Does unionization and working under collective agreements promote health?

Health promoters recognize the social determinants of health (SDOH) shape health outcomes yet generally neglect how unionization and collective agreements (CAs) shape these SDOH. This is surprising since extensive evidence indicates unions and CAs influence wages and benefits, job security, working conditions and income inequality, which go on to affect additional SDOH of food and housing security, child development and social exclusion. We argue unions and CAs should be a health promotion focus by examining how they influence the SDOH and health outcomes in wealthy developed nations in four ways. First, we consider how union density (UD) and CA coverage (CAC) are associated with differences between wealthy western nations in percentage of low-waged workers, extent of income inequality, and low birthweight and infant mortality rates. Second, we bring together literature that shows greater UD and CAC within national sub-jurisdictions are associated over time with more equitable distribution of the SDOH and better health outcomes. Third, we document-also using available literature-how within nations, union membership and working under a CA shape the SDOH one experiences. Fourth, we carry out a Canadian case study-applying a political economy lens-to examine how power relations, working through economic and political systems, determine extent of unionization and CAC and the inclination of health promoters to consider these issues. Implications for health promoters are considered.