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. 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. An example of successful approaches to developing integrated programs in each of these settings is described. Recommendations for improved research, training, and coordination among health departments, health practitioners, worksites and community organizations are proposed.

Objective. To investigate determinants of job satisfaction among home care workers in a consumer‐directed model. Data Sources/Setting. Analysis of data collected from telephone interviews with 1,614 Los Angeles home care workers on the state payroll in 2003. Data Collection and Analysis. Multivariate logistic regression analysis was used to determine the odds of job satisfaction using job stress model domains of demands, control, and support. Principal Findings. Abuse from consumers, unpaid overtime hours, and caring for more than one consumer as well as work‐health demands predict less satisfaction. Some physical and emotional demands of the dyadic care relationship are unexpectedly associated with greater job satisfaction. Social support and control, indicated by job security and union involvement, have a direct positive effect on job satisfaction. Conclusions. Policies that enhance the relational component of care may improve workers' ability to transform the demands of their job into dignified and satisfying labor. Adequate benefits and sufficient authorized hours of care can minimize the stress of unpaid overtime work, caring for multiple consumers, job insecurity, and the financial constraints to seeking health care. Results have implications for the structure of consumer‐directed models of care and efforts to retain long‐term care workers.

This paper examines the challenges facing California homecare workers in their historic struggle to unionize from the 1980s through the 90s. Three inter-related components were critical to their ultimate success: 1) grassroots organizing, 2) changing policy at the state and county level and 3) working in coalition with groups of senior and disabled care recipients. Now that the union represents more than 100,000 workers, consolidation of those victories involves challenges such as developing leadership among the new membership and strengthening the labor-consumer coalition that will be critical to further improvements in homecare services and working conditions. This campaign has already had significant impact on the structure of this emerging workforce, and will have long-term effects on social policy for care of the elderly and disabled.

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