title: Promoting integrated approaches to reducing health inequities among low-income workers: applying a social ecological framework.
abstract: BACKGROUND
  Nearly one of every three workers in the United States is low-income. Low-income populations have a lower life expectancy and greater rates of chronic diseases compared to those with higher incomes. Low- income workers face hazards in their workplaces as well as in their communities. Developing integrated public health programs that address these combined health hazards, especially the interaction of occupational and non-occupational risk factors, can promote greater health equity.
  
  
  METHODS
  We apply a social-ecological perspective in considering ways to improve the health of the low-income working population through integrated health protection and health promotion programs initiated in four different settings: the worksite, state and local health departments, community health centers, and community-based organizations.
  
  
  RESULTS
  Examples of successful approaches to developing integrated programs are presented in each of these settings. These examples illustrate several complementary venues for public health programs that consider the complex interplay between work-related and non work-related factors, that integrate health protection with health promotion and that are delivered at multiple levels to improve health for low-income workers.
  
  
  CONCLUSIONS
  Whether at the workplace or in the community, employers, workers, labor and community advocates, in partnership with public health practitioners, can deliver comprehensive and integrated health protection and health promotion programs. Recommendations for improved research, training, and coordination among health departments, health practitioners, worksites and community organizations are proposed.
authors.affiliation: Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, Cincinnati, Ohio.
authors.forename: Sherry L
authors.initials: SL
authors.lastname: Baron
authors.forename: Sharon
authors.initials: S
authors.lastname: Beard
authors.forename: Letitia K
authors.initials: LK
authors.lastname: Davis
authors.forename: Linda
authors.initials: L
authors.lastname: Delp
authors.forename: Linda
authors.initials: L
authors.lastname: Forst
authors.forename: Andrea
authors.initials: A
authors.lastname: Kidd-Taylor
authors.forename: Amy K
authors.initials: AK
authors.lastname: Liebman
authors.forename: Laura
authors.initials: L
authors.lastname: Linnan
authors.forename: Laura
authors.initials: L
authors.lastname: Punnett
authors.forename: Laura S
authors.initials: LS
authors.lastname: Welch
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D003153:Community Health Services / Q000379:methods*; D005260:Female; D006293:Health Promotion / Q000379:methods*; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000517:prevention & control*; D009786:Occupational Health Services / Q000379:methods*; D011203:Poverty; D011634:Public Health; D040242:Risk Reduction Behavior; D012931:Social Environment; D014481:United States; D017132:Workplace; D055815:Young Adult
keywords: disparities; health inequities; low-income workers; total worker health