Living and working conditions are the primary factors that shape whether individuals stay healthy or become ill; they are much more important than biological markers or behavioural choices. This truism applies to just about every physical, mental or social affliction that one may encounter. The term social determinants of health (SDOH) has come to stand for these living and working conditions that include income, housing, food security, unemployment, job security and working conditions, as well as the health care system and the social safety net, among others. The health care, public health and civil society sectors all accept this conclusion.
Yet even amongst those who have come to accept the concept and work to see it implemented through public policy action, there is a significant blind spot that requires attention: the roles unionization and collective agreements play in shaping the quality and equitable distribution of health outcomes.
This is surprising as unionization and working under collective agreements influence many societal health factors, such as income through wages and benefits, job security and working conditions. At a societal level, income inequality is a decisive predictor of our collective health, be it physical, mental, or social, which is why unionization and collective agreements have important impacts upon health.
We have brought together decisive evidence that greater unionization in wealthy nations of the Organisation for Economic Cooperation and Development (OECD) is related to lower poverty rates, fewer low-waged workers, less income inequality and lower rates of infant mortality and low birthweight.
Canada’s unionization rates are amongst the lowest of many wealthy nations, with just 30 per cent of workers belonging to unions, most of them in the public sector. By contrast, unionization rates are 65 per cent in Finland, 67 per cent in Denmark and 67 per cent in Sweden. And in these nations, union agreements are extended to those who may not be unionized, so that collective employment agreements cover 89 per cent of workers in Finland, 84 per cent in Denmark and 90 per cent in Sweden. In Canada, this extension of agreements simply does not occur. Canada’s poverty rates and income inequality rates are above the OECD average, and its infant mortality and low birthweight rates are also above the OECD average.
In Canada, belonging to a union is related to higher wages, better benefits and greater job security, all of which also have a positive influence on health.
Union members are paid more per hour than non-union members, with women and youth seeing the biggest differential. Unionization brings more bargaining power which allows for higher wages. Higher income offers greater access to housing, food security and quality childcare.
Health benefits are more likely in unionized workplaces, with benefits such as pension plans, dental care, vision care, sick pay and disability insurance commonly offered to union members.
Unions push toward better health by creating a standard of higher wages and benefits for not only unionized workers but the broader public. By bringing up lower wages, unions reduce levels of income inequality and poverty.
Health benefits also allow for greater access to drug and dental plans, employment training and mental health services. For those concerned with promoting health and reducing illness, a focus on making it easier to unionize a workplace seems a pressing issue.
Yet, despite these benefits for the average Canadian, Canada’s labour movement has weakened in the past 40 years, with rates of union membership declining from 38 per cent in 1981 to 30 per cent in 2019. Several factors contributed to this decline. Reduced union membership is in part a result of Canada’s response to globalization, which allows companies to easily move abroad in response to labour disputes with unions.
In addition, provincial governments have made it more difficult to organize a workplace. Until 1977, all workplaces in Canada could be organized by having a majority of workers sign a card indicating a wish for a union — a process called card-check authorization. In 1995, Ontario’s Conservative government under Premier Mike Harris removed this process, requiring an election. This shift allows employers to mobilize opposition to unionization through a range of tactics that make it more unlikely that certification of a union will occur. Card-check has been restored for the construction industry, but for most workers in Ontario, unionizing a workplace is difficult.
Towns like Lindsay have seen their manufacturing base eroded and, like other towns where this has happened, unless you are fortunate enough to work for the hospital, the local college or the city, then chances are that you are employed in the non-unionized service sector or other lower-wage places with few benefits and little job security. Yet these jobs need not remain precarious, low-waged and without benefits. The COVID-19 pandemic has laid bare many of these employment problems. Perhaps ironically, the pandemic makes it possible to conceive of a government that will consider more deeply the need for better income security — and thus, better health — for its citizens.
In these times of declining citizen power in the face of forces such as globalization, corporate concentration and growing employment precarity and insecurity, unions offer one of the strongest ways to balance out the inequalities in power and influence that are making life more difficult for the average person in Canada.