Conflicting Agendas, Interests, and Actors in Disease Prevention Policy-Making: Business, Labor, and the High Risk Act

Abstract

During 1985–1988, the U.S. Congress considered and nearly passed the controversial “High Risk Act.” This article analyzes the case in terms of a class-dialectic perspective that views contradictory class interests, the political economy context, intraclass divisions, and institutional biases favoring dominant class interests as important, underlying factors in shaping the character, course, and outcome of the policy-making process. These concepts are used as the basis for explicating the political conflicts surrounding the legislation, the course of its consideration by the Congress, and its ultimate defeat. The sharp labor-business conflicts over the bills are shown to be closely tied to the legislation's potential effects upon their class-based economic and ideological/political interests. The course of Congressional consideration of the legislation is demonstrated as strongly influenced by contextual factors and intraclass divisions, especially those within the business community. Finally, indirect and direct institutional biases favoring business interests are shown to be particularly relevant to the legislation's defeat. In conclusion, the author develops a series of lessons regarding the disease prevention policy-making process which illustrate how the political dynamics and outcomes associated with episodes of occupational health policy reform may be interpreted through a class-dialectic perspective focusing upon class interests, divisions, and struggle.