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Chapter 8 The New Employment Contract and Worker Health in the United States Richard H. Price and Sarah A. Burgard H istorically there have been three arenas of policy debate in the United States relevant to the health effects of employment for workers and their families . First, the physical environment of the workplace and its health impact has been a major arena of policy debate. The pathways from the physical environment to health include exposure to chemical and biological hazards leading to disease, as well as physical risks to safety. Second, the demanding nature of work activities has also been the topic of policy debate. The pathway from work activity to health most often implicates work stressors involving too little task control and high levels of demand, and the biological consequences of stress in response to work demands. Most recently, the contractual nature of jobs—their insecurity and their lack of benefits—has become a third major arena of policy debate. Here the pathway to ill health involves the stressful anticipation of involuntary job loss, the stresses associated with economic hardship following job loss, and the healthcompromising conditions associated with managing part-time or otherwise nonstandard jobs that lack predictability, adequate benefits, and adequate income. The debate on conditions of work and health is complex and has involved many different stakeholders. The various stakeholders have included organized labor, business organizations, legislators, and advocates for particular macroeconomic policies aimed at controlling inflation or economic growth. Furthermore, the employment policies that emerge from these debates are not the simple result of a single piece of legislation. Instead, they often involve long-running debates involving Congress, the courts, regulatory agencies, and unions. Workplace policies adopted by employers in the absence of any regulatory or protective legislation can also influence worker health. THE POLICY DEBATE The debate on the physical environment of the workplace and its health impact has revolved around the Occupational Safety and Health Administration, created / 201 by Congress through the Occupational Safety and Health Act signed by President Nixon in 1970. OSHA is responsible for receiving complaints about work dangers, inspect industries, maintain records to assure employer compliance, and render fines on employers for violations of workplace safety and health regulations. Among the policies established by OSHA are standards for workplace safety and health; training of workplace inspectors; creation of state OSHA programs; and exposure standards for cotton dust, lead, blood pathogens, asbestos, and vinyl chloride . There is evidence that these policies have improved worker health and safety. Susan Fleming (2001) reports that even though the workforce has greatly expanded since 1971, occupational fatalities have been decreasing. However, these successes have not been won easily or without considerable partisan policy debate. The protection of the physical health of American workers by OSHA regulation and standards has been the subject of sharply partisan debate, with shifts in policies swinging from one administration to the next. In its early stages, OSHA focused on physical safety, retrofitting industrial machines for safety despite objections to the costs involved. Later the Carter administration expanded the OSHA focus to include exposure to toxic chemicals and biohazards. A watershed change in policy occurred under the Reagan and Bush administrations, which oversaw the initiation of the Voluntary Protection Program. This program put regulation substantially in the hands of industry. The Clinton administration advocated “stakeholder satisfaction” aimed at compromise, but with the Republican congressional majority of 1994, legislation moved to support employer interests with the Small Business Regulatory Enforcement Fairness Act of 1996 and the Congressional Review Act. The George W. Bush administration has moved decisively to institute policies that shift mandatory guidelines to voluntary status and to increase budgetary support for earlier voluntary programs. The U.S. General Accounting Office (2004) has issued a report indicating that these programs are likely to reduce OSHA’s enforcement budget and are of questionable effectiveness in regulating business practices. Turning to the regulatory history around work activities themselves, there is a substantial body of evidence that their timing, speed, demands, and the way they structure relationships with coworkers can be stressful and threaten health through a number of biological, behavioral, and psychosocial pathways. For example , shift work can disrupt circadian rhythms and produce psychosomatic complaints (Frese and Zapf 1986). Lack of variety, complexity, or stimulation; demands for speed; and long hours all can produce stress and health problems (Kahn and Byosiere 1992; Karasek and Theorell 1990; Price and Kompier, forthcoming; Semmer 2003). In addition, ambiguous or conflicting work roles create stress and...

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