Occupational Disease in New York State: The Political Economic Context

Abstract

In 1987 Landrigan and Markowitz co-authored a report entitled “Occupational Disease in New York State.” They found that death and illness from occupational disease were common and that the costs of exposure to hazardous conditions warranted public funding for new occupational health infrastructure in New York State. A recent confirmatory report recognized a wider spectrum of contemporary hazards and emphasized how public health problems connect to work. These reports provide factual snapshots at 2 points in time, but they do not explain nor analyze the changing conditions they describe. Including macro-contexts such as globalization, financialization, and neoliberalism, this article demonstrates several unique occupational safety and health implications by clarifying key themes related to the state's role, especially regulation and healthcare delivery systems. Conclusions directly tie the trajectory of occupational disease to workers’ collective ability to confront and roll back neoliberalism while pushing occupational disease out of its medical/science silo.

Keywords

occupational disease occupational safety and health work-related health healthcare delivery systems occupational safety and health regulation workforce macro-economics

Introduction

In 1987 Landrigan and Markowitz co-authored a report entitled “Occupational Disease in New York State.” They found:

(1) Death and illness from occupational disease was common

(2) Many workers were exposed to hazardous conditions at work and were at increased risk of developing an occupational disease

(3) The costs of occupational disease to ill workers, their families, employers, insurers, and taxpayers were tremendous

(4) The clinical resources available to diagnose and prevent occupational disease were extremely limited and poorly distributed throughout the state.¹

To contribute to a remedy for these deficiencies Landrigan and Markowitz advocated that the State funds a network of Occupational Health Clinical Centers. Each center would be directed by a physician who was Board Certified in Occupational Medicine and further staffed with a multidisciplinary team that would include an Industrial Hygienist and a Social Worker. The idea was that such a team could provide comprehensive diagnostic and preventive occupational health services to individual patients and to employers and unions seeking to improve workplace conditions.

A recent report reassessed occupational disease in New York (NY) State, looking at the same aspects that occupied Landrigan and Markowitz.² On a general level much has remained the same since the 1987 report, with the general conclusions of that report still valid. However, some of the crucial specifics leading to the conclusions have changed profoundly over the last thirty-plus years. These include:

(1) A recognition that the spectrum of hazards contemporary workers face goes far beyond the chemicals, dust, and metals in the industrial and construction sectors. Hazards like poor ergonomics and stress pose a risk for workers in health care, education, office work, and many other jobs in the service sector.

(2) Increasing acknowledgment of the complex ways workplace and non-workplace exposure to hazards interact to produce disease. The paradigm of specific workplace exposure directly and solely causing a specific disease or set of diseases is an inadequate model for many diseases that are caused by some combination of work and non-work-related exposures. Put another way, work is an important aspect of most people's lives, and as such has the capability of impacting health in a myriad of ways. Work can be shown to have a potential role in all of the major health and public health issues confronting society including cardiovascular health, opiate and other substance abuse, obesity, diabetes, and mental health.

(3) A broadened definition of occupational disease based on a wider spectrum of recognized hazards and more complex models of disease causation.

(4) A shift in perspective from the recognition of occupational disease to continuing investigation of the ways work and health interact.

The Landrigan/Markowitz report was effective in its major goal: providing the factual underpinning to argue for State financing of an Occupational Health Clinic Network (OHCN). Labor unions and their allies in the grassroots health and safety movement, academia, and among Workers’ Compensation attorneys, used the report in their successful campaign to convince the legislature to found the OHCN in 1986.³ However, despite the evaluation and treatment of thousands of workers at OHCN clinics, thousands of recommendations to employers to improve workplace conditions, untold numbers of training and educational efforts, and a myriad of projects working with unions and employers, the toll of work on worker health remains high. A large proportion of workers work under hazardous conditions and are at risk of disease. The availability of clinical resources to address these issues remains alarmingly low.

While the Landrigan/Markowitz and the more recent reports provide snapshots at 2 points in time, they do not delve into the explanation for the conditions they describe, nor offer an analysis to explain the changes that have occurred in the 30 or so years in between the reports. Understanding the context and causes of the reports’ findings is crucial to any attempt to move more effectively toward reducing the adverse impacts work inflicts on health. The following is an attempt to describe key aspects of that context while acknowledging the limitations of any attempt to capture the full complexity of a large state over a several decade period.

The Macro-Context

On the most macro-scale, the global capitalist system provides the context for the political economic environment on the national, individual state, and local levels. Over the last several decades that system has been characterized by 3 major interconnected developments that have given these environments specific shape:

(1) Globalization

(2) Financialization

(3) Neoliberalism^4,5

Globalization

Marx characterized capitalism as a global system, but it is really only relatively recently that almost every country on the planet has been more or less incorporated into a unified arrangement. In the United States, the impact of globalization was being felt in the 1970s with the wave of industrial plant closings, and the transfer of manufacturing jobs to lower-wage countries. In 1999, antiglobalization activists at the Seattle meeting of the World Trade Organization (WTO) brought the issue to widespread consciousness in the United States. Despite the opposition in the United States and elsewhere, globalization has continued as capital engages on a relentless search to lower labor costs, find the least political, regulatory, and labor union impediments, and shed responsibility for the human and environmental costs of its activities. The result has been the creation of international “supply chains” where the extraction and manufacturing are done in countries in the Global South, and the research, design, marketing, and consumption takes place in the developed capitalist countries. Profit, as might be expected, mostly accrues to multinational corporations and the developed world.⁶

Financialization

In the 1950s manufacturing accounted for 2% of GDP in the United States, while the finance/insurance/real estate sector (FIRE sector) made up 13%. Fifty years later, those proportions were almost exactly reversed. This shift in economic activity is what analysts refer to as “financialization” of the US’ economy. While banking, credit, and investments are integral features of capitalist economies, the more recent growth of this sector is unprecedented. While the causes of this sector's growth are the subject of debate, it appears that the long-term tendency of mature capitalist economies is toward stagnation, or difficulty sustaining profits and growth. According to some economists, the root of the problem is that productive capacity exceeds the capacity of the market to absorb what is being produced. This is a chronic problem leading these economists to see periods of more exuberant growth as the exception, rather than the norm.^7,8 This problem reached its apex in the Great Depression of the 1930s. As the stock market crashed, unemployment mushroomed, and fewer people could afford to buy consumer goods, reducing the capacity of the market to absorb production. Credit froze, prices fell, and factories continued to close or reduce capacity. In a vicious cycle, more people lost their jobs and were unable to afford consumer goods, further reducing the capacity of the market to absorb production.

President Franklin Delano Roosevelt responded with the “New Deal” which created a welfare state based on the ideas of the economist John Maynard Keynes. The New Deal both created employment directly by having the government hire people to perform work and it put purchasing power in the hands of those who did not have jobs with unemployment insurance and welfare payments. By providing income to those who did not have it, the New Deal's Keynesian welfare state increased the capacity of the market to absorb production. The price of stabilizing capitalism in this way is a downward redistribution of wealth. By the 1970s, Keynesian policies were no longer functioning to prevent falling rates of profit for many large corporations in the United States, due, at least in part, to growing foreign competition. The 1970s neoliberal assault on the Keynesian welfare state, discussed below, was a response by the corporate class and the state to this problem. As a consequence, whatever stabilizing balance Keynesian policies had achieved was upset, as companies sought ways to maximize profits while simultaneously redistributing wealth upward out of the pockets of the working class.

In an environment where profit became harder to extract from the manufacture of things, other opportunities were sought to invest surplus capital. To meet this demand banks and investment companies developed a myriad of financial “products.” In addition, bankers and investors saw the wallets and bank accounts of the working and professional/managerial classes, as well as the coffers of other capitalists in the industrial and service sectors as lucrative sources of wealth to be tapped for profit. Toward that end massive amounts of credit were offered to induce people to buy homes (mortgages), go to school (student loans), and buy “stuff” (credit cards). One economist characterized this as an “expropriation” and the “systematic extraction of financial profits out of revenue of workers.”⁹ ^{P 138–159, 277–300} Corporate debt also has played a role in diminishing wages and benefits unions have been able to extract. Resources that could be available to improve wages and benefits are instead utilized to service the debt.¹⁰ As a result, wealth inequality has soared as a relative few have become incredibly rich or richer, and many become mired in debt.

Neoliberalism

What has come to be called the “neoliberal era” was ushered in during Carter's presidency in the late 1970s. Faced with high inflation and uneven growth, Carter's head of the Federal Reserve, Paul Volcker, dramatically raised interest rates. This had the effect of cooling inflation, while also plunging the economy into a significant recession, dampening business activity, accelerating deindustrialization, and raising unemployment.¹¹ Increased unemployment reduced the willingness of workers to stand up for themselves in the workplace for fear of job loss. This set the stage for the assault on unions that followed. With the election of Ronald Reagan to the Presidency in 1980, a more fully articulated neoliberal agenda replaced the policies of the Keynesian welfare state.¹²

The intent of neoliberalism was to remove barriers to maximizing profits. In practice that meant limiting government spending and corporate taxation; reducing government regulations; and radically reducing worker power by destroying existing unions and preventing the organization of new ones. Reagan signaled the ruthlessness of this approach by handling of the Air Traffic Controllers strike through mass firing rather than negotiation. He led successful efforts to cut taxes for the rich and for corporations. Though government spending increased during his presidency, Reagan was able to reduce the rate of increase to its lowest since Eisenhower. Military spending was the only major category immune from budget restrictions. He appointed a cabinet filled with people committed to finding ways to reduce their own departments’ power and role putting limits on the corporate class.¹³

The administrations that followed largely used Reagan's template. George H.W. Bush pursued policies that would establish neoliberal policy as the structure of a global architecture of trade. Bill Clinton followed this same path. He accelerated globalization by finalizing the North American Free Trade Agreement (NAFTA) and negotiating the creation of the WTO. Other Clinton initiatives included radically reducing eligibility for government-sponsored welfare programs, touting both the financial (ie, reducing government spending) and moral (ie, promoting self-reliance and reducing “dependency”) benefits.¹⁴

The financial sector was a particular deregulatory target for several administrations. Notably, under Clinton, the Glass-Steagall Act was repealed. Legislated under President Roosevelt during the depression, the Act created a wall between the investment and banking divisions of financial firms. After repeal, the sorts of intrafirm collusion the Act was meant to prevent played an important role resulting in the great recession of 2007-2008.¹⁵ By the time Barack Obama was elected President in 2008, neoliberalism had become the common wisdom of the age, accepted by both Republicans and Democrats.

The results of neoliberal policies have been dramatic. Financialization and its de-regulation directly led to the crisis of 2007-2008 which threatened to produce a systemic meltdown. The effects are still being felt by a working class that bore the brunt of the crisis.^16,17 Wealth has been transferred upward to the corporate class, while the export of jobs has impoverished the working class and greatly diminished the “middle class.” The balance of power between labor and capital has shifted enormously to the advantage of the corporate class. Historically, unions have been the organizational vehicle empowering workers and the working class to achieve better wages, benefits, working conditions, and government policies. In the neoliberal era, unions have markedly shrunk in terms of both members and power. The barriers to organizing a new union and successfully negotiating a contract are formidable. A declining presence, and a loss of support among the nonunion broader public who see only union faults rather than benefits, has contributed to the diminished political power wielded by unions. Increasingly dominated by big corporate and professional donors, the Democratic Party has prioritized those interests while assuring themselves that labor has nowhere else to go. However, there have been a number of recent union victories that may indicate a shift in the power dynamic. Unions have established a foothold in some traditionally nonunion industries including coffee houses (Starbucks) and warehouses (Amazon). In addition, the United Auto Workers (UAW) has scored several major victories with its strike at the Big Three automakers, its negotiation for a new contract with Daimler Trucks, and its breakthrough organizing of a new local at a Volkswagen plant in the notoriously difficult to organize south. The entertainment industry was the scene of strikes by both writers and actors that won significant concessions. Sustained union organizing and militancy would counteract the prolonged impact of the neoliberal corporate antiunion campaign.

New York State's political economy has been shaped by the same forces that have characterized the larger national, and even global, capitalist context. Some of the specific ways those forces have shaped New York State (NYS) are explored in the sections that follow along with their implications for the recognition and prevention of occupational disease.

Changing Work

The past several decades have been marked by the loss of manufacturing jobs in New York State. Between 1970 and 2021 the proportion of manufacturing jobs fell from 21.1% to 5.8%. In its place, “services” came to dominate and today education, health care, food and lodging, and warehouse- and transportation-related industries rank as most important across the state. Public sector jobs have also been an important employment source.^18,19

These general changes have not impacted the whole state uniformly. New York State is divided between Downstate (New York City and environs) and Upstate (everywhere north and west of the lower Hudson Valley). Downstate's economy has thrived in important ways. With Wall Street as the epicenter of the financial world and Manhattan as a real estate mecca, the “City” has benefited overall from the financialization of the capitalist economy, though the benefits have been distributed unevenly. Upstate the picture is quite different. Medium-sized cities that were heavily dependent on manufacturing, such as Syracuse, Rochester, and Buffalo, struggle to reinvent and redefine themselves. Large swathes of upstate are rural, dotted with small towns and cities. Many of these areas were devastated by the closing of one or more dominant employers, such as mines, mills, or factories. Especially in rural areas, public sector employment, for example in the many state prisons built in far-flung locales, has become increasingly important as a source of jobs.^20,21

The manufacturing jobs that have left the state were generally relatively well paid, with benefits including health care and retirement pensions, all hard won through union efforts. They were jobs that allowed post–World War II (mostly) men to earn a “middle-class” living, meaning they could support a family, send kids to college, and own a home. The jobs that replaced them did not replicate the jobs that were lost. Instead, the vast majority were nonunion, with the creation of some high-wage professional/technical/managerial positions, and a much larger number of low-wage, relatively low-skill jobs.^22–24

Between 1990 and 2018, the increase in low-wage work from 32% to 40% of total employment disproportionately affected Black and Latinx workers. Black and Latinx workers were overrepresented in the low-wage population by 21% and 44%, respectively, while white workers were underrepresented by 18%. In addition, each ethnic group tended to be overrepresented in a unique cluster of low-wage jobs. For example, Black people are overrepresented among health aides and guards, while Latinx workers are overrepresented in housekeeping and laundry work.²⁵

At the same time, the stereotype of the white male wage earner has been upended by a working class that has grown increasingly diverse. Women have entered the workforce in dramatic fashion, with a labor force participation rate of 54.1% in 2021 as compared to 36.8% in 1950, with the most dramatic increase (half the total) occurring between 1970 and 1990.^26,27

Downstate has also seen an influx of Black, Latino, and other people of color into the workforce, a significant proportion of whom are immigrants. Upstate urban areas echo these trends, though not quite as dramatically as in New York City (NYC). Rural areas have also experienced change as agricultural workers from Latin America and the Caribbean have been recruited to work at dairy and crop farms in significant numbers, (an estimated 53,000 currently). Originally many of these workers were migrants, but over the years have become year-round residents. Some have branched out from agricultural work into other sectors such as construction.^28,29

Overall, in 2022 immigrants made up almost 23% (about 4.6 million people) of the state's total population. This represents a 35.6% increase from 1990. As of 2020 immigrants in New York City alone numbered just over 3 million, roughly comparable to 2010 estimates, though a decline of about 200,000 from a 2015 peak. Immigrants are 36% of New York City's population and 43% of the workforce.³⁰

Women, people of color, and immigrants have not been evenly distributed in all industries and jobs. Racism, sexism, and other cultural factors exert a strong influence on the distribution. Women have made inroads into many sectors of the workforce but remain disproportionately segregated in service-sector “pink collar” and “caring” work including health care (nursing, nurse's aides, home health aides), education (teaching), and clerical positions.²² People of color and immigrants are overrepresented among low-wage earners in many sectors.^2,31–35

Like the rest of the country, New York State's economy took a major hit in the great recession of 2007-2008. In the aftermath, the rift between the Downstate and Upstate economies has been highlighted. New York City bounced back from the meltdown and has achieved growth rates bringing it back to above pre-recession levels. Upstate, however, has struggled, and many parts of the state are mired in slow or no-growth rates, leaving them still worse off in 2016, by many indicators, than they were before 2007.^20,36

Implications for Workplace Safety and Health

Manufacturing, agriculture, and construction are thought of as high hazard industries, and they continue to make up a significant portion of NY's workforce (around 4%, 0.2%, and 4%, respectively). However, the now dominant service sector also puts workers at risk of occupational disease through exposures that overlap with those found in industrial settings as well as more recently recognized hazards.²⁵

Workers exposed to “traditional” hazards include about 470,000 potentially exposed to hazardous chemicals, over 42 000 with lead exposure, almost 100 000 exposed to silica, and an unknown number to asbestos. More recently identified hazards include ergonomic conditions putting workers at risk of musculoskeletal disorders. The prevalence of ergonomic hazards is enormous. Over 4 million workers (41% of the workforce) report that their jobs require significant repetitive motion. Work-related stress is another major hazard faced by NY's workforce. As many as 6 million workers report exposure to at least 1 stress-producing condition at work. As discussed below, the COVID-19 pandemic revealed infectious diseases to be another hazard of serious concern.²⁵

While most “traditional” hazards occurred in expected settings, it should be noted that some workers are exposed in more recently recognized occupations. For example, worker exposure to silica dust, a serious respiratory hazard, occurs in work activities such as hydraulic fracturing for natural gas, and the fabrication of artificial stone countertops for kitchens and bathrooms. Another example is the more intensive use of chemical cleaners and disinfectants since the onset of the COVID-19 pandemic in schools, health care, offices, and other settings.²⁵

Exposure to hazardous working conditions produces occupational disease, which, according to recent estimates leads to more than 7000 deaths of New York workers each year. More than 2.2 million New Yorkers are estimated to be suffering from a work-related illness, with more than half ergonomics-related musculoskeletal disorders. Occupational disease accounts for more than 7% of deaths and 13% of disease prevalence annually.²⁵

Low-wage jobs have been increasing in NY as described above. Low-wage work, in which Black people and Latinos are disproportionately represented, is associated with increased exposure to hazardous conditions and has put a large section of workers in the state at increased risk of occupational disease.²⁵

In summary, while the landscape of work in NYS has changed significantly over the last few decades, millions of workers are exposed to hazardous conditions on the job and the burden of occupational disease is very heavy.

Changing Workplace Relations

Neoliberalism has had an important impact in New York State. Working class power as reflected in union density has fallen in New York, as manufacturing industry unions, once the backbone of the labor and safety and health movement, have shrunk dramatically. In their place public- and service-sector unions have gained proportionally, but overall union membership has declined markedly. Though the nonteacher public sector unions retain relatively large memberships, they are hampered by laws that prohibit them from striking and acting in concert, taking much of the teeth out of any threat they might pose.^37,38

With more than 90% of the private-sector work force employed in nonunion workplaces, the ability of employers to impose a neoliberal agenda has been enhanced. The aggressive pursuit of cost reduction in the form of decreased wages and benefits and the creation of new low-wage jobs characterizes this agenda. In addition, the idea of job security has been replaced with the demand for labor flexibility, which in practice often means workers must accept irregular work hours that could mean reduced hours, forced overtime with no notice, and last-minute scheduling.^39–41

In the burgeoning low-wage sector, front-line supervisors (often underpaid and under pressure themselves from their supervisors to “produce”) try to wring every drop of profit from workers. Nothing should be allowed to get in the way of production and since many of these jobs are relatively low skilled, workers who are “too much trouble” can be fired and replaced rather than worked with and accommodated. As a result, workers feel a pressure to work sick, to resign themselves to less-than-ideal childcare arrangements, to sacrifice family, leisure, and health, to keep quiet about health and safety or other problematic workplace issues, and to endure bullying and harassment by supervisors and sometimes co-workers all for the sake of keeping a job and paycheck.^42,43

An important result of the shift in the balance of power between capital and labor is that employers feel they have a freer hand to flout regulations on wages and hours, discrimination, union organizing, and health and safety without too much concern for the consequences. Workers have less capacity to resist directly due to weakened unions and fewer good job options. Government, at the federal and state levels, has signaled a “relaxed” attitude toward holding employers responsible. Meanwhile, workers are often not aware of their workplace rights or the resources available to help them realize those rights. Even if they are aware, they frequently are reluctant to take any action that might expose them to employer retribution.^43,44

Implications for Workplace Safety and Health

Improving workplace health and safety conditions has typically been dependent on workers, unions, and their allies accessing information and utilizing their rights to promote action to reduce or eliminate exposures. In the setting of decreased unionization and union power, and an increase of low-wage and vulnerable work, this has become more difficult for the same reasons workers now struggle to pursue their rights more generally as described above. As a result, there will likely be more workers at risk of occupational disease.

The State and Regulation

With the development of neoliberalism, austerity and deregulation have become dominant themes of policy at both federal and state levels. As a result of austerity and deregulation, the federal Occupational Safety and Health Administration (OSHA) with a decreasing capacity to inspect workplaces, keep up with new hazards, and modify regulations to reflect advances in knowledge about “old” hazards. The number of compliance officers employed by OSHA has steadily declined since the Carter administration with 40% fewer by the Obama administration.⁴⁵ With current staffing levels, it would take an estimated 210 years for all of New York's workplaces to be inspected. Of 38 major health standards promulgated since 1970 only 6 have been finalized since 2000 and none since 2017. The Biden administration promulgated 2 COVID-19-related emergency standards, one of which was soon withdrawn due to the threat of legal action, and the second was ended after a court injunction. The silica standard, promulgated in 2016, illustrates the lengthy standard-setting process with 19 years elapsing between the initiation of rulemaking and its actual implementation.⁴⁶ In addition, OSHA has evidenced much more of a desire to negotiate with regulation-violating employers than to aggressively enforce standards and regulations.^47–50 This shift is illustrated by OSHA budgets during the Clinton years. In 1995 47% of the budget was allotted to compliance activities. By 2001 compliance activities were receiving only 36% of the budget with the difference shifted to compliance assistance. In addition, the budget of the National Institute for Occupational Safety and Health (NIOSH) has fluctuated since the Administration of President Jimmy Carter. Reagan and GW Bush made deep cuts that were only partially restored by Clinton and Obama. During Trump's early years, NIOSH funding remained 6% less in constant dollars than what it had been initially under Carter. These fluctuations, funding uncertainty, and reduced funding have resulted in a reduction in funds for the training of occupational safety and health (OSH) professionals⁴⁵

More positively, also on the federal level, unions and their supporters have managed to keep the Harwood Grant program which funds a number of NYS grass roots safety and health training efforts in the budget. The Harwood program is paltry ($11.5 million nationally) relative to the need for technical and rights-based training among workers working under hazardous conditions. The $11.5 million allocated to the program in 2022 was the first increase in almost 20 years, still lagging almost $5 million behind inflation.^45,51,52 The federal government has also contributed significant resources to programs following health and safety disasters, such as the 9-11 attack on the World Trade Center and Hurricane Sandy.^53,54

Though New York State politics has been dominated by 2 neoliberal governors since 1994 (George Pataki 1994–2006) and Andrew Cuomo (2010-2021), the state has managed to maintain a substantially publicly funded occupational health infrastructure and has passed laws to address important health and safety issues left un- or poorly covered by OSHA. As described in a later section, union, COSH groups (Committees for Occupational Safety and Health), and health and safety advocate coalitions have played a major role in both the successful creation and maintenance of this infrastructure and the passing of OSH legislation. Two major innovations: the OHCN, and the Occupational Safety and Health Training and Education Program (OSHTEP) were legislated in the 1980s when Mario Cuomo, a traditional liberal Democrat, more willing to see government as playing an important role in mitigating the harsher results of an unrestrained capitalism was still in power. Safety and health legislation has included Safe Needles,⁵⁵ Safe Patient Handling,⁵⁶ and the Health and Essential Rights (HERO) Act (in response to workplace COVID-19). New regulations such as the NY Nail Salon Workers’ Bill of Rights passed in 2015 to improve conditions in nail salons have occasionally been promulgated.^57,58

While impressive, the potential achievements of these efforts have been unfulfilled due to the same forces pushing for austerity and deregulation on the federal level. Funding levels for the statewide OHCN and the OSHTEP have remained relatively small and flat for many years. The OHCN receives about $9.5 million and OSHTEP just under $6 million. The last increase for the OHCN was more than 14 years ago. Clinics have struggled to provide the multidisciplinary services expected of them in the face of what amounts to annual funding cuts. COSHs and other groups depending on OSHTEP funding have similarly struggled.^59–61

New York also oversees the Public Employees Safety and Health (PESH) program that enforces standards in the public sector and provides voluntary compliance inspections under contract with OSHA in the private sector. PESH has been long and repeatedly criticized for its less-than-aggressive approach to citations and fines.⁶²

On the one hand, the above-noted, state-passed safety and health legislation and regulations were significant accomplishments, each reflecting the power of a specific union and grassroots advocacy campaign. On the other hand, these laws and regulations were severely compromised, greatly limiting their potential effectiveness. The most significant limitation was the lack of enforcement mechanisms or penalties for noncompliance.^63,64 The HERO Act had the potential as an organizing tool, mandating the formation of health and safety committees if demanded by workers. However, to date the State has failed to put the rules governing the process in place, rendering this an inactive regulation. These limitations reflect the power of neoliberal forces among elected officials and State agencies to blunt pro-worker measures. The strategy allows a neoliberal Democrat like Andrew Cuomo to appear progressive by signing these laws and regulations while appeasing his business backers by constraining the impact.

The Workers’ Compensation Board (WCB) is another piece of New York State's occupational safety and health infrastructure. The role of the WCB is to adjudicate claims made by injured and ill workers for medical and indemnity benefits. Since the 1990s, New York's business community has campaigned continuously to reduce their Workers’ Compensation costs by reducing the premiums they pay to Workers’ Compensation insurance carriers. The legislature has obliged with reform legislation, with the most recent round in 2017. The focus on cost cutting for business has made a system that is tremendously difficult for injured workers and their treating doctors to navigate, even more difficult.^65–70

The State agencies primarily involved in OSH the Department of Labor (DOL), Department of Health (DOH), and WCB) are executive agencies reporting directly to the governor. The governor typically appoints agency leaders. Consequently, they reflect the political agenda and strategy of the governor. As already noted, the limited funding for OSH initiatives like the OHCN and OSHTEP; the passing of toothless legislation and regulations; the meek public employees OSH enforcement program; and the reform of Workers’ Compensation to reduce costs for business at the expense of workers are all consistent with a neoliberal agenda. In addition, each agency evinces a profound reluctance to pursue activities that would identify particular employers or types of businesses as hazardous and in need of change. For example, the DOH oversees Heavy Metals, Occupational lung disease, and Pesticide exposure registries, each requiring reporting of information that could be used to identify hazardous occupations, industries, and specific employers that need to improve workplace conditions. Instead, this information has not been made available publicly or even to affiliated organizations like the OHCN. The patient population of the OHCN provides a rich data source that could be utilized for preventive activities. The DOH has never analyzed or publicized this data beyond a very basic summary many years ago. Likewise, the WCB possesses a tremendous dataset that remains untapped and inaccessible. And while it may be a problem inherent to bureaucracy, efforts are further hampered by the lack of communication and coordination between agencies. It is not coincidental that all of these issues work to the benefit of businesses and their interests in cost cutting, consistent with a neoliberal agenda. Given the state government's structure and hierarchy, it is reasonable to assume that these policies and practices are in line with the governor's desires and approach.

Implications for Workplace Safety and Health

While the neoliberal consensus has shown some signs of fraying since the 2008 recession, it remains the dominant ideology. Consequently, workers will continue to face the same kinds of barriers to stronger health and safety laws, projects, and regulations, and better-funded OSH programs as described in this section.

Overcoming these barriers will remain the task of workers, unions, and their OSH allies and advocates as discussed in a later section.

Changes in Healthcare Delivery

The healthcare industry and healthcare delivery have changed dramatically in the past several decades. One of the characteristics of the American system of health care is the tension between product manufacturers and service providers seeking to maximize profits and product and service consumers attempting to mitigate their costs. In this struggle physician behavior has been identified by health insurers and health policy analysts as a major cost driver, resulting in efforts to exert increased control over provider practices.⁷¹ About three quarters of physicians are now employees of hospitals or other corporate entities. The solo practitioner is becoming vanishingly rare as 90% of physicians entering practice after training are doing so as employees. This is an increase from 60% in 2001.⁷² As health insurers push to control costs, the pressure they exert on corporations and hospitals is transmitted to physician and nurse practitioner employees. This is translated into practices designed to make clinicians more “productive,” meaning seeing more patients in less time and maximizing the “value” of each patient encounter.

Most workers with a possible work-related condition will first seek evaluation from their primary care providers, or perhaps from specialists in fields such as orthopedics or dermatology. The meticulous history taking necessary to make a work-related disease diagnosis can take a considerable amount of time.⁷³ Frequent additional needs include:

- researching unfamiliar exposures and their potential relationship to disease;

- dealing with the paperwork and other excessive burdens of the Workers’ Compensation system; and

- engaging the patient's employer with work-related recommendations.

All of this is time-consuming and mostly uncompensated. Consequently, it runs directly counter to the productivity imperative clinicians labor under.

The difficulties of New York State's Workers’ Compensation system have been a specific major barrier to the recognition of occupational disease. Doctors have long complained about poor compensation, slow payment, too much paperwork, testimony in court, and inability to obtain diagnostic testing and treatment. As noted in an earlier section, New York State has legislated several rounds of Workers’ Compensation reform, most recently in 2017, which made the system even more burdensome and caused many physicians to exit the system. The result has been increasing difficulty for injured or ill workers to find a treating physician, especially for occupational disease. To make matters worse, the WCB has, until very recently, refused to accept medical reports from nurse practitioners and physician assistants, reducing accessibility even further.

An additional matter is that physicians receive minimal training in the diagnosis and treatment of occupational conditions, with medical schools averaging a paltry 4 hours devoted to the topic in a 4-year curriculum. Given the lack of training it is not surprising that providers are reluctant to offer opinions on occupational causation and impairment and lack effectiveness as advocates for their patients when they do participate in Workers’ Compensation.

A more subtle issue is the way that participation in Workers’ Compensation shifts the clinician's role from healthcare provider and advocate to gatekeeper for financial benefits. While patients are trying to wring benefits out of a stingy system, clinicians may perceive they are being pressured to tailor or change their opinions. The result is an antagonistic rather than therapeutic doctor/patient relationship. This can sour physicians’ attitudes toward any patient seeking, or even just asking about, a work-related diagnosis. Patients are perceived as chasing financial benefits they do not really deserve, and as being willing to exaggerate or even fake their symptoms. Clinicians become defensive and always suspicious that patients are trying to “pull one over” on them. These dynamics lead some clinicians to set an inordinately high bar for patients to cross before recognizing an occupational illness. Other clinicians wash their hands entirely by refusing to see patients with potential Workers’ Compensation claims.

Occupational Medicine specialists are residency-trained physicians for whom the recognition, treatment and prevention of work-related disease is a primary focus. However, occupational medicine specialists are few, and only a limited number of small residencies are producing new clinicians.⁷⁴ Many occupational medicine specialists are not engaged in clinical care, opting instead for government, academic and industry jobs. Those involved in patient care typically work in Industrial Clinics or for hospitals, settings that are financially dependent on contracts with multiple employers.

As described earlier, the OHCN was a major innovation to try and remedy workers’ lack of access to employer independent occupational medicine specialists who could diagnose, treat, and prevent occupational disease. Created in 1987, as a result of a campaign by labor unions and their allies, the OHCN includes 8 regionally based centers and 1 center with a statewide mandate to focus on agriculture and farm-related health. Despite its impressive achievements, the OHCN, as noted earlier, has been chronically underfunded and remains small relative to the need. Currently there are only 30 Occupational Medicine specialists in the entire state accepting Workers’ Compensation and taking new patients. Of those 30, OHCN affiliated clinicians make up more than a third. In a state where millions of workers labor under hazardous conditions and where work contributes to the deaths and illness of thousands these are insignificant numbers.²

Implications for Safety and Health

Occupational disease remains un- or under-recognized by healthcare providers. Due to the lack of Occupational Medicine specialists, the powerful incentives for clinicians not to participate in Workers’ Compensation, and the pressure to be “productive,” workers will continue to have great difficulty identifying and accessing medical resources to diagnose and treat their suspected workplace condition. In some situations (eg, “long” COVID-19) workers may paradoxically lose access to medical care by claiming work relatedness and seeking care using Workers’ Compensation. As a consequence, workers suffer illness, disability, and death not only because of the hazards they face, but also because they are unable to access appropriate health care.

Occupational Medicine, Science, and Research

NIOSH plays a key role in determining the direction of occupational health research. In the early 200 s NIOSH began developing a major initiative officially dubbed Total Worker Health (TWH) in 2011. The stated goal of TWH was to further research and encourage practices based on a more complex view of occupational disease than the traditional model of a specific workplace exposure causing a specific disease. NIOSH scientists contributed significantly to this changing conception.^75,76

In theory, TWH focuses on the environments of work and non-work life, identifying the hazards of both, exploring how those environments interact, and searching for ways to reduce or eliminate identified hazards in both. One of the strengths of this approach is that it calls for an examination of the potential role that work plays in virtually any health issue (eg, cardiovascular disease, obesity, opiate, and other substance use).⁷⁷

To date, however, the practice of TWH has not matched the theory. Instead, many “TWH” projects have focused on personal behaviors such as smoking and diet and the responsibilities of the individual in making these choices. The workplace plays a role mainly as a place to try interventions to modify these risk factors through behavioral change. The role of work in the production of disease, and the need to change the work environment to reduce or eliminate hazards is frequently ignored.

NIOSH's pivot to TWH could also be interpreted as a clever survival mechanism in the face of threats to agency funding and the neoliberal emphasis on personal responsibility for health. It appears acceptable to neoliberal critics and offers the possibility of funding for projects that do focus on the work environment and their potential impact on health. Unfortunately, it also wastes limited resources on projects seeking to change worker behavior without attention to the work environment.^78,79

Implications for Safety and Health

NIOSH's TWH approach offers promise in broadening the conception of occupational disease and elucidating the role work plays in producing health and illness. However, to date that promise has not been realized, and it is unclear which direction future efforts will take.

Organizing for Safety and Health

Workers in New York State seeking action on general workplace issues including safety and health have 2 organizational options: labor unions and Worker Centers. For health and safety specific concerns they can turn to Councils on Safety and Health (COSH groups). These organizations have had different trajectories over the past several decades.

Historically New York has been a relatively heavily unionized state. Industrial unions were concentrated in cities like Buffalo, Rochester, and Syracuse. In the service-sector unions have a strong presence among healthcare workers, and public sector workers (teachers, prison workers, state, county and local government, State university, transit) are relatively highly unionized. The construction trades have maintained a statewide presence. The industrial unions have declined substantially in number as factories have closed down. Union membership overall has slipped from 24.0% in the private sector and 69.3% in the public sector in 1983 to 13.1% and 66.7% currently (2021).⁸⁰ With decreased membership has come decreased political clout.⁸¹

Unions at every level including the New York State Federation of Labor, its affiliated Area Labor Federations and Labor Councils, and local unions have advocated for improved working conditions to protect members’ health and have recognized workplace safety and health as a core labor issue. The safety and health legislative reforms in New York that have benefited working people would not have been possible without the active support of the trade union movement.

Public funding through the OSHTEP program has strengthened the health and safety presence in some unions. The public sector unions in particular (Civil Service Employees’ Association, Public Employees’ Federation, and New York State United Teachers) have used these funds to create and sustain health and safety departments.⁸²

However, labor support for health and safety has not been universally consistent. Union staffers have told the author that health and safety issues are not an effective way to mobilize or organize members. Safety and health may be de-prioritized in the face of other competing demands and limited union resources. As an example, the Occupational Health Clinical Center in Syracuse, which the author directed, interviewed a number of members from a union local as part of a larger survey of working conditions among low-wage workers. The union workers identified a number of significant job-related health hazards which neither the employer nor the union had addressed. The Occupational Health Clincal Center (OHCC) met with union staff and provided a report, recommendations for hazard reduction, and an offer to assist in developing a strategy and approach to management. Despite initial union enthusiasm these issues were not subsequently pursued. Industrial unions may be reticent about pursuing health and safety too aggressively out of fear that the company may decide to close up shop and move elsewhere where labor is more controlled. For example, the author observed that a large industrial facility in Syracuse used an extensive amount of machining fluids in the relatively small space of its machine shop. Workers in the shop reported visible aerosol and a variety of respiratory symptoms and skin rashes. For a number of years, the plant was under continual threat of closure and the union explicitly told members not to push too hard for reducing exposure levels as their demands might push the company to close. Despite the union shying away from an assertive campaign, the company subsequently closed and moved operations elsewhere.

Despite their declining numbers and clout, unions remain crucial to worker-focused health and safety efforts in the state. Workers in unionized workplaces are more likely to bring forward health and safety concerns, and more likely to see those concerns addressed.

In the wake of the Occupational Safety and Health Act of 1970, which created OSHA and bolstered worker health and safety rights, the COSH movement spread across larger US cities, responding to the need for occupational health and safety information, training, and advocacy. The groups were union-led coalitions that included health and safety activists, attorneys, and individual workers. COSH groups provide technical assistance to unions and workers, more formal safety and health training and education, and participate in statewide and national health and safety advocacy and legislative campaigns.

Seven COSHs were created in New York of which 3 remain (New York COSH in New York City, Western New York COSH in Buffalo, Midstate COSH in Ithaca), 3 are defunct (Central New York COSH in Syracuse, Rochester COSH, Allegheny COSH in Jamestown), and 1 has been recently re-created (Northeastern New York COSH in Albany) after the original folded years ago.

All of the remaining COSHs have achieved widespread recognition as leading and expert voices advocating for worker safety and health. Yet all remain relatively small organizations, continuously scrambling to maintain funding. And all are fragile, as evidenced by the demise of longstanding and labor-supported groups in Syracuse and Rochester.⁸³

Worker Centers are a relatively new organizational development both in New York State and nationally. They have been built to respond to the needs of nonunion workers, who are the great majority of workers currently in low-wage and high-risk jobs. Workers Centers provide these workers with information about their workplace rights and support them in their struggles to improve their workplace conditions. Most are urban based, but Upstate Centers have expended considerable effort organizing among farm workers. Much of the impetus to create these centers has stemmed from the efforts of immigrants’ rights advocates.^84,85

While wage theft and discrimination are the more common issues brought by workers to the centers, safety and health concerns are also relatively common and considered one of the core areas the centers address. In New York Worker Centers have had some notable health and safety successes. The Upstate Centers convinced OSHA to implement a local enforcement program focused on agricultural hazards by bringing the agency's attention to serious injuries suffered by farm workers that the centers documented and publicized^.^86,87 Downstate Worker Centers, along with NYCOSH, played a key role in revealing hazardous conditions in nail salons (along with wage theft and other poor working conditions) that led to the rapid promulgation of new state regulations that included workplace ventilation and other health and safety concerns.⁸⁸

Like the COSHs, Worker Centers struggle to sustain themselves, existing mostly on grant funding that they must continually scramble to pursue. Their limited resources severely constrain their ability to broaden their reach and increase their impact.

Relations between unions, COSHs, and Worker Centers range from collaborative to conflictual. At times, each group works in its own sphere without the engagement of the others. On the one hand, there would seem to be a natural alliance between groups all struggling for worker rights. But unions have been an embattled group for decades, with a need to defend what they perceive as their turf. In general, they supported development of the COSH groups, but sought to ensure the COSHs were seen as allies not substitutes for the union, and that the COSHs did not pursue activities and campaigns that strayed from the union's agenda. Worker Centers may be perceived as more of a direct threat to unions as they build alternative organizations and strategies among the unorganized. Most unions’ answer to the problems of unorganized workers is simply to join a union. Worker Centers counter with the observation that unions have not seemed to put adequate effort into organizing, particularly among low-wage and immigrant workers, and when they do, they have not been very effective. It should be noted that these are generalizations and may not accurately describe conditions in specific parts of the state.

Over the last few years there have been some encouraging signs of union rejuvenation in New York State. The COVID-19 pandemic impelled some unions, particularly teachers and nurses/healthcare workers into action to protect members, and to advocate for student and patient safety. In addition, as part of a nation-wide trend, union organizing in previously unorganized sectors gained momentum with workers at Starbucks and Amazon voting to join unions. Unions have also been important supporters of health and safety legislation including the Safe Patient Handling Act⁸⁹ and the HERO Act⁹⁰ which opened up possibilities for worker and union health and safety organizing.

Health and Safety Implications

New union organizing in companies such as Amazon and Starbucks has sought to address health and safety issues among other working conditions. Perhaps the inclusion of health and safety in these active organizing campaigns will encourage similar activities among other workers, both organized and unorganized.

Compared to other states, New York has a developed safety and health infrastructure and health and safety legislation that provide resources, access, and opportunities for workers. Despite their shrinkage, unions maintain a significant presence in New York, particularly in the public sector. Some of these unions have strong health and safety staff. Labor will remain an essential part of any coalition advocating for improved working conditions. In addition, as indicated above, there are grassroots organizations, including COSHs and Worker Centers that have a strong track record supporting worker health and safety efforts, and who also will remain core coalition members.

Recent Developments

COVID-19

The COVID-19 pandemic has added a new crisis, the full long-term contours of which are unclear. While many businesses, particularly smaller ones with relatively small profit margins and dependency on in-person gatherings (eg, restaurants) closed, initial dire predictions of massive personal bankruptcies, business closures, mortgage foreclosures, and rental evictions, gaping state budget deficits have not come to pass. Government intervention (eg, business loans and grants, supplemental unemployment insurance, rent moratoria) effectively mitigated many of these expected problems. However, while the pandemic has been officially declared over, COVID-19 remains an ongoing issue and crises may have been deferred rather than averted.

New York State stepped in early to try and control the pandemic. Governor Andrew Cuomo used emergency powers to take measures impacting worker exposure by designating certain nonessential workplaces to close, mandatory masking, and other steps. These actions were not undertaken specifically to protect worker health, but rather as general public health measures and as means to prevent hospital overload. As noted in a previous section, NYS passed the union-supported HERO Act which required, in a public health emergency, employers to implement an exposure control plan to minimize worker exposure to airborne infectious agents, which basically functions as a substitute for an OSHA standard. Additionally, the Act requires employers to create health and safety committees if requested to do so by workers. This part of the law has been theoretically in force since 11/1/21, but final regulations guiding implementation have not yet been issued.⁹¹

As the pandemic has unfolded, the perception of its nature has transformed from a health/public health crisis to a question of economic health. Preliminary estimates for workers at the highest risk of COVID-19 exposure in NYS were just under 300 000 for healthcare occupations and about 140 000 in non-healthcare jobs with more than 10 000 COVID-19 infections to be expected. Another study estimated that more than 3 million workers in the state had some increased risk of occupational COVID-19 exposure and predicted more than 1,200 deaths would result.²⁵ Despite ongoing significant levels of exposure, and predicted infections and deaths, the “normalization” of life has been vigorously pursued. As in other states, the protection of public health as a top priority was replaced by business reopening and the “normalization” of life, despite ongoing significant levels of infection. There is little appetite for the re-institution of preventive measures such as mandatory masking, and health officials timidly follow the line laid out by the politicians who employ them.

Health and Safety Implications

With the urgent push to “normalize” life including business operations and consumer spending, health and safety will likely be a low priority or even seen as an impediment to normalization. Regulations and mandates have been increasingly viewed as assaults on individual rights and activities, with supportive politicians and public health officials vilified and receiving death threats. With COVID-19 rates waxing and waning, it appears that business leaders, politicians, and wide swathes of the public have decided to put the pandemic behind them, and politicians and public health officials have shown little appetite for assessing and applying the lessons of the pandemic to prevent future outbreaks or for re-instituting mask mandates or other regulations when COVID-19 rates rise.

However, the health and safety committee provisions of the recently passed HERO Act may offer workers a potentially significant new right that can be implemented.⁹⁰ And some unions have been stimulated to pursue health and safety rights and goals during the pandemic. For example, the author has observed that teachers’ unions in the Syracuse area became quite active around issues including appropriate mask use; school ventilation and air filtration; surface disinfection methods; and school openings and closings. He observed that unions representing orchestras sought assistance in determining safe work practices including seating distances and arrangements; ventilation; masking; and filtration options for air blown through horns and wind instruments. Perhaps these efforts will persist and may translate into a more generalized increased consciousness of workplace health.

Re-industrialization and Economic Development

Recovery from deindustrialization has been difficult for medium and smaller cities across upstate New York. Success has been variable and large-scale manufacturing industries and jobs have not made a comeback anywhere. However, after years of what seemed like a quixotic quest to position itself as a desirable place for high-tech industrial growth, the state succeeded in luring Micron, one of the world's largest semiconductor manufacturers to Syracuse. With promises to invest $100 billion in 4 plants, and projections of 50,000 new jobs, the project would be transformative for the region. Officials are optimistic that the siting of this plant will also result in Albany being chosen for a national chip research facility.^92–95

Micron's decision to locate in Syracuse was dependent upon a package of tax and other incentives worth billions of dollars. Legislation at the federal and the state level (federal CHIPS Act, NYS Green CHIPS Act) enabled the package.⁹⁶ Neither the legislation nor the celebratory rhetoric contains a word about the need to protect workers from hazardous exposures and disease in an industry historically known for both extensive chemical use and increased risk of disease including cancers and reproductive effects.⁹⁷

Implications for Health and Safety

The Micron experience provides an illustration of an approach to economic development that will continue to be used to lure businesses to the state. This approach could significantly change the profile of hazards and related diseases in a region. In a state desperate for redevelopment, especially upstate, corporations and their political allies will try to avoid attention to potentially troublesome issues like safety and health, or environmental contamination. Because of almost universal desperation for bringing jobs to the region, individuals, groups, and unions that seek to bring attention to these issues will have to fight to avoid marginalization. Under these circumstances, the pursuit of safety and health goals will be extremely challenging.

Growth of “Independent Contractors” and “Gig” Workers

As documented in a recent report, there are an estimated 873 000 workers, about 10% of the total workforce in the state, who are misclassified as independent contractors. Truly independent contractors are free from employer control over their time, typically work for multiple employers, and set (or negotiate) their own pay rates. The misclassified workers are employed in low-wage industries, and do not fulfill these criteria. Employers misclassify workers to reduce costs, related to reduced payroll and other taxes and to benefits, such as workers’ comp and unemployment insurance.⁹⁸

Of the 873,000 misclassified workers in New York State, more than half are in New York City, 21% work in Downstate suburbs, and 24% are Upstate. Demographically, there is a distinct contrast. In NYC, more than 70% of misclassified workers are people of color and/or foreign born. Upstate, more than 80% of misclassified workers are white and/or US-born. Fifty-eight percent are men, but women dominate in certain occupations (eg, child care) and for the last decade the number of women entering this category has increased faster than men. Two thirds of the jobs are in 4 industry sectors: Transportation; Other Services (eg, nail salons, housecleaning); administration and support; and construction^.⁹⁸

“Gig” workers are the 190,000-person subset of misclassified workers who are employed in app- or platform-based occupations. “Gig” work has grown rapidly since 2012 when the number of workers was estimated to be 1254. Over 90% of “gig” workers are employed in 3 NYC-based transportation businesses: For hire vehicles like Uber and Lyft (75 000); Restaurant delivery (65 000) and Other Delivery (17 000).⁹⁸

The rise in workers either misclassified or engaged in “gig” work is an attempt by employers to cut costs at the expense of workers, and to reduce union power and the potential of unionization. Overall workers in these precarious jobs suffer from low pay, lack of benefits, and a lack of any job security. With few exceptions, they are unable to access unemploymentiInsurance if they are out of work, and Workers’ Compensation if they are injured on the job. They are not covered by the Fair Labor Standards Act nor the New York State Sick and Paid Family Leave Act. As a consequence, if they are laid off, injured on the job, victims of discrimination or unfair labor practices, sick or needing to attend to a sick family member, they are completely unprotected and uncompensated.⁹⁸

In the face of aggressive corporate lobbying to maintain the status quo, unions and workers’ rights groups have had limited success to date in strengthening worker rights and protections. In 2022 Unions and Workers’ Centers successfully advocated for increased state funding for Labor Standard enforcement efforts. NYCOSH and other worker advocacy groups were instrumental in the successful effort to promulgate new labor standards for nail salons in 2015.⁹⁹ Aside from these cases, and various advocacy groups supporting individual workers’ legal suits against specific employers, misclassified workers remain extremely vulnerable to hardship and deprivation.

Implications for Health and Safety

The hazards found in low-wage occupations employing misclassified independent contractors are amplified by precariousness and lack of access to resources. The hazards faced by workers in these jobs can be significant. Bicycle delivery workers in NYC have a fatality rate over 5 times higher than construction workers.¹⁰⁰ Nail salon hazards include a myriad of plastics, solvents, and other chemicals associated with skin and respiratory disease, and potentially cancer and adverse reproductive effects^.¹⁰¹ Warehouse workers have high rates of musculoskeletal disorders due to the fast-paced repetitive work.¹⁰²

What makes these hazards even more dangerous is that many employers are uninterested in paying the costs of preventing and compensating work-related injuries and illnesses. By denying the worker is an employee, the employer avoids responsibility for training workers on the hazards they work with, providing safety equipment, or paying for Workers’ Compensation insurance. Workers who experience work-related injuries or illnesses can be discarded and replaced. They are left to fend for themselves. In addition, “independent contractors,” who lack legal employment relationships, are continuously at risk of losing their incomes, making it extremely unlikely that they would complain about safety and health risks or seek to improve their working conditions.

Despite these hardships, some gig workers, and misclassified workers will continue to try and organize their co-workers into collectivities capable of finding ways to improve working conditions. COSHs, Workers’ Centers, Immigrant Rights groups, and some unions will continue to ally themselves with these workers. This may be effective for individual workers and in specific workplaces, but a sustained effort to build power will be necessary to effect change on the policy level.

Conclusion

Why does occupational disease persist at such a high level in New York State? What accounts for the specific barriers to the identification and prevention of occupational disease in a perennially “blue” state? These are fundamental questions raised by our report “Occupational Disease in New York State: An Update” that this study has attempted to answer. Briefly, much of the responsibility lies with employers allied with a state government wedded to an aggressive neoliberal capitalist approach to politics and economics.

As described in the preceding sections, the neoliberal approach has implications for occupational disease in a number of ways:

(1) Austerity

The commitment to reduced government spending affects occupational health in fundamental ways by limiting resources for every aspect of the field: training of health and safety professionals; training of workers; research; regulatory activities; publicly funded occupational health clinics.

(2) Deregulation

(3) Hostility to regulation helps ensure that existing state regulation of health and safety is constrained, that the barriers to enacting new regulations are maximized, and that if new regulations cannot be avoided their impact is minimized. On the federal level workplace standard setting and enforcement are severely limited by lack of compliance officers; shifting resources from enforcement to voluntary compliance; outdated standards; and a glacially slow standard-setting process. On the state level, the PESH agency suffers from the same limitations as federal OSHA; and state agencies responsible for safety and health are hamstrung by lack of funding, oversight by bureaucrats beholden to the governor, and lack of coordination between agencies. While New York State has passed several workplace safety and health laws to compensate for holes in OSHA's regulations (eg, Safe Needles, Safe Patient Handling, the Hero Act) the legislation suffers from serious limitations, most notably the lack of effective enforcement mechanisms or penalties for noncompliance. Reducing business costs

Businesses have succeeded in socializing the vast majority of their health and safety costs. Repeated rounds of business-initiated Workers’ Compensation reform have ensured that employers have continued to enjoy the benefits of paying only a small proportion of the costs incurred by injured and ill workers. At the same time, Workers’ Compensation reform has driven many physicians out of the system, making it difficult for injured workers to find doctors and to file claims in the first place.

(4) Reducing union and worker power

The decline of private-sector union density in NY State to 10% as a result of de-industrialization and of the neoliberal assault on unions described above has diminished union presence and power, thereby reducing the availability of the major institutional resources and support workers have to address health and safety challenges.

The neoliberal assault, however, also has provoked resistance and created new opportunities for challengers. The labor movement shows signs of rejuvenation, COSH groups have persisted, and Worker Centers have emerged. New York State still has a relatively developed health and safety infrastructure and set of regulations that came about due to the efforts of creative workers and their organizations and could be effectively exploited and perhaps developed further.

Over the long term, the trajectory of occupational disease is directly tied to:

- The increased collective power of workers and their ability to confront and roll back neoliberalism to strengthen unions and increase their health and safety capacity and to strengthen health and safety regulation as well as increase public funding for health and safety.

- The ability of health and safety activists to push occupational disease out of its medical/science silo, in which inquiry into the causation of disease stops with the identification of hazardous agents, and firmly onto the agenda of movements for workers’ rights, in which the power of the workers to compel employers to implement solutions in the workplace is understood to be a key driver of prevention as is the capacity of the state to make and enforce regulations to protect worker health and safety.

Footnotes

Declaration of Conflicting Interests

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

Funding

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

ORCID iD

Michael Lax

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