes upon patients as well as employees, arbitration awards should be required, should be binding upon both parties, and should be federally enforced.

Organized labor in the United States strongly supported pre-New Deal proposals for state pensions for the elderly. The idea that American labor, unlike its European counterparts, did not contribute to the rise of the welfare state is based on evidence from national organizations and their leaders. Review of the activities of the highly political state federations, and of the campaign for old age pensions in Massachusetts, indicates that labor, rather than middle-class reformers, was responsible for the promotion of new public welfare programs.

Experience with and reflections on the interaction among the workplace, the society, and various institutions in the area of occupational health have played an important role in the general political debate in Italy since the 1960s. This paper describes the emergence of the worker's model of investigation into health hazards, an element unique to the Italian experience, and analyzes its impact on the organization of work, government policies, health institutions, and scientific research.

By the mid-1930s, U.S. coal miners could no longer tolerate company doctors. They objected to the misuse of preemployment and periodic medical examinations and to many other facets of employer-controlled health benefit plans. The rank-and-file movement for reform received critical assistance from the Bureau of Cooperative Medicine, which conducted an extensive investigation of health services in 157 Appalachian communities. This study not only substantiated the workers' indictment of prevailing conditions but illuminated new deficiencies in the quality and availability of hospital and medical care as well. The miners' union curtailed the undemocratic, exploitative system of company doctors and proprietary hospitals by establishing the United Mine Workers of America Welfare and Retirement Fund in 1946.

Hospital house staff movements for collective bargaining have persisted for more than 35 years. The problems addressed seen equally persistent--inadequate pay, excessive hours, poor working conditions, and low standards of training and patient care. Interns and residents continue to face the organizational handicaps of transient membership, poor funding, and apathy, yet negotiated contracts indicate limited legal successes. Improved patient care conditions are less evident than improved house staff conditions.

The black lung movement that erupted in West Virginia in 1968 was not simply a struggle for recognition of an occupational disease; it grew into a bitter controversy over who would control the definition of that disease. This article examines the historical background and medical politics of that controversy, arguing that black lung was socially produced and defined on several different levels. As a medical construct, the changing definitions of this disease can be traced to major shifts in the political economy of the coal industry. As an occupational disease, the history of black lung is internally related to the history of the workplace in which it is produced. As the object of a mass movement, black lung acquired a political definition that grew out of the collective experience of miners and their families. The definition of disease with which black lung activists challenged the medical establishment has historical roots and justification; their experience suggests that other health advocates may need to redefine the diseases they hope to eradicate.