The United Mine Workers of American and the recognition of occupational respiratory diseases, 1902-1968

Brazilian union actions for workers' health protection

CONTEXT

Many authors have emphasized the importance of worker strength through unionized organizations, in relation to the improvement of working procedures, and have reported on the decisiveness of labor movement actions in achieving modifications within the field of work and health.

OBJECTIVE

To describe the ways in which Brazilian unions have tried to intervene in health-illness and work processes, identifying the existence of commonality in union actions in this field.

TYPE OF STUDY

Qualitative study.

SETTING

Postgraduate Program, Environmental Health Department, Faculdade de Saúde Publica, Universidade de São Paulo, São Paulo, Brazil.

METHODS

Union health advisers and directors were interviewed. Documents relating to union action towards protecting workers' health were collected and analyzed.

RESULTS

Unions articulate actions regarding workers' health of a technical and political nature that involve many aspects and high complexity. These have been divided into thematic categories for better analysis.

DISCUSSION

Union actions regarding workers' health in Brazil are restricted to some unions, located mainly in the southern, southeastern and northeastern regions of the country. Nonetheless, the unions undertaking such actions represent many professions of great economic and political importance.

CONCLUSIONS

The recent changes in health and safety at work regulations, recognition of professional diseases, creation of workers' health services and programs within the unified health system, and operational improvements in companies' specialized safety and occupational medicine services, all basically result from union action. There is commonality of union action in this field in its seeking of technical and political strengthening for all workers and their general and local representation. This has the objective of benefiting collective bargaining between employers and workers. Inter-institutional action on behalf of workers' rights guarantees and amplifies the improvement of health and working conditions.

The rhetorics and realities of community health care: the limits of countervailing powers to meet the health care needs of the twenty-first century

As the paradox of medical success leaves behind more chronicity, policy makers around the world increasingly focus on community-based programs both to address chronic health problems and to prevent major disorders. This essay presents my comparative sociological framework of ideal-type models for understanding the countervailing powers that underlie and shape different kinds of heath care systems and their limitations in addressing the health care needs of the twenty-first century. In this context, I then analyze the revival of community health care rhetoric in the United States and compare it to the realities in which it operates. The realities of institutional power, fragmentation in funding, illness as a private condition and health care as a private good, the lack of societal commitment, competition, and the waning of community cohesion all suggest that communal democracy will be difficult to achieve. Current successes require further investigation. Examples from abroad suggest, ironically, that community health care develops best if the state and health professionals make a deep commitment to it, against their own immediate interests but for their enlightened self-interest.

The medical care programs of the Farm Security Administration, 1932 through 1947: a rehearsal for national health insurance?

At a time of renewed interest in universal health insurance, an examination of earlier periods when society grappled with the link between socioeconomic status and health is fruitful. Between 1935 and 1947, the federal government sponsored a comprehensive medical care program for low-income farmers, sharecroppers, and migrant workers under the auspices of the Farm Security Administration (FSA). Despite the strong opposition of the American Medical Association, humanitarian and economic concerns at the local level often promoted physicians' participation in the program's group prepayment plans. Many FSA leaders clearly saw the program as a model upon which national health insurance might advance. However, in the wake of World War II, the FSA program declined as physicians' income improved, the rural population declined, and traditional ideological objections to federal intervention in medical care resurfaced. The FSA experience illuminates the complex ideological, economic, and humanitarian motivations of American physicians in the face of health care reform.