Date Available


Year of Publication


Degree Name

Doctor of Philosophy (PhD)

Document Type



Arts and Sciences



First Advisor

Dr. Mary K. Anglin


It has long been argued that the organization of the U.S. health care system is shaped by the struggles between capital and labor, and this relationship is of increasing significance today. 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. This dissertation is an ethnographic study of how workers in two leading unions in the “new” unionism movement, the Retail, Wholesale, and Distribution Service Union (RWDSU) and the United Steelworkers (USW) in urban Central Appalachia, characterize union membership and economic (and benefit) transformations that threaten security for working and middle class families. Using health care as a case study, this dissertation demonstrates the ways in which economic transformations are making health care less affordable for working and middle class families. Through a discussion of the importance of union membership that highlights job protection in the face of the expansion and increasing feminization of service work and the decline in work sponsored benefits, this dissertation details how these processes reduce access to and affordability of health care. In so doing, this research highlights individual pragmatic action and broader union activism in seeking economic and health security for their families. More broadly, new unionism tactics are described in the actions of a Central Labor Council as it seeks to renew community alliances and link rank-and-file concerns of job security to current labor issues, including the Employee Free Choice Act and Right-to-Work legislation, on local, state, and national levels. This dissertation links access to health care problems in this community to broader national issues (e.g. job protection, service work, and outsourcing) and highlights how union members, individually and collectively, are participating in “new” unionism tactics to maintain job security and secure resources, including health care, for their families.



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