"¡Viva La Clinica!": The United Farm Workers' Fight for Medical Care.

Farm work is among the most dangerous and unhealthy occupations in the United States, but efforts to address farm workers' health needs have been sporadic and inadequate. In the 1960s and 1970s, the United Farm Workers of America (UFW) famously organized workers in California's grape and lettuce fields and won national and international recognition through its boycott tactics. The UFW also opened several medical clinics, staffed by volunteer nurses and physicians, and created the Robert F. Kennedy Medical Plan, a medical insurance program, for its members. Both efforts were initially successful, but foundered in the face of many obstacles, including the reluctance of the UFW leadership to organize undocumented farm workers. However, the UFW's medical work laid the foundation for continuing efforts on behalf of farm workers' and undocumented people's right to health care.

Labor Unionization Among Physicians in Training.

This study examines the number of unique unions and characteristics of unionization elections among physicians in training in the US.

Labor union members play an OLG repeated game.

Humans are capable of cooperating with one another even when it is costly and a deviation provides an immediate gain. An important reason is that cooperation is reciprocated or rewarded and deviations are penalized in later stages. For cooperation to be sustainable, not only must rewards and penalties be strong enough but individuals should also have the right incentives to provide rewards and punishments. Codes of conduct with such properties have been studied extensively in game theory (as repeated game equilibria), and the literature on the evolution of cooperation shows how equilibrium behavior might emerge and proliferate in society. We found that community unions, a subclass of labor unions that admits individual affiliations, are ideal to corroborate these theories with reality, because (i) their activities are simple and (ii) they have a structure that closely resembles a theoretical model, the overlapping generations repeated game. A detailed case study of a community union revealed a possible equilibrium that can function under the very limited observability in the union. The equilibrium code of conduct appears to be a natural focal point based on simple heuristic reasoning. The union we studied was created out of necessity for cooperation, without knowing or anticipating how cooperation might be sustained. The union has successfully resolved about 3,000 labor disputes and created a number of offspring.

The Role of Labor Unions in Creating Working Conditions That Promote Public Health.

We sought to portray how collective bargaining contracts promote public health, beyond their known effect on individual, family, and community well-being. In November 2014, we created an abstraction tool to identify health-related elements in 16 union contracts from industries in the Pacific Northwest. After enumerating the contract-protected benefits and working conditions, we interviewed union organizers and members to learn how these promoted health. Labor union contracts create higher wage and benefit standards, working hours limits, workplace hazards protections, and other factors. Unions also promote well-being by encouraging democratic participation and a sense of community among workers. Labor union contracts are largely underutilized, but a potentially fertile ground for public health innovation. Public health practitioners and labor unions would benefit by partnering to create sophisticated contracts to address social determinants of health.

The role of unions and why they matter.

Unions are even more important today than any other time in history, especially the Queensland Nurses' Union.

Organising for future success.

New Zealand's first organising conference pondered future directions for the union movement.

Public health agenda setting in a global context: the International Labor Organization's decent work agenda.

We drew on two agenda-setting theories usually applied at the state or national level to assess their utility at the global level: Kingdon's multiple streams theory and Baumgartner and Jones's punctuated equilibrium theory. We illustrate our analysis with findings from a qualitative study of the International Labor Organization's Decent Work Agenda. We found that both theories help explain the agenda-setting mechanisms that operate in the global context, including how windows of opportunity open and what role institutions play as policy entrepreneurs. Future application of these theories could help characterize power struggles between global actors, whose voices are heard or silenced, and their impact on global policy agenda setting.

Labor unions: a public health institution.

Using a social-ecological framework, we drew on a targeted literature review and historical and contemporary cases from the US labor movement to illustrate how unions address physical and psychosocial conditions of work and the underlying inequalities and social determinants of health. We reviewed labor involvement in tobacco cessation, hypertension control, and asthma, limiting articles to those in English published in peer-reviewed public health or medical journals from 1970 to 2013. More rigorous research is needed on potential pathways from union membership to health outcomes and the facilitators of and barriers to union-public health collaboration. Despite occasional challenges, public health professionals should increase their efforts to engage with unions as critical partners.

Labor unions in medicine: the intersection of patient advocacy and self-advocacy.

BACKGROUND: Labor unions have been a weak force in the medical marketplace. OBJECTIVES: To briefly review the history of physicians' and nurses' labor unions, explore the ethics of unions in medicine, and offer a solution that simultaneously serves patients and professionals. RESEARCH DESIGN: A selective review of the literature. RESULTS: Labor unions of medical professionals pose an ethical quandary, that is a tension between selfless patient advocacy versus self-advocacy. The primary role of labor unions has been to extract from management benefits for employees. The threat of work actions is the primary tool that labor unions can apply to encourage management to negotiate mutually acceptable conditions of employment. Work actions-namely slow-downs and strikes-may harm patients and may therefore run afoul of professionals' primary duty to the primacy of patients' welfare. An alternative model is offered wherein medical unions align self-centered and patient-centered interests and leverage the Public Good, in the form of public opinion, to encourage good-faith bargaining with management. CONCLUSIONS: As medicine becomes increasingly corporatized, physicians will join nurses in "at-will employment" arrangements whereby self-advocacy and patient advocacy may be impacted. Although labor unions have been a means of counterbalancing unchecked discretion of corporate management, conventional labor unions may run afoul of medical ethical principles. Reconsideration and innovation, to address this ethical dilemma, could provide a solution that aligns both clinicians' and patients' welfare.

What do health care unions do?: A response to Manthous.

In response to Manthous, we discuss the role of unions in health care. The ethical quandary that Manthous perceives in health care worker unions is overstated because patient and worker interests are frequently aligned. The search for a "selfless" union overlooks the importance of adequate compensation for providing excellent care. The collective actions employed by health care workers' unions need not include strikes or slowdowns and can be consistent with patient safety and well-being.

Health care unions response: fortifying clinicians' patient advocacy.

In a previous article in this point-counter-point, I argued that work actions could be ethically problematic and undermine clinicians' values and goals. I now respond to the elegant arguments made by Ash and colleagues, presenting additional measures that may be required-until health care unions (if ever) grow-to fortify protections for clinicians who advocate for patient safety and medical professionalism.