Doctoral Dissertation Improvement Grant: Healthcare and Community Citizenship among Unionized Service Workers in Central Appalachia

Transformations from an industrial to a service economy, rising insurance costs, neoliberal social policies, and decreased labor union power have increased the number of Americans with reduced access to health care, especially for service workers and women. Quantitative public health surveys measure access to health care for individuals but fail to account for or contextualize dynamic concerns of individuals and families. Grounded in a theoretical perspective of political economic medical anthropology and citizenship, this research is an ethnographic study of the importance of health care benefits for rank-and-file service workers and their households. Focusing on service workers in two unions in the "new" or "social movement" unionism, the Service Employees International Union (SEIU) and the United Steelworkers of America (USW A), this study investigates the significance of health care benefits resulting from union membership, explores health care concerns, barriers, and strategies to obtain care for individuals and households, and describes how union member and household concerns, especially regarding health care, are reflected in the actions of these union locals. Methods and Analysis: This research incorporates multiple methodologies to triangulate data and enhance analysis. In-depth interviewing with male and female service union members (60- 70) will examine the benefits union members identify as reasons to belong to a union, especially the significance of health insurance and access to health care, and the specific health concerns, barriers, and strategies employed to secure health care. Case studies describing the dynamics of household access to health care will be created from a subset of twenty households through secondary interviews, including follow-up interviews with union participants and interviews with their adult household members. Interviews with union staffwill allow for understanding the concerns and actions within the workings of the local labor unions, including insights into the negotiations they have with employers, health insurance companies, and union members. Comprehensive participant-observation at the union locals and within the community will also permit a broad analysis of discourse and activities regarding health care and union membership. Intellectual Merit: Through an analysis of access to health care and substantive citizenship rights of workers in the fastest growing economic sector, this study addresses current U.S. and global processes of economic restructuring and marginalization. By prioritizing "patient perspective" accounts of the daily impacts of reduced access to health care, this research expands medical anthropology and public health understandings of the interconnections and dynamic relations among gendered accounts of access to health care, work and activism. Broader Impacts: Because rank-and-file service workers and women are underrepresented in accounts of health care access, work and activism, this research broadens understandings of their practical struggles regarding health care provisioning. This research spotlights access to health care among workers in the "new" unionism as an issue with the potential to unify labor union, grassroots, and academic activists in articulating and responding to the growing crisis in disparities in health care provisioning. Informed by bodies of literature in anthropology, labor history, public health, gender studies, and U.S. and Appalachian Studies, this project unites disparate bodies of research and encourages further collaborations among these disciplines.