Department of Health, Society, and Behavior, Susan & Henry Samulei College of Health Sciences, UC Irvine Joe C. Wen School of Population & Public Health, 856 Health Sciences Road, Irvine, CA 92617, USA.
Department of Political Science and Department of African American Studies, Penn State University, 308 Pond Laboratory, University Park, PA 16802, USA.
Soc Sci Med. 2024 Oct;358:117254. doi: 10.1016/j.socscimed.2024.117254. Epub 2024 Aug 16.
Labor unions are associated with better wages, improved working conditions, and greater worker empowerment, which may result in better health. However, less is known about the relationship between unionization and health among U.S. healthcare workers, whether the relationship differs among racially diverse workers, and how much control over workplace schedules and location mediates the relationship.
We analyzed a cross-sectional survey of a nationally representative sample of 3000 U.S. healthcare workers collected from March 14 through April 5, 2023. Using ordinal logistic regression, we evaluated whether unionized healthcare workers had better self-rated health (SRH) than their nonunionized counterparts and examined potential differences between White and racially minoritized respondents. We quantified the mediation percentage explained by control over one's schedule and workplace location in the total and stratified samples using Karlson, Holm, and Breen decomposition analysis.
Over a third (36.1%) of racially minoritized respondents were unionized, compared to 22.3% of White respondents. Among racially minoritized workers, a greater share of unionized workers reported excellent health (40.6% vs. 21.8%) than their nonunionized counterparts. In confounder-adjusted ordinal logistic regression analyses, labor union membership was associated with better SRH overall, with a stronger association for racially minoritized workers. Among White healthcare workers, control over workplace arrangements explained 68.1% of the union membership and SRH relationship. For racially minoritized workers, control over workplace arrangements partially mediated the relationship, explaining 17.4% of the variation, suggesting that labor unions may impact health through additional pathways for these workers.
This study provides empirical evidence of the relationship between labor union membership and health among U.S. healthcare workers. We demonstrate that control over schedules and location is an important mechanism by which unionization may protect healthcare workers' health. Among racially diverse healthcare workers, labor unions may play an important role in health through various pathways beyond workplace control.
工会与更好的工资、改善的工作条件和更大的工人赋权有关，这可能导致更好的健康。然而，关于工会化与美国医疗保健工作者健康之间的关系，在不同种族多样化的工人中这种关系是否不同，以及对工作安排和工作地点的控制在多大程度上调解这种关系，人们知之甚少。
我们分析了 2023 年 3 月 14 日至 4 月 5 日期间从全美代表性样本中收集的 3000 名美国医疗保健工作者的横断面调查。我们使用有序逻辑回归评估工会化的医疗保健工作者的自我评估健康状况（SRH）是否优于非工会化的同行，并检查白人和少数族裔受访者之间的潜在差异。我们使用 Karlson、Holm 和 Breen 分解分析量化了在总样本和分层样本中对一个人工作安排和工作地点的控制解释的中介百分比。
超过三分之一（36.1%）的少数族裔受访者是工会成员，而白人为 22.3%。在少数族裔工人中，更多的工会化工人报告了优秀的健康状况（40.6%比 21.8%）比他们的非工会化同行。在调整混杂因素的有序逻辑回归分析中，工会成员资格与整体上更好的 SRH 相关，与少数族裔工人的关联更强。在白人医疗保健工作者中，对工作场所安排的控制解释了工会成员资格和 SRH 关系的 68.1%。对于少数族裔工人，对工作场所安排的控制部分调解了这种关系，解释了 17.4%的差异，这表明工会可能通过这些工人的其他途径影响健康。
这项研究提供了美国医疗保健工作者工会成员资格与健康之间关系的实证证据。我们表明，对工作安排和工作地点的控制是工会可能保护医疗保健工作者健康的一个重要机制。在种族多样化的医疗保健工作者中，工会可能通过各种途径而不仅仅是工作场所控制在健康方面发挥重要作用。
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