"The state plays a major role in occupational safety and health in the United States, impacting all aspects including resources, training, research, standard setting, and enforcement. Howard Waitzkin has challenged public health activists to rethink their understanding of the State and to replace the dominant pluralist view with a conception that serves as the theory for more effective public health action to improve the health of working people. This paper is a response to Waitzkin's challenge utilizing a framework that views the State as a reflection of the relationship and power dynamics between capital and labor, within the confines of institutions, policies, and laws organized to protect and maintain the capitalist system. A historical review of safety and health since the Occupational Safety and Health Act of 1970 in the context of the capitalist state serves as the basis for suggestions as to how this might shape safety and health advocates' strategy."

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