摘要：Objectives. Socioeconomic factors are associated with reduced health status in low-income populations. We sought to identify affordable employment benefit packages that might ameliorate these socioeconomic factors and would be consonant with employees’ priorities. Methods. Working in groups (n = 53), low-income employees (n = 408; 62% women, 65% Black) from the Washington, DC, and Baltimore, Md, metropolitan area, participated in a computerized exercise in which they expressed their preference for employment benefit packages intended to address socioeconomic determinants of health. The hypothetical costs of these benefits reflected those of the average US benefit package available to low-income employees. Questionnaires ascertained sociodemographic information and attitudes. Descriptive statistics and logistic regression analysis were used to examine benefit choices. Results. Groups chose offered benefits in the following descending rank order: health care, retirement, vacation, disability pay, training, job flexibility, family time, dependent care, monetary advice, anxiety assistance, wellness, housing assistance, and nutrition programs. Participants varied in their personal choices, but 78% expressed willingness to abide by their groups’ choices. Conclusions. It is possible to design employment benefits that ameliorate socioeconomic determinants of health and are acceptable to low-income employees. These benefit packages can be provided at the cost of benefit packages currently available to some low-income employees. Socioeconomic factors play an important role in determining health status. 1 , 2 Low-income individuals have higher mortality rates than higher-income individuals, even when health insurance is universally available. 3 This reality has led many countries in the Organization for Economic Cooperation and Development (e.g., the United Kingdom, Canada, Sweden, and Norway), as well as developing countries (e.g., Mexico and Chile), to propose public programs to improve socioeconomic factors that contribute to health. 4 – 7 Such public policy approaches are unlikely to be forthcoming in the United States, at least in the near future. A focus on market-based strategies, along with federal and state budget deficits, makes it improbable that either federal or state governments will quickly champion new programs aimed at promoting the health of low-income populations in the United States. In light of this reality, employment benefits might serve as a vehicle for improving the health of these populations. This approach could be advantageous from both employers’ and employees’ points of view. For employers, improved employee health may enhance productivity, reduce absenteeism, and reduce health insurance costs. 8 – 10 For employees, improved health could augment well-being, lifespan, and economic prospects. Nonetheless, efforts to improve employee health through employment benefits may seem prohibitively costly. We have therefore conducted research aimed at identifying health-promoting employee benefits that would be consonant with employees’ preferences and comparable in cost to currently provided fringe benefits for low-income US employees. In our study, we offered low-income participants an opportunity to express a preference for employment benefit packages, including health insurance and other benefits aimed at ameliorating socioeconomic factors that influence health. We report on their priorities regarding these benefits.
