Falling Short: The State’s Role in Workplace Safety and Health

Abstract

The state plays a major role in occupational safety and health in the United States, impacting all aspects including resources, training, research, standard setting, and enforcement. Howard Waitzkin has challenged public health activists to rethink their understanding of the State and to replace the dominant pluralist view with a conception that serves as the theory for more effective public health action to improve the health of working people. This paper is a response to Waitzkin’s challenge utilizing a framework that views the State as a reflection of the relationship and power dynamics between capital and labor, within the confines of institutions, policies, and laws organized to protect and maintain the capitalist system. A historical review of safety and health since the Occupational Safety and Health Act of 1970 in the context of the capitalist state serves as the basis for suggestions as to how this might shape safety and health advocates’ strategy.

Keywords

state and occupational health and safety Occupational Safety and Health Act state and worker health

Introduction

Every presidential election cycle the hopes and expectations of activists and trade unionists involved in workplace safety and health are raised. Much of their hope is pinned to electing a Democrat who will make worker-friendly appointments to the Occupational Safety and Health Administration (OSHA) and other agencies concerned with workplace safety and health. Obama satisfied those hopes with the appointment of David Michaels as the head of OSHA. Michaels hailed from the ranks of the progressive academic/activist safety and health community and had written a book highly critical of widespread corporate efforts to cast doubt on possible connections between workplace and environmental exposures and illness.¹ However, Michaels and OSHA functioned within the Obama administration and were subject to the constraints and direction imposed by the administration, as well as the constraints imposed by the historic mandate and development of OSHA itself.

In fact, in the almost fifty years since the Occupational Safety and Health Act (OSH Act) in 1970, the limited rights and protections offered by the act have been seriously eroded, and unions and activists have been engaged in a largely defensive struggle. Howard Waitzkin has asserted that public health activists need to rethink their understanding of the state in order to be more effective in their efforts.² His challenge has relevance for safety and health activists. As Waitzkin suggests, the point of theory is to inform and guide action. For workers, unions, and safety and health activists, action is aimed at finding paths to changing working conditions that allow workers to work without risk of getting injured or ill. Understanding the role of the state is crucial to guiding, or misguiding, these efforts. This paper will look at the U.S. “state” and focus primarily on the federal government.

Understanding the State in Capitalist Systems

The state in modern capitalist societies has been the object of study from many angles. The enduring dominant perspective can be found in every student’s civics or government textbook and conceives of the state as representing the will of the “people” through the election of office-holders who carry out that will through legislation, regulation, and court decisions. The state is a neutral vessel, and individuals can band together in interest groups, each of which have the opportunity to amass the power necessary to influence the state. The structure of the state, with its checks and balances between branches, and the architecture of each branch, is designed to prevent any one interest group from exercising complete control. In this “pluralist” view, the state is supposed to transcend the interests of any one group by representing the best interests of society as a whole.³ The modern liberals and conservatives who make up the majority of the Democratic and Republican parties would likely all agree with the general outline of the state just described.

Explicitly or implicitly, the vast majority of union leaders and activists, safety and health included, accept the pluralist conception of the state. Some accept it out of conviction, others out of pragmatism or resignation in the face of a lack of perceived realistic alternatives. This outlook has important implications for political action in pursuit of their goals and in the construction of the goals themselves. Specifically, it has meant the often uncritical support of the Democratic Party. It has also meant that unions and activists generally “act” within the boundaries set by the state: National Labor Relations Board rules related to union activities and rights; OSHA regulations and activities as the focal points of safety and health; lobbying politicians to advocate for favorable legislation and policy; and testifying at government hearings. Though Democrats are typically counted on, at times it is possible to engage individual Republicans, gaining their support on specific issues.

The Marxist conception of the capitalist state offers an alternative to the liberal view, with its own implications for strategy and action for change. Since capitalism requires the exploitation of labor, Marxist theorists focus their arguments on working-class struggles to gain political and economic power and end that exploitation. It must be acknowledged that there is no monolithic Marxist theory of the state. Marxists have debated the issue contentiously, so the version outlined here is one particular strand, without claiming to be the Marxist theory of the state. It is, however, a useful strand in that it effectively frames and explains the state and offers a basis for action for change in ways unaddressed or theorized by the pluralist perspective. What follows below is a brief summary of some of the key theorists in this tradition, to illustrate the evolution of this strand of thought.

Karl Marx, though repeatedly criticized for his underdeveloped theory of the capitalist state, laid out the fundamental Marxist concept that the state is not a neutral arbiter of “society’s” interests but rather is “the executive committee of the capitalist class.”⁴ The idea that the state is involved in carrying out the will of the ruling class unites all Marxist theorists after Marx. However, the precise relationship between class power and state power has been a prolonged subject of debate among Marxists.⁵

V.I. Lenin, leader of the Bolshevik Revolution that overthrew Czarism in Russia interpreted Marx strategically. For him, the capitalist class ruled through a state apparatus that used repressive means to keep the working class and any opposition movements in check. The task of the revolutionary socialist party was to take over the state and preside over its dismantling.⁶

Antonio Gramsci, an Italian Marxist and Communist Party leader in the 1920s, was an important figure in developing Marxist state theory. Imprisoned by Mussolini until his death in the mid-1930s, Gramsci grappled with the significance of fascism for the socialist movement. Though the fascists obviously made widespread use of the repressive means at their disposal to physically eliminate their opposition, many in the working class supported the fascists as a matter of belief, without being coerced. In this context, Gramsci further developed the concept of hegemony, the idea that the ruling class maintains its domination over society not only through direct repression but also through mechanisms that build consent to capitalist rule. This was an important insight that offers a framework for understanding how in developed capitalist countries the working class can be subjugated and voluntarily colludes in its own subjugation.⁷

Gramsci explored the relationship between the formal state (executive, legislature, judiciary, ministries, army, etc.) and civil society, identifying ways in which the state influenced civil society. Schools and religion were two major institutions in Italian civil society, and Gramsci discussed the roles they played in a socialization process that convinced people to accept the status quo. He also devoted much time to describing the development of the traditional intellectual class and its role in providing ongoing intellectual justification for society as it is. These, and other, ideas broadened both the concept of what the state is and what the State does. They have important implications for socialist strategies for change. Gramsci rejected the idea of emulating the Russian revolution with a frontal assault on the state as unsuited to the more developed countries of Western Europe, instead seeing change as a prolonged process. In his conception, the site of struggle is not confined to the workplace and the state but is more diffuse. Efforts to counter the hegemony of the ruling class include counter-hegemonic activities wherever they are possible. These might include struggles in schools, publishing newspapers, and cultural activities.⁸

Post Gramsci, Marxist state theory was relatively neglected until its revival in the 1970s with a debate spanning several years between Ralph Miliband and Nicos Poulantzas. The exchanges between the two have inspired much of the thinking among Marxists since then. Miliband wrote The State in Capitalist Society in the late 1960s. In this work, he was primarily concerned with critiquing the dominant liberal view of the capitalist state as a neutral arbiter of society’s general interest. He argued that the capitalist class played a dominant role in the state but that class power was not synonymous with state power. Miliband described some of the mechanisms the capitalist class used to gain influence in the state including capitalists capturing top jobs in government and a socialization process that helps ensure that other government employees share a common outlook on the role of the state in protecting and furthering the interests of capital, even if they themselves are not, strictly speaking, members of the capitalist class.⁹ Poulantzas criticized Miliband for placing too much emphasis on the specific people in state positions and neglecting the central role of state structures in determining how the state functions. According to Poulantzas, the state developed with a primary function of facilitating the capitalists’ accumulation of capital and the state structures that have developed reflect that function. Consequently, anyone, even the reform-minded, will find their field of action enclosed by the constraints imposed by the way the state is structured and functions.¹⁰

However, Poulantzas does not share the idea of the state as merely the “executive committee of the capitalist class.” Instead, he proposes the idea of “partial autonomy” of the state which maintains the connection with the capitalist class but denies that the class and state are synonymous. Poulantzas recognizes that all capitalists share a general desire to maintain and perpetuate the capitalist system but that the class is not monolithic in its economic interests, or in its politics. Different factions of capitalists may oppose each other’s economic interests, as, for example, oil versus renewable-based energy companies, and will push for different governmental energy policies. Even capitalists with shared economic interests will invariably have differences over the best political approach to realize those interests. They will support different candidates for office and will lobby for different legislative and regulatory agendas. Intracapitalist conflict can be intense and state policies reflect the power dynamics between the conflicting factions. However, “partial autonomy” of the state is necessary to allow the state to act against the interests of specific sectors of capital to maintain the viability of the overall system. In this view, the state acts as a manager always serving the overall capitalist system rather than the impartial “referee” of the pluralists.^11,12

Like Gramsci, Poulantzas conceives of the state structure and function broadly. He asserts that the state fulfills its role through action in three spheres: economic, political, and ideological. He also shares Gramsci’s view that mechanisms of repression and consent are at play in keeping capitalist societies in order, though he emphasizes the fact that the use of repressive means is still amply in evidence.

Many theorists have found Poulantzas’ work prescient and valuable and have sought to develop Marxist state theory using aspects of the base he created. Bob Jessop, a British Marxist, in particular has explored and developed important themes that are inspired in large part by Poulantzas. Jessop’s central proposition is that the state is neither an object of study nor a subject autonomously creating an identity and pursuing action but rather is a “social relation.” Poulantzas argued that State structures embodied relations between the two fundamental classes in capitalist society: workers and capitalists. In suggesting that that relationship is the state, Jessop rejects the idea that there is a separation between class power and state power. However, this is not a hearkening back to Marx’s view of the state as the “executive committee” of the ruling class. Jessop’s conception recognizes that the capitalist class is not united in its economic and political aims and also recognizes that the strength and activity of the working class plays an important role in shaping state policies and activities. Consequently, the state at any given time reflects the balance of forces between different factions of the capitalist class and between capital and labor. These forces struggle on already existing terrain which limits their potential choices for action. The state is already quite developed with institutions, bureaucracy, and laws organized to perpetuate the protection of the capitalist system. One key implication of Jessop’s framework is a recognition that while capitalists may agree on the general need for the state to play a role in perpetuating capitalism, there is no guarantee that the state will be successful in that role.¹³ As an example, the state may very well fail in protecting capitalism from literal extinction due to climate change. Another example is how capitalist policies of financial deregulation led to a meltdown in 2008 that brought the system to the brink of collapse.

One theme that has dominated state theorists of all persuasions over the last three decades has been the issue of the impact of globalization on the state. Some have argued that a globalized economy has largely diminished or even negated the role of individual nation states, rendering much state theory obsolete. Poulantzas had already considered this issue in the 1970s and agreed that the nature of capitalism was changing with the growth of multinational capital. But he argued for the continuing importance of individual nation states in protecting and furthering national interests and in jockeying for advantageous positions in the developing world economic order. Jessop and others agree on the continuing importance of the nation in globalized capitalism. However, they also recognize the rise of supranational organizations like the World Trade Organization and the European Union which do impinge on an individual nation’s ability to fully control its own economic activities.¹⁴

Finally, the unique role the United States has played in the construction of a globalized capitalist system must be acknowledged. The size of the U.S. economy, and the might of its military, has allowed the United States to play a dominant role persuading other countries to follow Washington’s lead or risk its wrath. The consequences of deviation include both economic and military coercion.

What follows below is an attempt to use synthesis of this theoretical framework to analyze the role of the state in OSH since the signing of the OSH Act and to suggest the implications for those involved in actions aimed at improving working conditions.¹⁵

OSH in the Twilight of the Welfare State

The Postwar Welfare State

The thirty years following the Second World War was characterized in the United States by an economic boom that created profits for corporations and rising wages and standard of living for much of the working class. Manufacturing provided the backbone of the economy, and workers in these industries were able to achieve a solid “middle class” existence. Unions were crucial to these advances, building strength following the massive organizing in key industries including mining, auto, steel, and rubber in the 1930s and benefiting from the political space opened up in the New Deal era.

The New Deal provided the basis for what became the postwar welfare state. The growing economy and relatively empowered labor unions allowed the redistribution of a portion of corporate profits. Some of the surplus went into wages and benefits, putting more money in workers’ pockets, which in turn put more money into the economy as workers spent that money. The surplus also allowed for the expansion of the social safety net and other public programs that increased protections and prospects for broad swaths of citizens. Education, healthcare, housing, and social security were among the areas addressed.

As the Cold War commenced, anti-Communism became a dominant theme of U.S. life. Under the impetus of a virulent anti-Communism, left-wing activists of all types were rooted out of union positions, resulting in a purge of a whole section of workers who had been crucial to the movement’s organizing and success. One result was that the movements that developed in the 1960s and 1970s to demand rights and justice were not led, or even necessarily supported, by the official union movement. These efforts included the heroic struggle of African Americans for political, economic, and social equality, a huge anti-Viet Nam war movement, a women’s movement, and a fledgling environmental movement. The student-led creation of a New Left, and “counterculture” rejected many of the values of “middle class” America and advocated new ways of living.¹⁶

In this milieu, the answer to many of the social problems being brought to light was an enlarged role for the State. Landmark federal legislation brought voting rights and desegregation to African Americans and access to healthcare for older and poor Americans through Medicare and Medicaid. Lyndon Johnson initiated his “Great Society” programs aimed at ameliorating poverty through a modest redistribution of wealth. The social legislation also recognized that unfettered capitalism has significant social costs and that the State needs to play a role in mitigating those costs before they threaten the system itself.^17,18

The ferment of the 1960s inevitably had a powerful impact on unions and workers. By the 1960s, union strength conferred a degree of legitimacy which increased their workplace and political clout. Unions won impressive gains in wages and benefits for many workers and were recognized as an important part of the coalition supporting the Democratic Party.^19,20

These gains, however, did not come without major costs. The purging of the left labor leadership and activists in the 1950s contributed to a narrow vision of union activity focused almost solely on wage and benefit increases. Decisions about what gets produced, how it is produced, and who produces it were considered management prerogatives and not subject to collective bargaining. The unions maintained a top-down structure which centralized power in a small group of officials. The rank and file were generally far removed from decision-making and negotiating. The thorough entwinement with the Democratic Party resulted in mostly uncritical support for the Party and the suppression of any more radical political alternatives. These costs had major consequences for the labor movement, eventually manifesting as weaknesses rendering the union movement unable to resist the transition to neoliberalism in the late 1970s and beyond.^20–23

Setting the Stage for the OSH Act

Prior to the OSH Act, legislation occurred at the State rather than the federal level, resulting in vastly different rules and conditions in different states. The result was a patchwork of weak laws with gaping holes.^24–26 In the mid-1960s, union activity around health and safety was generally at a low level. However, a confluence of factors came together over the next few years that activated at least part of the union movement and created a coalition that included participants from outside labor. The high incidence of work-related injuries and illnesses did not escape the notice of workers and unions and was documented in a report (the Frye Report) published in 1965 by the federal Bureau of Occupational Health. The report along with the work of academic public health professionals like Irving Selikoff at Mt. Sinai in New York who publicized findings of lethal and pervasive occupational disease among asbestos-exposed workers was effective in raising awareness of the toll of workplace injuries and illnesses.^27,28

The late 1960s saw the dramatic mobilization of coal miners around the issues of “black lung” and mine safety. The deaths of seventy-eight miners in an explosion at Consolidation Coal Company in West Virginia on 20 November 1968 galvanized workers and drew widespread public attention to coal mine conditions. The culmination of a rank and file-led struggle was the creation of the Mine Safety and Health Administration which set safety and health standards and a national compensation program for victims of “black lung.” The miners set an example for other workers and unions to emulate.²⁹

Outside of the labor movement, mostly student-based “public interest” groups associated with Ralph Nader were growing, with particular interest in consumer safety and environmental protection. Some of these groups made the obvious connection to workplace health and began developing information to raise awareness and advocating for policy changes.

In addition, Rachel Carson’s Silent Spring was a wake-up call stimulating more widespread exploration and denunciation of toxic pollutants released into the air, soil, and water. No doubt some workers were awakened to the hazards in their workplace when they realized the same toxics that could make someone sick at home were even more likely to make workers sick given the higher exposure levels at work.³⁰

By 1968, the issue of OSH made it onto the radar of President Johnson and important and growing numbers of Congress members. For Johnson, federal legislation to improve workplace conditions was a natural aspect of other “Great Society” legislation. In 1968, he proposed legislation in a major speech. Congress held hearings on the issue.

Though Nixon replaced Johnson in early 1969, momentum for federal OSH legislation was building. Over the next two years, a Congressional battle was waged between competing bills, one aligned with labor’s vision and the other sympathetic to employers. Eventually, the OSH Act that emerged was more reflective of labor’s proposals. This achievement was all the more remarkable as the bill was passed and signed during the decidedly probusiness Nixon administration.

What accounts for this victory? The relative strength of labor, and in particular the efforts of George Taylor (American Federation of Labor- Congress of Industrial Organizations (AFL-CIO) staff), Tony Mazzochi (Oil, Chemical, and Atomic Workers), and Jack Sheehan (United Steelworkers of America) deserve credit. The work of middle class and student reformers in alliance with labor was another crucial part of the effort. In and of itself, it was not enough. Their mobilization occurred at the right time and place, and their framing of the issues caught business unprepared and unable to mobilize an effective response. At what, in retrospect, was the end of the liberal postwar era, the idea that workers should not have to give up their health or their lives for their jobs and that the federal goal had a responsibility to protect working people had widespread currency. Business scrambled to find a way to protect their interests without seeming to be profiteers who put their own financial interests before those of working Americans.^31–33

Shaping the Content of the OSH Act

The OSH Act was a watershed in the history of efforts to make work safer. For the first time, the federal government asserted a central role creating a national uniform floor of regulations. The Act conferred significant new rights on workers and clearly stated that employers bear responsibility for creating and maintaining safe and healthy working conditions. It specifically defined the roles of government, employers, and workers/unions.

The role of the federal government in OSH had several aspects. The setting of workplace health and safety standards with which employers would have to comply and the enforcement of those standards would fall to a newly created agency: the OSHA. Simultaneously, another agency, the National Institute for Occupational Safety and Health (NIOSH), was created to organize and fund the research necessary to support OSHA’s standard-setting efforts. Training and education also was to fall under the mandate of both agencies with NIOSH tasked with funding training for health and safety professionals and OSHA providing funding for worker training.

The OSH Act gave workers important rights in the enforcement process. The right to file a complaint to OSHA was crucial and gave workers a way to bring an inspector into their workplace to investigate a problem. The Act also allowed for worker/union participation in an OSHA inspection and follow-up including accompanying the inspector during the inspection, participating in all conferences held with the employer, receiving reports on the outcome of the inspection, and maintaining the right to contest settlements employers tried to negotiate with OSHA. In addition, the OSH Act gave workers the right to refuse hazardous work and to be protected from retaliatory action by the employer for utilizing their OSHA rights.

Limitations of the OSH Act

The OSH Act gave working people significant new rights and employers important responsibilities while creating a large government role and apparatus for carrying out that role. In defining rights, responsibilities, and role, the Act also created limits within which the whole process was to operate. Some of those limits were the result of the relative balance of power between labor and business, with labor unable to achieve its full agenda. But the limits also reflect the boundaries of labor’s vision characterized by its attachment to the Democratic Party and rejection of more radical alternatives, its top-down service orientation, and its reluctance to activate the rank and file. As a result, in many situations, workers would be forced to look beyond the limits of the OSH Act to address hazardous working conditions.

One significant limitation of the OSH Act was that it excluded a large portion of the work force from coverage by the law. Public-sector workers were not covered, and though partially remedied, around eight million state and local workers remain uncovered. In addition, millions of workers in specific industries, including transportation, agriculture, and Department of Energy contractors, lack coverage. Federal agencies must have health and safety programs that meet OSHA standards; however, no fines may be levied for violations.³⁴

The effectiveness of state OSHA plans has remained a contentious issue, with those plans exhibiting a considerable amount of variability in their quality (conversations, January 2019). Some states have developed effective and innovative programs that likely surpass federal OSHA in many respects. At the other end of the spectrum are states with clearly deficient programs requiring federal OSHA intervention and remediation. A major impediment has been the lack of any widely agreed upon criteria and methodology to uniformly evaluate state OSHA programs.^35,36

While the OSH Act gives workers significant new rights, the gap between the theory and actual effective use of those rights remains wide. Fundamentally, the OSH Act is a prototypical liberal measure that looks primarily to the state to monitor and correct workplace hazards. Safety and health is conceived primarily as a technical/scientific problem and as such will be addressed by trained scientists and medical professionals. While measures are included that promote a role for workers, that role is truncated. As a result, the OSH Act had the effect of demobilizing workers or diminishing the likelihood of workers seeing themselves as active participants in the struggle to control workplace hazards. This aspect was consistent with the unions’ general approach to unionism as described earlier. The business/service model of unionism relegated rank-and-file members to recipients of services provided by union leadership and staff. This model also reflected a fear of an active rank and file upsetting the status quo the union leadership had negotiated with management and raised the possibility of a more confrontational and destabilizing atmosphere. In a unionized setting, the role of the rank and file was to bring potential health and safety problems to the attention of the union. From there, the union in negotiation with the employer would take care of things. If necessary, the union may utilize its own health and safety staff or bring in outside technical consultants. Or the union may decide to avail itself of state resources, primarily OSHA or NIOSH. Often the process devolves into an argument over numbers: permissible exposure limits and risk assessments. Health and safety was something for the experts to address, instead of an exercise of rights or a struggle over workplace power.³⁷

In nonunion workplaces, the rights conferred by the OSH Act were likely to be much less effective, utilized, understood, or even known to exist. Workers employed “at will” live in fear of the repercussions of even asking for information, let alone trying to use their rights. Workers were skeptical of OSHA’s ability to keep the identities of workers who filed complaints confidential. Even if the agency did not reveal any names, in small workplaces, it would be relatively easy for the employer to determine who the “troublemaker” was. Workers also lacked confidence in the strength of whistleblower protections to shield them from discriminatory action. If they did file an OSHA complaint, nonunion workers were disadvantaged by their lack of access to resources that would help them prepare the complaint, prepare for the visit, accompany the inspector, attend conferences, and critically evaluate results. All of these activities are critical to ensuring maximal effectiveness of the complaint process.

Alternative, more participatory models of active worker engagement in workplace safety and health have been envisioned. Workers in these settings would have increased abilities to identify hazards, recommend controls, and participate in the process of hazard reduction. Health and safety committees could be made mandatory. They would need to be supported with paid time for workers to devote to the effort, significant training to build workers’ health and safety knowledge and skills, and workers’ access to their own chosen outside experts and resources. In this context, workers could have a strong say in the identification, prioritization, and control of hazards, which could include influence over decisions as to what materials are used and how work is organized as they are fundamental determinants of health and unhealthy work. However, empowering workers in this way did not fit with either the liberal model of reform or the top-down business union style view of labor.^38,39

Another major limitation of the OSH Act was the cumbersome standard-setting process which has become only more evident over the years. As a consequence, there are standards or permissible exposure limits for less than five hundred of the thousands of chemicals currently in use. While some standards have been updated, many are those adopted in the early 1970s. Even many of those that are updated do not reflect current knowledge of potential health effects and remain higher than what many health and safety scientists regard as desirable.^40,41 Addressing hazards one by one with such a high burden of proof, and a process that allows for multiple interventions by opposing businesses, ensures the impossibility of regulation keeping up with scientific knowledge and the introduction of new materials into the workplace. Finally, even if a standard is promulgated, it can still be blocked, as evidenced by the demise of the ergonomics standard through use of the Congressional Review Act after George W. Bush’s election.⁴²

As a consequence of the limited number, and outdated status of many existing OSHA standards and permissible exposure limits, the effectiveness of OSHA as a tool to secure healthy and safe working conditions has been severely curtailed. Limited and outdated standards often result in OSHA finding no violation and management claiming a “clean bill of health.”⁴³

A good deal of OSHA’s effectiveness depends on the deterrence effect the law and the agency’s activities are able to exert on employers generally. Regulation with teeth would include a substantial risk that an employer will be inspected by OSHA, that the penalties for violations will be financially painful, and that the fines will stick once they have been imposed. The OSH Act fulfills none of these criteria. Staffing levels, particularly of compliance officers, has generally been low, with the threat of an inspection remote.⁴⁴ Though the agency has garnered headlines over the years for large fines levied on specific companies, they are exceptions to the low average cost of a citation, even for a fatality. Fines are routinely contested, appealed, and negotiated down by employers. In certain specific situations, OSHA may have a deterrence effect, but overall, the law lacks the teeth to make it generally effective in this way.⁴⁵

From Welfare State to Neoliberal State

By the late 1970s, the capitalist welfare state was seriously challenged and replaced by what has come to be called the “neoliberal” state. The neoliberal agenda in the United States was a response to a crisis of capitalism and a decline of U.S. power in the face of global competition. The major manufacturing companies saw their profits being squeezed. Unions were viewed as major impediments to the ability of capital to compete. The gains in wages, benefits (especially health insurance for current workers and retirees), and workplace rights unions had fought for and won were targeted by employers as out of control costs. Companies tried to deal with this problem by moving their facilities to lower cost areas in the United States or abroad and by reducing costs at their existing plants. Neoliberalism as an ideology was characterized by a bedrock assumption that the wealth of society as a whole is generated by business and anything that gets in the way of capital’s pursuit of profit threatens society as a whole.⁴⁶

Based on these assumptions, neoliberals elaborated a political economic agenda of “free market fundamentalism,” the major elements of which included:

Reduction in corporate and individual taxes;

Elimination of government regulations impinging on capital’s activities;

Shrinking government and the associated costs of the public sector and privatizing segments that offer potential profit; and

Curbing of union and working-class power.

The last forty years has seen a relentless effort to put neoliberalism into practice, and in Gramsci’s terms, to establish the hegemony of the neoliberal model. This effort has been largely successful as the capitalist class has united around the fundamental ideas and goals of neoliberalism, which have become the dominant “common sense” and have penetrated deeply, even among the working class. On the political level, every administration since Carter has shared the neoliberal perspective and has pursued policies consistent with the neoliberal construct. This is not to say there have been no differences of consequence between administrations but rather to acknowledge that they all have been operating within the confines of a fundamentally shared perspective.⁴⁷

While Trump differs substantially from his predecessors in terms of personal style, overt disdain for democratic aspirations, admiration of other “strong man” world leaders, and bellicose advocacy of “America first” policies, whether this translates into a fundamental challenge to neoliberalism is doubtful. Trump’s proposed policies and budgets fully reflect neoliberal goals.

For the working class and labor unions, the assault of neoliberalism has been a disaster. It has contributed to a drastic diminishment in membership, most pronounced among the industrial unions.⁴⁸ For the last decade, public-sector unions have been a particular target with attacks on fundamental issues including maintaining a union shop, right to negotiate, and right to strike.^49,50 Nonunion workers felt the impacts of neoliberalism as well as at will work that was already precarious and difficult became even more so.

For the state itself, neoliberalism has had a paradoxical impact. Neoliberalism is committed to radically shrinking the role and size of government to cover only defense and a few other “essential” functions. Toward this end, government austerity has been the goal, and programs associated with social welfare have been targeted. Regulations of all kinds come under scrutiny and are targets for elimination in the name of economic growth.⁴⁶

However, administering and maintaining a neoliberal economy requires a significant government effort.⁴⁶ Paradoxically, deficit spending and the national debt have soared under the most aggressive neoliberals like Reagan and now Trump. Spending on the military seems to be immune from calls for austerity. This shift from welfare state to neoliberal state provides the context within which the inherent constraints of the OSH Act have had to operate.

Neoliberalism and OSH

Many mainstream analyses of the history of the OSH Act and the state’s role in OSH compare the activities of each presidential administration, assuming that OSH is primarily an executive branch function and that there are fundamental differences between Republican and Democratic approaches. There are shortcomings to this viewpoint. While the executive branch is tasked with enforcing OSH law, Congress and the judiciary have played important roles in shaping the OSH landscape. The aspirations of any particular administration are tempered by the makeup of the Congress they have before them. While Congress is reshaped every two years, the judiciary turns over more slowly as federal and Supreme Court judges are appointed for life, allowing an administration that finds itself in a position to appoint a large number of judges to have an impact that could last for decades. Consequently, the OSH achievements and shortcomings are not purely those of the administration, but rather the result of the specific composition of administration, Congress and the judiciary at the time. And as articulated by Jessop, it is the totality of actions by all of the state actors that establishes the structures and policies that in turn provide the possibilities and the constraints for action.⁵¹

Austerity

Overall resources devoted to OSH have been small relative to other federal agencies. In constant, 2017 dollars current spending on OSHA and NIOSH is below the Carter administration’s 1980 budget. With regard to OSHA, Reagan slashed its budget 10 percent, while Clinton not only restored the cuts but succeeded in increasing spending 8 percent above Carter. Subsequently, George W. Bush was less of a budget cutter than Obama, as Bush cut OSHA’s funding by a relatively small 2 percent, while Obama’s budgets ultimately cut OSHA 7 percent.⁵²

Like OSHA, NIOSH was cut considerably during the Reagan years and built up under Clinton. In contrast to OSHA, however, Clinton’s restoration was still 14 percent less than under Carter. George W. Bush cut NIOSH’s budget 25 percent. These cuts were restored during the Obama era, though Obama himself had proposed significant cuts in his later budgets that were resisted by Congress. Obama’s 2017 budget leaves NIOSH about 6 percent short of its funding in 1980.^53,54

In terms of personnel, total positions at OSHA have declined nearly a third since 1980. Compliance officer positions followed a more extreme trajectory and are currently about 40 percent less than in 1980. As a result, the number of compliance officers per million workers has dropped from a high of 14.8 under Carter to 5.8 under Obama. Both parties have contributed to the decline in personnel, including under the Obama administration.⁵⁵

Because Congress plays such an important role in budget-setting and spending, the level of OSH resources allocated cannot be solely attributed to the Presidential administration. An administration is not likely to submit a budget that will be dismissed immediately by Congress and will likely work within Congressional expectations. The direction Congress takes is not always along expected party lines. Clinton achieved his budget increases with a Republican-dominated Senate and House explicitly committed, from 1994 on, to an aggressive neoliberal agenda. More recently, Obama repeatedly proposed the elimination of NIOSH funding for professional training, which a Republican Congress restored. Republicans also rebuffed Trump’s attempt to eliminate OSHA funding for worker training grants.⁵⁶

Deregulation

The promulgation, enforcement, and updating of OSHA standards are areas in which neoliberal challenges have been particularly strong and effective. Since its inception, OSHA has been on the defensive trying to prove the relevance and importance of its regulations. It has always been difficult to create an OSHA standard, and that difficulty has only been multiplied under the neoliberal state.

This difficulty is reflected in the history of OSHA standard setting. As might be expected, OSHA’s first ten years saw a considerable number of major health and safety standards promulgated (twelve health and eighteen safety). Less expectedly, in the following twelve years under Reagan and George H. W. Bush, fifteen health and twenty-two safety standards were passed. After George H. W. Bush, the pace of standard setting declined markedly with fifteen under Clinton, six under George W. Bush, and seven under Obama. Over the last twenty years, standard setting has slowed considerably compared to earlier years, despite similar funding, and notwithstanding the administration’s party affiliation.⁵⁷

The Judiciary, Legislative, and Executive branches have all played roles making standard setting increasingly more difficult. In a landmark legal case, employers challenged OSHA’s benzene standard, winning a Supreme Court decision that required OSHA standards to prove a “significant risk” of adverse effect, in practice a risk of at least one worker in one thousand dying from the exposure. As a consequence of the ruling, OSHA has had to devote a tremendous amount of resources toward the necessary proof in order to defend its risk assessment from the inevitable industry attack.^45,58

From the Executive branch originated a demand to justify any economic costs of regulation for business. Already under Carter, the administration proposed ways to inject business cost considerations into OSHA standard setting, but it was under Reagan’s much more aggressive antiregulatory approach that agencies like the Office of Management and Budget (OMB) became much more heavily involved in the review of proposed standards. By 2007, David Michaels, the future OSHA director, testified to a Congressional subcommittee that OSHA standard setting was effectively blocked by “numerous barriers … including Congressionally imposed special reviews by ‘small’ business employers, OMB imposed regulatory reviews, and increasing demands for detailed economic analyses.”⁵⁹

An additional weapon in the deregulatory effort was developed by the Legislative branch. The Congressional Review Act was passed in 1996 as part of Newt Gingrich’s Contract with America and was signed by President Clinton. The Congressional Review Act allows Congress to repeal federal regulations. Ironically, the first time the Congressional Review Act was used, was to repeal OSHA’s ergonomics standard promulgated in the last days of the Clinton administration.⁶⁰ Repeal sent a strong message to future administrations to carefully consider additional regulations as Congress might very well choose to negate with a quick vote the immense effort OSHA puts into readying and promulgating a standard.

Aside from developing new standards, OSHA has also had to face the difficulties of updating outdated standards and regulations. A court decision thwarted an attempt to update its permissible exposure limits en masse in the late 1980s, ruling the agency must demonstrate whether each specific substance poses a significant risk. Even comprehensive standards like lead have not been updated to reflect current knowledge of health effects and risk. Consequently, OSHA is in the remarkable position of disavowing the protectiveness of its own standards and regulations, encouraging those seeking information to consult other organizations and resources for more adequate exposure recommendations.⁶¹

An additional consequence of the barriers to standard setting is the inability of OSHA to keep up with emerging hazards, particularly health hazards. Musculoskeletal disorders, new hazardous chemical exposures like diacetyl, indoor air quality, and workplace violence are among the hazards that are unregulated.

Aside from blocking new standards, and resisting the strengthening of old ones, the deregulatory impulse is reflected in a shift in OSHA’s emphasis from enforcement to consultation and voluntary compliance. During the Clinton administration, OSHA’s resources saw a significant shift. In 1995, OSHA spent 47 percent of its budget on enforcement efforts. By 2001 that had been reduced to 36 percent with almost all of the funding being shifted to federal compliance assistance. These compliance assistance programs included free employer consultation services and development of the Voluntary Protection Program that allows employers to avoid inspections if they agree to meet certain standards.⁶²

Each administration also sets a tone that signals business and labor what they can expect with regard to OSH regulation. And every administration has seen the need to genuflect to business, promising friendlier compliance officers, more cooperation and inclusion, increased technical assistance, a focus on important hazards, and the elimination of “silly” regulations for “nonhazards.” But after the genuflection, administrations have differed substantially in tone. OSHA directors and their supervisors, the head of the Department of Labor, under more aggressively conservative Presidents like Reagan, George W. Bush, and now Trump, have been appointed because of their credentials opposing business regulations and seem committed to finding ways to reduce OSHA’s effectiveness if not eliminate it. In contrast, Clinton and Obama appointed people like Robert Reich and David Michaels to these posts. These appointees had a strong commitment to improving the effectiveness of federal OSH efforts, and their perspectives would not be considered neoliberal.

These differences have been reflected in concrete actions such as more targeted inspections and local-emphasis programs and more citations and fines under Democratic administrations. But generally, more progressive appointees have chafed against the constraints of operating within the context of a neoliberal administration and often hostile Congress and have found their attempts to pursue actions to make OSHA more effective thwarted.⁶³

NIOSH also deserves consideration in a discussion of deregulation. Trump proposed a huge cut that was rejected once by Congress but reproposed by the administration.⁵⁶ A smaller budget means NIOSH will have fewer resources to pursue and fund research. Reduced training funds will reduce the already understaffed OSH professional work force. Without research, fewer regulations can be promulgated or strengthened, and without trained human power, there will be fewer personnel to carry out research- and enforcement-related activities.

Reducing Union/Worker Power

As already noted, unions have been essential to improved workplace conditions and to workers being able to utilize their OSH Act rights effectively. In fact, the OSH Act was a spur to many unions, industrial, service, and public sector, developing their own health and safety staff.³⁸ As unions have lost members, however, many have cut, or even eliminated, that staff. The staff that remain are often underresourced and stretched very thin trying to service a geographically dispersed membership.

Coalitions for Occupational Safety and Health (COSH) groups remain an important support for both unionized and nonunion workers on health and safety issues. But they are relatively small, concentrated in a few large urban areas, and consequently, accessible to only a limited section of the work force. Likewise, Workers’ Centers, which are organizations that have developed over the last couple of decades in many parts of the country, have stepped in to advance the rights, including health and safety, of workers in nonunion workplaces.⁶⁴ In acknowledgement of the role of these grassroots organizations, OSHA under Obama officially recognized them as worker representatives with the same rights as unions to advocate for workers filing an OSHA complaint. Though this was a major step forward to counter the trend of worker/union disempowerment, the experience of these groups attempting to utilize these rights demonstrates their ephemeral and limited nature.⁶⁵

Funding for worker health and safety training was provided for under the OSH Act. New Directions grants under Eula Bingham were important in helping unions and COSH groups hire staff toward building a durable health and safety infrastructure. They were reduced under Reagan and then renamed and increasingly funded (Susan Harwood grants) during Clinton’s second term. Trump has attempted to eliminate these funds. The amount of funding has remained relatively static at around $11 million.⁵⁶ It provides vital funding to unions, COSH groups, and Worker Centers but is a paltry amount when considering the needs of a working population topping 150 million. Other important sources of funding for worker training have included Hazardous Waste Worker and Environmental Justice grants originating in the National Institute for Environmental Health Sciences and the Environmental Protection Agency, respectively. The practical and symbolic importance of worker health and safety training has not been lost on either Democratic or Republican administrations. For Democrats, it is a relatively cheap way to prove their commitment to labor and workers. Republicans achieve the opposite effect by cutting funding or strictly limiting how funds can be spent, proving to their corporate backers they are ready and willing to try and curb labor’s power.

Bumping Up Against the Limits: David Michaels

To further explore the limits of the neoliberal context on OSHA, it is useful to describe the trajectory of David Michaels, who served as OSHA director for both of Obama’s terms. Michaels came to OSHA with a long background as a critic of corporate influence over environmental/occupational science and policy, an advocate for workers and unions in safety and health, and a supporter of measures to strengthen OSHA’s enforcement capacity.⁶⁶ In 2007, prior to his appointment, Michaels testified in front of a Congressional subcommittee and asserted that OSHA was not working for working people. In that testimony, he focused on the major barriers OSHA faced in promulgating and updating standards. His recommendations for improvement included more use of the general duty clause, making the issuance of a comprehensive workplace safety and health standard a top priority and urging Congress to force OSHA to issue standards for beryllium, silica, and other hazards being worked on and to authorize OSHA to adopt the current Threshold Limit Values (TLV) list.⁵⁹ In his seven-year tenure at OSHA, none of these recommendations came to fruition except for the eventual finalization of the silica standard.

In a self-assessment after his time at OSHA came to an end, Michaels noted he had entered a situation as OSHA director where the tools he had to work with in the form of standards/regulations, restricted funding and staff, and the almost impossible standard-setting process forced him to focus his efforts in ways that were different from what he had originally envisioned. Michaels was committed to OSHA’s role and identity as primarily an enforcement agency and was critical of using scarce resources on efforts like the Voluntary Protection Program. He attempted to focus OSHA’s enforcement efforts on high-risk workplaces and paid particular attention to marginalized workers who historically have lacked access to OSH resources.⁶³

Data on OSHA’s enforcement activity show that inspections and violations markedly increased during Obama’s first term compared to the Bush administration. However, that activity was not sustained during Obama’s second term with the number of inspections and violations dropping to below levels seen in the Bush era. The drop-in program inspections were particularly sharp, with 2016 levels a little more than half of the number at the end of the Bush administration. The amount of penalties collected from OSHA citations increased under Obama compared to Bush, but even with a large penalty rate increase in 2016, the amount collected that year was an almost 20 percent drop from the peak in 2012. In summary, the more vigorous and focused enforcement that characterized Obama’s first term was not sustained in the second, as Michaels’ intentions ran into constraints, both fiscal and political.⁶⁷

Forced to work with outdated and absent standards, scant resources, and with Obama’s ambivalent support for regulation, Michaels sought to find other means to use OSHA to improve worker health. In 2013, OSHA issued a remarkable news release that acknowledged the outdated character of most of OSHA’s health standards and the lack of OSHA standards for many hazardous substances and conditions. He encouraged employers, unions, and workers to look to other resources for guidance in reducing hazards to more protective levels.⁶⁸ In a number of ways, Michaels used his position to draw attention to the most vulnerable workers at high risk of injury or illness. Most substantively, OSHA officially began recognizing Worker Centers and other similar groups as worker representatives in nonunion workplaces, giving them the same rights as unions to participate in the complaint, inspection, and follow-up process. Though doing so had its limits as described earlier, it was a marked advance for unorganized workers.⁶³

Michaels came to recognize the importance of tone-setting as a way to increase OSHA’s impact. Michaels’ attempt to use OSHA’s “bully pulpit” as a way to project a more aggressive enforcement tone and increase OSHA’s ability to act as a deterrent. In his posttenure interviews, he pointed to his use of press releases to publicly identify corporate OSH violators as one of his greatest successes, claiming that this practice had a powerful deterrent effect on similar employers.⁶³ Other tone-setting measures under Michaels included support for the continuation of the Harwood funding for unions and worker advocate organizations and, for the first time, securing funding for whistleblower protection efforts.

Conclusion: OSH in the Context of the Capitalist State

Most union and safety and health advocates’ response to the bleak neoliberal terrain has remained firmly within the theoretical framework of the pluralist/liberal conception of the capitalist state. On a practical level, it has meant working for the election of a Democratic president and Congress. It has also meant periodic calls to defend existing worker protections from attack through tried-and-true lobbying methods and nurturing Congressional relationships. While some of these efforts have proven successful such as blocking efforts to defund OSHA’s Harwood grant program, it is not a viable long-term strategy to strengthen the OSH movement. If union and working-class power continues to fade, there will be ever-lessening resources available to devote to these efforts, long-term relationships with Congressional representatives and staff will not be sustained, and new Congressional figures will have even fewer labor connections. This defensive posture, seen as a way to weather difficult times, has morphed into a decades-long position with no end in sight.

Recognizing the nature and role of the capitalist State is critical to the development of a strategy that wins safer and healthier workplace conditions. Returning to Jessop’s conception of the capitalist State, he describes it as a manifestation of the relationship and power dynamics between capital and labor, within the confines of state institutions, policies, and laws organized to protect and maintain the capitalist system. As capital’s power has flourished at the expense of labor, even the limited opportunities available in the welfare-state era to increase resources and rights for workers have vanished in the neoliberal era. The consensus around neoliberal economic policies is in conflict with the idea of social protections and worker rights. The state is organized increasingly tightly around this consensus. In this context, advocates who pine for the “right” Democrat to set things straight and bring us back to the glory days of welfare-state reform will be doomed to disappointment as every Democrat falls short and worker rights continue to erode.

The OSH Act of 1970 was a landmark in the federal government’s role in OSH. It placed responsibility for a safe workplace on employers, gave workers important rights, established a mechanism for developing and enforcing workplace standards, and provided funding for training OSH professionals as well as workers and employers. In addition, OSH funding has contributed to the development of a worker-oriented safety and health infrastructure that includes COSH groups, union health and safety staff, Worker Centers, academics, and clinical practitioners.

However, the Act was hamstrung from the beginning by inherent limitations. Using Jessop’s perspective, labor was strong enough to successfully wring a significant law from a Republican administration. But the content of the law was shaped by the limits to labor’s power and vision, as well as by the constraints of the existing institutions, policies, and ideologies that defined the “possible” of the times. As a result, the Act suffered from inadequate funding, an extremely onerous standard-setting process, low fines, and little deterrence impact, few resources devoted to developing educated active workers and an emphasis on experts rather than empowered workers.

Beginning in the late 1970s, the neoliberal era ushered in a profound shift in power and ideology, as businesses went on the offensive to free capital from the restraints of unions, the costs of wages, benefits, taxes, and regulations. In Gramsci’s terms, the new hegemony saw the state more explicitly as an institution dedicated to removing all barriers to capital’s profitability and ability to hold onto the vast majority of those profits. Under this onslaught, the inherent limitations of the OSH Act have been compounded under every administration since Carter by their commitment to the neoliberal agenda. They may differ in how much of a role the government should play in smoothing some of capitalism’s rough edges, but they all maintain a commitment to deregulation and public-sector repurposing to unleash business’ economic potential. The history of OSH since 1970 reflects differences between the parties that are meaningful but not fundamental. In this context, Republicans like Reagan and George W. Bush have proven they can do a lot of damage, while Democrats like Obama have been limited to rolling back some of that damage.

The election of Trump can be seen as a symptom of a crisis of legitimacy for neoliberalism and the neoliberal state.⁶⁹ The many immiserated by neoliberalism have recognized that “recovery” since the economic collapse of 2008 does not include them, and they are looking for ways to voice a demand for an accounting and for recognition of and provisions to meet their needs. Trump has successfully gained a following by acknowledging this situation as a central issue and arguing that mainstream politicians have failed working people. By emphasizing the “rigged” nature of the system, Trump has articulated the widespread feeling that the state, and the system it protects and manages, benefits the wealthy at working people’s expense. His solution is to combine a more extreme freedom for capital with a fierce defense of the United States’ “rightful place” at the apex of global political and economic power. This message of American “greatness” resonates with an overwhelmingly white base of support that includes a significant portion of the white working class. From this perspective, blame for the current predicament lies with many “others” including foreigners (especially the Chinese), immigrants (Muslims and Latin Americans in particular), environmentalists, unions, women, and people of color. As a predictable outcome of this approach, the country is divided, tensions are high, and the old demons of racism, sexism, xenophobia, and immigrant scapegoating have blatantly reasserted their presence.

The election of Trump has not been the only response to neoliberalism’s crisis of legitimacy. Over the last few years, a substantial political space has been opened, where not only can the doing so directly challenges the idea that neoliberal capitalism, or capitalism generally, is the best of all worlds and argues that the pursuit of justice for working people requires system change. Neoliberalism’s crisis has spawned both the great dangers of Trumpism (or worse) and the brighter possibility of fundamental transformation that benefits the great mass of working people and of humanity as a whole.

All of the state theorists surveyed earlier would agree that that capitalist domination and hegemony will be challenged through the development of a powerful working-class movement. Where they disagree, and where debates continue to rage, is over whether the capitalist state can ever be transformed to effectively serve working-class interests, and what the most effective strategy for transforming the state would be. This theoretical debate will be resolved in practice, which at the moment is dominated by electoral politics.

The presidential campaigns of Bernie Sanders and the election of avowed socialists like Alexandria Ocasio-Cortez are manifestations of the widespread desire for a more hopeful challenge to neoliberalism. How far they, and others with similar politics, will be able to take their agenda within the confines of the Democratic Party is a question yet to be answered. But they have managed to put the issue of fundamental transformation into the mainstream and have gotten specific about what “transformation” might look like in areas like healthcare, housing, labor rights, and the environment.

The “Green New Deal” proposed by Sanders, Ocasio-Cortez, and others is a bold attempt to take on climate change and environmental degradation by addressing root causes and linking technical solutions with economic justice. It challenges a capitalist growth model based on colonial extraction, environmental destruction, and racial and gendered hierarchies. As a consequence of this analysis, any solutions must pose an alternative sustainable model for life on this planet, along with justice for those who have been disproportionately harmed by these environmentally destructive practices. They are examples of a reform that could fundamentally transform neoliberal capitalism and has the potential to unite people across gender, race, and even class boundaries.⁷⁰

The relevance of these developments for OSH activists is that they provide an opportunity for engagement with a growing movement that offers a resolution to the OSH movement’s isolation. Fundamentally, the struggle for OSH is a struggle over the conditions of work and their control. Seen in this way, there is a potential natural alliance with those struggling to gain control of other areas of working-class life. The making and strengthening of connections with the many engaged in these related struggles should be the number one priority of the OSH movement.

This does not mean that other efforts described above should be abandoned. Any measure that improves working conditions and/or increases workers’ ability to assert control over those conditions should be supported. Toward that end, the defense of the Harwood grants or support for a progressive head of OSHA is desirable. The point is that they are not end goals but must be situated and prioritized within a strategy linking OSH to broader systemic change. But without that strategy, the OSH movement will remain imprisoned within the limitations imposed by a neoliberal capitalist State or, worse, will fade to irrelevance.

Despite their limitations, unions, COSH groups, and Worker Centers, as organizations that represent and ally with workers, will remain central to this struggle. To avoid the dead end of utopianism (i.e., a nicely constructed agenda or theory with no practical basis for realization), OSH advocates need to have a clear-eyed sense of the political spaces that are opening up and need to build upon and ally with social forces with the power and interest to challenge corporate control.⁷¹

Footnotes

Acknowledgments

Thanks very much to John Wooding, Jeanette Zoeckler, Federica Manetti, and Natalia Manetti-Lax for reviewing earlier drafts. Thanks to Jeanette Zoeckler also for helping with the research and the myriad details necessary to getting the paper ready for submission. And finally, many thanks to Craig Slatin for his suggestions and guidance.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Author Biography

Michael B. Lax is an occupational medicine specialist and has been the medical director of the Occupational Health Clinical Center in Syracuse, New York since 1988. He is a professor in the Department of Family Medicine, State University of New York Upstate Medical University.

References

Michaels

Tricks of the trade. Doubt is their product: how industry’s assault on science threaten your health. Oxford: Oxford University Press, 2008, pp.60–79.

Waitzkin

Jasso-Aguilar

Contradictions of the state in the struggle to improve access and the social determinants of illness. In: American Public Health Association annual meeting, American Public Health Association, San Francisco, CA, 27–31 October 2012, presentation no. 260482.

Dahl

Who governs? Democracy and power in an American city. 2nd ed. New Haven: Yale University Press, 2005, pp.223–228.

Marx

The communist manifesto. In: McLellan

(ed) Karl Marx: selected writings. Oxford: Oxford University Press, 1977, p.223.

Hay

Marxism and the state. In: Gamble

Marsh

, and Tant

(eds) Marxism and social science. Urbana-Chicago: University of Illinois Press, 1999, pp.152–174.

Lenin

VI.

State and revolution. In: Connor

(ed) Lenin on politics and revolution. New York: Pegasus, 1968, pp.184–230.

Gramsci

Hegemony, relations of force, historical bloc. In: Forgacs

(ed) The Gramsci reader: selected writings 1916-1935. New York: New York University Press, 2000, pp.189–221.

Gramsci

The art and science of politics. In: Forgacs

(ed) The Gramsci reader: selected writings 1916–1935. New York: New York University Press, 2000, pp.222–245.

Miliband

The state in capitalist society. New York: Basic Books, 1969.

10.

Poulantzas

The problem of the capitalist state. New Left Rev 1969; 58: 67–78.

11.

Poulantzas

State, power, socialism. New York: Verso, 2014, pp.117–129.

12.

Levine

RF.

The withering away of the welfare state? Class, state, and capitalism. In: Aronowitz

Bratsis

(eds) Paradigm lost: state theory reconsidered. Minneapolis: University of Minnesota Press, 2002, pp.170–184.

13.

Jessop

State power: a strategic-relational approach. Malden, MA: Polity, 2008, pp.54–82.

14.

Jessop

Globalization and the national state. In: Aronowitz

Bratsis

(eds) Paradigm lost: state theory reconsidered. Minneapolis: University of Minnesota Press, 2002, pp.185–220.

15.

Heino

The state, class and occupational health and safety: locating the capitalist state’s role in the regulation of OHS in NSW. Lab Indus 2013; 23: 150–167.

16.

Moody

An injury to all: the decline of American unionism. New York: Verso, 1988, pp.272–281.

17.

Greenberg

I’m OK with calling LBJ a “liberal hero” (and no, I’m not ignoring Vietnam). The New Republic, 15 April 2014, https://newrepublic.com/article/117369/lbj-accomplishments-make-him-liberal-hero-despite-vietnam (2014, accessed 5 January 2019).

18.

Wood

The Great Society: the forgotten reform movement. The Conversation, 30 January 2015, http://theconversation.com/the-great-society-the-forgotten-reform-movement-35727 (2015, accessed 10 January 2019).

19.

Moody

An injury to all: the decline of American unionism. New York: Verso, 1988, pp.76–77.

20.

Lichtenstein

State of the union: a century of American labor. Princeton: Princeton University Press, 2013, pp.131–136, 141–170, 185–191.

21.

Noble

Liberalism at work: the rise and fall of OSHA. Philadelphia: Temple University Press, 1986, p.48.

22.

Moody

An injury to all: the decline of American unionism. New York: Verso, 1988, pp.41–70, 343–346.

23.

Buhle

Taking care of business: Samuel Gompers, George Meany, Lane Kirkland, and the tragedy of American labor. New York: Monthly Review Press, 1999, pp.147–195.

24.

Page

O’Brien

Nader

Bitter wages: Ralph Nader’s study group report on disease and injury on the job. New York: Grossman, 1973, pp.69–85.

25.

Noble

Liberalism at work: the rise and fall of OSHA. Philadelphia: Temple University Press, 1986, pp.55–57.

26.

Derickson

Inventing the right to know: Herbert Abrams’s efforts to democratize access to workplace health hazard information in the 1950’s. Am J Public Health 2016; 106: 237–245.

27.

Noble

Liberalism at work: the rise and fall of OSHA. Philadelphia: Temple University Press, 1986, pp.71–77.

28.

Page

O’Brien

Nader

Bitter wages: Ralph Nader’s study group report on disease and injury on the job. New York: Grossman, 1973, pp.90–94.

29.

Derickson

Black lung anatomy of a public health disaster. Ithaca and London: Cornell University Press, 1998, pp.143–182.

30.

Grossman

Rachel Carson’s Silent Spring turns 50. The Atlantic, 25 June 2012, https://www.theatlantic.com/health/archive/2012/06/rachel-carsons-silent-spring-turns-50/258926/ (2012, accessed 31 January, 2019).

31.

Leopold

The man who hated work and loved labor: the life and times of Tony Mazzocchi. White River Junction, VT: Chelsea Green Publishing Company, 2007, pp.279–282.

32.

Noble

Liberalism at work: the rise and fall of OSHA. Philadelphia: Temple University Press, 1986, pp.68–98.

33.

Page

O’Brien

Nader

Bitter wages: Ralph Nader’s study group report on disease and injury on the job. New York: Grossman, 1973, pp.137–189.

34.

Occupational Safety and Health Administration. Am I covered by OSHA? https://www.osha.gov/workers/index.html (2018, accessed 28 January 2019).

35.

Oudiz

Views of a Cal/OSHA inspector. New Solut 2009; 19: 493–501.

36.

Nevada’s Workplace Health and Safety Enforcement Program: OSHA’s Finding and Recommendations. Hearing before the Committee on Education and Labor, Senator Harry Reid of Nevada; Jordan Barab, Acting Assistant Secretary, OSHA, Department of Labor; Donald E. Jayne, Administrator, Division of Industrial Relations, Department of Business and Industry, State of Nevada; and public witnesses. 111th Congress, 1st Sess. (29 October 2009).

37.

Lax

Inspiration for a movement: re-reading “Death on the Job” by Daniel Berman. New Solut 2006; 16: 315–346.

38.

Silverstein

Getting home safe and sound: Occupational Safety and Health Administration at 38. Am J Public Health 2008; 98: 416–423.

39.

Noble

OSHA at 20: regulatory strategy and institutional structure in the work environment. New Solut 1990; 1: 30–42.

40.

Johnson

OSHA’s exposure limits are dangerously out of date. Industrial Safety and Hygiene News, 4 January 2016, https://www.ishn.com/articles/103083-oshas-exposure-limits-are-dangerously-out-of-date (2016, accessed 28 January 2019).

41.

Occupational Safety and Health Administration. Lead health effects, https://www.osha.gov/SLTC/lead/healtheffects.html (2019, accessed 31 January 2019).

42.

Mogenson

State or society? The rise and repeal of OSHA’s ergonomic standard. In: Mogenson

(ed). Worker safety under siege: labor, capital, and the politics of workplace safety in a deregulated world. New York: Armonk, 2006, pp.108–140.

43.

Tarlau

ES.

Playing industrial hygiene to win. New Solut 1992; 1: 72–81.

44.

AFL-CIO. Death on the job – the toll of neglect: a national and state-by-state profile of worker safety and health in the United States. 27th ed. Washington, DC: AFL-CIO, 2018, p.96.

45.

Brill

Government breaks the law: the sabotaging of the Occupational Safety and Health Act. Soc Justice 1992; 19: 63–81.

46.

Harvey

The neoliberal state. A brief history of neoliberalism. New York: Oxford University Press, 2007, pp.64–87.

47.

Cooper

Somewhere in between: the rise and fall of Clintonism, The Nation, 14 February 2018, https://www.thenation.com/article/the-rise-and-fall-of-clintonism/ (2018, accessed 31 January 2019).

48.

Bureau of Labor Statistics. Union Members-2018, https://www.bls.gov/news.release/pdf/union2.pdf (2019, accessed 28 January 2019).

49.

Bottari

Behind Janus: documents reveal decade-long plot to kill public-sector unions. In These Times, 22 February 2018, http://inthesetimes.com/features/janus_supreme_court_unions_investigation.html (2018, accessed 31 January 2019).

50.

McCartin

JA.

Convenient scapegoat: public workers under assault. Dissent, Spring 2011, https://www.dissentmagazine.org/article/convenient-scapegoat-public-workers-under-assault (2011, accessed 31 January 2019).

51.

Jessop

State power: a strategic-relational approach. Malden, MA: Polity, 2008, p.6.

52.

AFL-CIO. Death on the job – the toll of neglect: a national and state-by-state profile of worker safety and health in the United States. 27th ed. Washington, DC: AFL-CIO, 2018, p.111.

53.

AFL-CIO. Death on the job – the toll of neglect: a national and state-by-state profile of worker safety and health in the United States. 19th ed. Washington, DC: AFL-CIO, 2010, p.71.

54.

American Federation of Government Employees (AFGE). The future of NIOSH: a view from inside. Cincinnati, OH: AFGE Local 3840, 2004.

55.

AFL-CIO. Death on the job – the toll of neglect: a national and state-by-state profile of worker safety and health in the United States. 27th ed. Washington, DC: AFL-CIO, 2018, pp.109–110.

56.

AFL-CIO. Death on the job – the toll of neglect: a national and state-by-state profile of worker safety and health in the United States. 27th ed. Washington, DC: AFL-CIO, 2018, pp.29–30.

57.

AFL-CIO. Death on the job – the toll of neglect: a national and state-by-state profile of worker safety and health in the United States. 27th ed. Washington, DC: AFL-CIO, 2018, pp.103–104.

58.

Rabinowitz

Judicial interpretations of OSHA’s standard setting authority. In: Dale

Tracy

(eds) Occupational safety and health law. 4th ed. Arlington: Bloomberg Law, 2018, pp.569–614.

59.

Michaels

Is OSHA working for working people?: Hearing Before the Subcomm. on Employment and Workplace Safety of the Senate Comm. on Health, Education, Labor, and Pensions, 110th Cong. 1st Sess. (Apr. 26, 2007).

60.

Scott

The new Republican plan to deregulate America, explained. Vox, 25April 2018, https://www.vox.com/policy-and-politics/2018/4/25/17275566/congressional-review-act-what-regulations-has-trump-cut (2018, accessed 1 January 2019).

61.

Morris

JA.

44 years, halting progress on workplace disease. Center for Public Integrity. 6 July 2015, https://publicintegrity.org/business/workers-rights/after-44-years-halting-progress-on-workplace-disease/ (2015, accessed 2 January 2019).

62.

AFL-CIO. Death on the job – the toll of neglect: a national and state-by-state profile of worker safety and health in the United States. 27th ed. Washington, DC: AFL-CIO, 2001, p.103.

63.

Musick

Long run: an interview with OSHA’s David Michaels. Safety and Health: The Official Magazine of the NSC Congress and Expo, 26 June 2016, https://www.safetyandhealthmagazine.com/articles/14298-long-run-an-interview-with-oshas-david-michaels (2016, accessed 2 January 2019).

64.

Fine

Worker Centers: organizing communities at the edge of the dream. Ithaca, NY: Cornell University Press, 2006.

65.

Liebman

Franko

Reyes , et al. An overview and impact assessment of OSHA large dairy local emphasis programs in New York and Wisconsin. Am J Ind Med 2018; 6: 658–666.

66.

Slatin

Rosenberg

Siqueira

CE.

David Michaels a strong choice to head OSHA. New Solut 2009; 19: 395–398.

67.

AFL-CIO. Death on the job – the toll of neglect: a national and state-by-state profile of worker safety and health in the United States. 27th ed. Washington, DC: AFL-CIO, 2018, p.92.

68.

United States Department of Labor Occupational Safety and Health Administration. National News Release 24 Oct 2013. OSHA releases new resources to better protect workers from hazardous chemicals, https://www.osha.gov/news/newsreleases/national/10242013 (2013, accessed 28 January 2019).

69.

Fraser

Jaeggi

Capitalism: a conversation in critical theory. Cambridge/Medford: Polity Press, 2018, pp.195–213.

70.

United States House of Representatives. House Resolution 109 – recognizing the duty of the Federal Government to create a Green New Deal. 116th Congress 2019–2020.

71.

Fraser

Jaeggi

Capitalism: a conversation in critical theory. Cambridge/Medford: Polity Press, 2018, p.223.