Labor Was Crucial in Building Public Health Institutions Trump Wants to Destroy

The Biden administration supervised the largest repeal in social benefits in U.S. history upon declaring the COVID-19 pandemic over. The Trump administration appears to be surpassing that feat, rapidly winding down the project called the United States.

The fallout includes the health of the American people. In recent weeks, we’ve seen billions slashed from state health programs, life-saving drugs and research discontinued, repeals in environmental protection and food safety, tens of thousands fired from the Department of Health and Human Services (HHS), and whole HHS units closed down for good.

These are attacks on the very foundations of the public commons. They will profoundly exacerbate the decades-long divestment from U.S. public health previously pursued under the neoliberal model of governance.

The Trump administration won’t be “making America healthy again,” critics contend. It almost certainly will make the U.S. sicker.

The effects of such a campaign will be compounded by the administration’s attacks on labor. These include a proposed 12 percent cut atop the Occupational Safety and Health Administration’s (OSHA’s) long understaffing; 11 regional OSHA offices slated to be closed by the so-called “Department of Government Efficiency”; and a bill angling for OSHA’s elimination. There’s also a campaign to destroy federal unions; plans to fire two-thirds of staff at the National Institute for Occupational Safety and Health (NIOSH); and accelerating efforts to deport thousands of immigrant workers, replacing them across several states with child labor.

The attacks on workers and public health are interconnected, as the modern public commons were established in large part in response to worker demands.

A century-plus of health interventions that unions helped build from factory floors to neighborhood streets succeeded to an astonishing degree. The outcomes are imprinted upon the very map of the country. U.S. states on the union-led “closed shop” labor model unambiguously report better public health outcomes across disease and condition.

For over 125 years, labor rights have been repeatedly operationalized in U.S. public health, saving and extending millions of lives.

Unions Made Pandemic Plans Even Before COVID

Recent history underscores the connection between public health and labor.

One of the roles of the Department of Veterans Affairs (VA) is to protect the country during emergencies. There is an entire division within the VA for emergency preparedness. After 9/11, both the VA and the American Federation of Government Employees (AFGE) — the federal union representing over 300,000 VA workers, the largest single bargaining unit in the United States — expanded their work in preparedness.

In 2008, AFGE pushed for pandemic policies at the VA, and negotiated contract language in 2011 to protect members there from shifting political winds at the policy level. Other AFGE members employed at the Defense Contract Management Agency had “flu pandemic” contract language that upon the COVID pandemic, the first Trump administration declared only applied to the flu.

Prior to 2020, partly in response to AFGE’s contract language, the VA developed caches of personal protective equipment (PPE), practiced emergency responses, hired for full-time jobs in decontamination and proactively vaccinated for smallpox. When the COVID-19 pandemic hit, the VA added to its collection of negative pressure rooms to hold infected patients, likely hosting more of such rooms than anywhere else in the country outside the Centers for Disease Control and Prevention (CDC).

Yet despite the scale of the emergency, the Trump administration chose to follow only CDC guidance — which Biden officials subsequently discovered wasn’t even written by CDC staff — and ignored the superior pandemic contract language AFGE outlined. The VA has yet to settle a grievance filed by AFGE in 2020 to enforce the language of the contract.

AFGE also helped institute the American Rescue Plan Act of 2021 (ARPA), which improved the pandemic response. Under ARPA, the VA dedicated $17 billion to its pandemic program, including COVID-related health care coverage for more than 9 million veterans, debt forgiveness for veterans’ medical copayments, and retraining and food stamp access for veterans.

We learned in a phone interview with an AFGE National VA Council attorney that for those working at the VA harmed by COVID, the Department of Labor acted under the presumption that the employees caught COVID on-site, making their workplace injury compensable.

With COVID still circulating despite the government’s declaration to the contrary, and bird flu and other pathogens back, other unions should consider following AFGE’s example and include similar pandemic safety precautions into their next contracts.

Bargaining units should also invest in the capacity to enforce that language, including working with the social movements needed to maneuver employers into respecting the contracts they helped negotiate.

Educator Unions on the Pandemic Front Line

While no one has yet cataloged the breadth of union responses to COVID, academics reported on the importance of local union fights for pandemic safety. This work includes initial findings projecting that “a 10 percent increase in unionization in the United States would lead to around 5 percent decrease in total cases of COVID-19 100 days after the onset of the virus.”

With high union density in U.S. public schools, educators’ unions are well positioned to prioritize public health. Schools are the most numerous indoor gathering spaces in most cities and counties for the majority of the year.

Public health interventions in schools, as in hospitals and nursing homes, have a disproportionately positive effect, especially as school children are a primary vector for community spread of respiratory illnesses, including COVID.

One example of a strong educator union response is that of the Racine Educators United (REU), a mid-sized union located in Racine, Wisconsin, that Joe Sexauer (a co-author of this piece) works for.

In the face of working in a state that gutted collective bargaining for teachers, REU started a pandemic campaign that by spring of 2021 had won so many COVID protections that the industrial hygienist working with the union commented that “there’s not much more you can win.”

The attacks on workers and public health are interconnected, as the modern public commons were established in large part in response to worker demands.

The REU campaign started with emails and calls to the superintendent and school board. Virtual building meetings led to massive public comments to the board. A petition of over 2,000 signatures demanded teachers be able to work remotely, and a car caravan wound its way to the school board. Some members phone banked, and more than 500 people sent online letters to city councilors.

Ultimately, 114 grievance issues were discussed, with over two dozen elevated to the written step. The grievances were initially denied and moved to hearing officers, but the union won all its safety demands.

The district transitioned from a punitive approach to mask wearing to one of education. When COVID vaccinations became available in 2021, the district helped prioritize teachers’ inoculations and hosted vaccination clinics.

The union successfully lobbied against using scarce resources for the unproven technology of bipolar ionization to focus instead on ventilation and filtration. Despite older equipment, district engineers overcame technical obstacles to make MERV 13 filters work in every school. The MERV 13s filter out small particles, including viruses. The engineers set seven air exchanges an hour during school hours. Classrooms that had inadequate ventilation received individual air filters.

The district permitted union building leaders and the engineering team to perform safety walks through each building before the return of students to ensure that all the indoor air quality (IAQ) work above the ceiling made it below into classrooms. The safety checks were supplemented by monthly walks by building engineers who fixed inoperable vents and double-checked that the filters were MERV 13s.

If Wisconsin educators subjected to unprecedented attacks upon their rights to organize can fight and win on such a critical issue, occupational health and its greater impacts on the public can be placed on every educator union’s agenda.

Nurses to the Country STAT!

Teachers weren’t the only occupation whose members had an uphill battle during the pandemic. Given our frenetic historical moment, it’s easy to forget that U.S. health workers were fighting early COVID in PPE they made out of garbage bags.

Amid thousands of nurses getting sick and dying under such circumstances, National Nurses United (NNU) quickly emerged as a leading counterweight to the CDC on the pandemic, exposing the failures of hospitals and government at all levels to protect both health care workers and communities at large.

NNU fought on a multitude of fronts during the earlier years of the pandemic and continues that fight today. NNU’s primary focus is the protection of hospital-based nurses. But NNU’s strategic demands around following the precautionary principle, data gathering and mitigation methods had impacts well beyond its membership.

First, as a member of the AFL-CIO, NNU’s positions on necessary protective measures in the pandemic were adopted by other trade unionists eager to protect their own members.

Second, the protections demanded by NNU naturally benefited patients and the community at large. NNU testified, educated, petitioned and demonstrated for PPE and more. It repeatedly amplified virologist Ian Mackay’s adaptation of the Swiss cheese model for respiratory defense — layering different kinds of interventions to help cover each intervention’s functional holes.

NNU also exposed the gross structural inequities of class and race baked into hospitals and other health care institutions.

Hollywood Unions Portray Health and Safety

From the ER to ER. COVID shut down movie production in 2020, with some work continuing in Canada and in other countries with weaker unions.

The peculiarities of the industry lend themselves to powerful unionization, however much AI purveyors and studios aim to chip that away. In this case, the unions’ strength permitted the industry to get back to work safely, and sooner at full capacity than many other sectors that also weren’t designated “critical infrastructure.”

Five Hollywood unions coordinated an initial report on a safer return to work. Through impressive coalition building, over a dozen Hollywood unions settled on a return to work with strong safety protocols in September 2020.

The COVID protocols agreed upon with the Alliance of Motion Picture and Television Producers were strict and comprehensive, eventually including the DGA, SAG-AFTRA, IATSE, the International Brotherhood of Teamsters, Hollywood’s Teamsters Local 399, IBEW Local 40, Laborers Local 724, Plasterers and Cement Masons Local 755 and Plumbers Local 78.

The agreement provides copious layers of protections, and at 67 pages, contains more pages on pandemic safety alone than many union contracts contain in their entirety.

There were several levels of consistent testing of all employees, all on paid time. If, for example, a background actor had to travel to get a test on a non-work day, they received a stipend. Employees went to COVID training on paid time. Producers divided employees into work groups to limit contact and movement. A COVID compliance officer oversaw the safety of every production, with responsibilities listed over three pages in the return-to-work agreement.

The agreement provided a maximum of 10 paid COVID sick days and kept this benefit in long after the rest of the country’s workforce lost it when “COVID FMLA,” or the Family and Medical Leave Act, stopped serving as federal law. The intervention prevented the perverse incentive of a sick worker choosing between their health and that of others and a paycheck.

By May 2023, when the Biden administration wrapped up declaring the pandemic “over,” Hollywood’s COVID protections were ended. Commentary focused on the costs such protections added to productions: By one estimate, $223.5 million, with 40 percent to labor costs and 60 percent to materials.

It’s a bean-counting that skips over the lives saved, the COVID dead who cannot speak for themselves, and the impetus to avoid such costs by stopping pandemics from emerging in the first place.

Unions Preparing for Pandemics to Come

Unions inherited a pandemic they did not create. Many responded well. Some showed that strong pandemic responses were possible even within crumbling public institutions.

If more unions ran the table on COVID in their workplaces, if there were more unions, if unions had the capacity for a more thorough national response, perhaps over a million Americans lost to COVID would still be alive. Without the responses of many union members, perhaps we would have lost a million more. In our current moment, it’ll take people organizing through unions and community groups to win us better chances at healthy and fulfilling lives.

With the Trump administration twisting off the neoliberal program that was already degrading public health, initial efforts to create a people’s parallel governance will have to aim at building modest replacements. These campaigns will have to try to work with what government units are still standing to respond to ongoing outbreaks and the pandemics to come.

Victories are possible. Unions successfully lobbied during early COVID for legislation to improve indoor air quality at workplaces. The Inflation Reduction Act contains significant funding for HVAC upgrades, although a CDC survey found only 34 percent of school districts used COVID money Congress earmarked to schools for upgrades. Progress is found state-by-state. The Sheet Metal, Air, Rail, and Transportation Workers (SMART) worked in coalition with other unions to advance IAQ legislation in Connecticut. The public gets the health benefits; the union members get the work.

The historical precedents are important here. Clean water helped end waterborne pandemics. Laborers built and maintained water systems that saved more lives than the medical establishment, even as medicine remains, of course, essential. Those who build the HVAC systems for clean indoor air will likely play yet another unsung role in maintaining public health in the future.

Johns Hopkins has created a Model Clean Indoor Air Act that unions might help push across states. There’s work that remains. Although there is a centralized list of IAQ laws in all 50 states, organizations have yet to assemble a centralized list of proposed IAQ legislation for public health advocates to support.

Keeping the International in the Union

A lot can be done to protect both workers and public health even under terrible constraints.

For the most part, workers outside labor unions (90 percent of the U.S. workforce currently) do not grasp the decentralized and democratic structures of international unions and their affiliates. Local affiliates often have broad discretion to participate in their international unions’ safety programs, take an even stronger stance on safety, or none at all. This creates enormous democratic opportunities for creativity, but sometimes can make uniform safety organizing more difficult.

The U.S. labor movement shows signs of resurgence, but national trends against its interests are many. The Democrats, the party putatively supporting public goods such as public health, left us in the face of a deadly pandemic to the sink-or-swim of personal responsibility. The Republicans, the party of so-called personal responsibility, left us to social Darwinism.

It’s not just the standard of governing that has fallen. There now seem to be no “adults in the room.” Workers, through their unions and collective action, are positioned to be some of those adults and help win the clean water and clean air — from workplace to neighborhood — we all need to live full and healthy lives.

What the labor heroes of yesterday and today have in common is their insistence on expanding the scope of what constitutes health. Individuals’ decision-making is important. Choosing to vaccinate, wear masks and shelter-in-place remain important interventions when confronted by emergency outbreaks. But far more impactful interventions are found farther up the scale of societal organization, as one final 2024 NIOSH report described in detail.

In that spirit, unions need to lean into the “international” at the beginning of almost all their names, not only because workers can learn from other countries with standards for indoor CO2 or masking on the line, but because pandemics prove that the labor movement doesn’t just speak about “an injury to one is an injury to all.”

Organized labor acts on this most bedrock of creeds, one that the Trump administration rejects to its misanthropic and xenophobic core while it impersonates capital’s crisis. And this creed could not be more fundamental to surviving this historical juncture, as pandemics, climate change and other existential dangers sweep over humanity from one side of the world to the other.

This piece was adapted from Pandemic Research for the People (PReP) Dispatch #10 on collective choice and public health.

PReP will be holding a community webinar on labor, community organization and public health on Wednesday, April 23. You can register for the webinar here. Along with the co-authors, scheduled speakers include Rupa Marya, Steve Striffler and Deborah Wallace.