Informal Employment Under the Skin: Informality and Health Inequalities Among Chilean Workers.

Informal employment has been identified as an important social determinant of health. This article addresses the processes through which informal employment affects workers' health in Chile. The study's methodological approach was based on qualitative interviews with 34 formal and informal workers. The findings show how workers perceive informal employment as negatively affecting their mental and physical health through different dimensions of their living and working conditions. Incorporating a gender perspective proves to be integral to the analysis of these processes. The article concludes by discussing how neoliberalism underlies such vulnerability processes and negatively impacts on the population's health.

Socio-demographic predictors of obesity among women in Mukono Central Division in Central Uganda: a cross-sectional study.

BACKGROUND: There is a steadily increasing trend in obesity globally and in Sub-Saharan Africa that disproportionately affects women in most places. This is not different in Uganda, where the Uganda Demographic and Health Survey indicated an increase in obesity among women of reproductive age as measured by the body mass index (BMI). However, studies on the predictors of obesity in women are still limited. Particularly, studies using specific indicators of body fat are scant. This study explored the socio-demographic predictors of obesity as indicated by total body fat percentage among women in the age range of 18 to 69 years old living in Mukono Central Division in Central Uganda. METHODS: A cross sectional study design using quantitative methods was employed. A total of 384 women between 18 and 69 years old from Mukono Central Division in Central Uganda were randomly recruited. A structured questionnaire was used to collect socio-demographic data including age, level of education, marital status, childbearing status, household expenditure, household size and employment status. Total body fat percentage, the indicator for obesity was measured using the body composition meter from TANITA. The data was analyzed using multinomial logistic regression analysis using SPSS version 20. RESULTS: 155 women, nearly two fifths (40.4% CI 95% 38.4-42.4) were classified as obese. Age, marital status, childbearing status, and employment status were the factors that were associated with obesity among these women. Employment status was the only variable that remained significantly associated with obesity among the women after adjusting for other factors. Unemployed women were nearly two times more likely to be obese than the employed women (AOR 1.9; 95% CI 1.1-3.1). The prevalence of obesity among the unemployed and employed women was 48.2% and 34.4% respectively. CONCLUSIONS: Obesity in women was predicted by employment status. An in-depth study on factors that predispose unemployed women to obesity, will be instrumental in guiding interventions to curb the emerging obesity epidemic in Uganda. In the same vein, strategies to reduce levels of unemployment among women living in urban Uganda are essential for protecting public health from the dimension of reducing obesity levels.

The health consequences of informal employment among female workers and their children: a systematic review.

BACKGROUND: Informal employment is unprotected and unregistered and it is often characterized by precarious working arrangements. Although being a global phenomenon and the most common type of employment worldwide, scholarly attention to its health effects has only recently accelerated. While there is still some debate, informal employment is generally understood to be detrimental to workers' health. However, because women are more vulnerable to informality than men, attention is required to the health consequences of female workers specifically. We conducted a systematic review with the objective to examine the global evidence on the consequences of informal employment, compared to formal employment, on the health of female workers and their children. METHODS: We searched peer-reviewed literature in Embase, Medline, PsychInfo, Scopus and Web of Science up until November 11, 2022. No restrictions were applied in terms of year, language or country. Individual-level quantitative studies that compared women of reproductive age in informal and formal employment, or their children (≤ 5 years), were eligible for inclusion. If studies reported outcomes per subgroup level, these were included. Study quality was assessed using the Joanna Briggs Institute checklist and a narrative synthesis of the results were conducted. RESULTS: 13 articles were included in the review, looking at breastfeeding outcomes (n = 4), child nutritional status and low birthweight (n = 4), antenatal health (n = 3), and general health outcomes for women (n = 2). The overall evidence from the included studies was that compared to formal employment, there was an association between informal employment and worse health outcomes, especially on child nutritional status and antenatal health. The evidence for breastfeeding outcomes was mixed and showed that informal employment may be both protective and damaging to health. CONCLUSION: This review showed that informal employment is a potential risk factor for health among female workers and their children. Further research on the pathways between informal employment and health is needed to strengthen the understanding of the health consequences of informal employment.

COVID-19-associated income loss and job loss: Evidence from Indonesia.

COVID-19 pandemic has substantially altered socioeconomic conditions around the world. While numerous existing studies analyze the impact of the COVID-19 pandemic among developed states, little is known about its effects on people's lives and social discrepancies in emerging economies. To this end, we empirically analyze the 2020 Indonesian Labor Force Survey data, hypothesizing that COVID-19 has given idiosyncratic risks and impacts on people by gender, age, education, occupation and regions. We find that income loss and job loss are prominent among males, younger and less educated people as well as among self-employed and part-time non-agricultural workers. These tendencies are not pronounced for people enjoying high income and mobility, but tend to be evident for urban residents and those having dependents. Notably, self-employed people have the highest risk of losing income, while part-time urban workers face the highest probability of losing their jobs. The propensity score matching method also demonstrates that these losses are most evident for the regions susceptible to COVID-19. Overall, we suggest that socioeconomically disadvantaged groups require additional support to strengthen their resilience in the face of exogenous shocks, such as the one caused by the global coronavirus pandemic.

Informal employment and catastrophic health expenditures: Evidence from Pakistan.

Workers in informal employment suffered significant out-of-pocket healthcare expenditures (OOPHEs) due to their low earnings and a lack of a social safety net or health insurance. There is little or no evidence of impoverishment caused by OOPHEs in the context of labor market categorization. Therefore, this study examines the economic burden of OOPHEs and its associated consequences on households, whose members are in informal employment. This study estimates the incidence of catastrophic health expenditures (CHEs) and impoverishment across the households in formal and informal employment and their key determinants in Pakistan by employing the data from the two rounds of the Household Integrated Economic Survey (2015-16, 2018-19). For measuring CHEs and impoverishment, the budget share and capacity-to-pay approaches are applied. Various thresholds are used to demonstrate the sensitivity of catastrophic measures. We found a higher incidence of catastrophic healthcare payments among the informal workers, that is, 4.03% and 7.11% for 2015-16 and 2018-19, respectively, at a 10% threshold, while at a 40% threshold, the incidence of CHEs is found to be 0.40% and 2.34% for 2015-16 and 2018-19, respectively. These OOPHEs caused 1.53% and 3.66% of households who are in informal employment to become impoverished, compared with their formal counterparts. The study demonstrates that the probability of incurring CHEs and becoming impoverished is high among informal workers, compared with their formal counterparts. This result has clear policy implications, in which to protect the informal workers, it is necessary to expand the insurance coverage, particularly during the COVID-19 response and recovery efforts.

Research on the Influence of Informal Employment on Residents' Happiness in China: Empirical Analysis Based on CLDS Data.

The influence of informal employment on residents' happiness has gained wide attention around the world. However, few studies focus on this topic in China. Using the 2016 wave of the China Labor Force Dynamics Survey (CLDS) data, we examined the effect of informal employment and its mechanisms on residents' happiness in China. Our study shows there is a significant negative correlation between informal employment and residents' happiness in China. Moreover, the correlation between informal employment and residents' happiness is stronger for residents who are female, migrating, and with a rural household registration. In addition, we investigated possible mechanisms of the effect, including individual income, social respect, unemployment expectations, and social security, and found that informal employment reduces the happiness of residents by widening the gap in unemployment probability and social insurance level among residents.

Informal Employment and Poor Mental Health in a Sample of 180,260 Workers from 13 Iberoamerican Countries.

The aim of this study is to estimate the association between employment conditions and mental health status in the working population of Iberoamerica. In this cross-sectional study, we pooled individual-level data from nationally representative surveys across 13 countries. A sample of 180,260 workers was analyzed. Informality was assessed by social security, health affiliation, or contract holding. Mental health was assessed using several instruments. We used Poisson regression models to estimate the contribution of informality to poor mental health by sex and country, adjusted by sociodemographic and work-related characteristics. Then, we performed a meta-analysis pooling of aggregate data using a random-effects inverse-variance model. Workers in informal employments showed a higher adjusted prevalence ratio (aPR) of poor mental health than those in formal employment in Peru (aPR men 1.5 [95% confidence intervals 1.16; 1.93]), Spain (aPR men 2.2 [1.01; 4.78]) and Mexico (aPR men 1.24 [1.04; 1.47]; women 1.39 [1.18; 1.64]). Overall estimates showed that workers in informal employment have a higher prevalence of poor mental health than formal workers, with it being 1.19 times higher (aPR 1.19 [1.02; 1.39]) among men, and 1.11 times higher prevalence among women (aPR 1.11 [1.00; 1.23]). Addressing informal employment could contribute to improving workers' mental health.

How does informal employment affect health and health equity? Emerging gaps in research from a scoping review and modified e-Delphi survey.

INTRODUCTION: This article reports on the results from a scoping review and a modified e-Delphi survey with experts which aimed to synthesize existing knowledge and identify research gaps on the health and health equity implications of informal employment in both low- and middle-income countries (LMICs) and high-income countries (HICs). METHODS: The scoping review included peer-reviewed articles published online between January 2015 and December 2019 in English. Additionally, a modified e-Delphi survey with experts was conducted to validate our findings from the scoping review and receive feedback on additional research and policy gaps. We drew on micro- and macro-level frameworks on employment relations and health inequities developed by the Employment Conditions Knowledge Network to synthesize and analyze existing literature. RESULTS: A total of 540 articles were screened, and 57 met the eligibility criteria for this scoping review study, including 36 on micro-level research, 19 on macro-level research, and 13 on policy intervention research. Most of the included studies were conducted in LMICs while the research interest in informal work and health has increased globally. Findings from existing literature on the health and health equity implications of informal employment are mixed: informal employment does not necessarily lead to poorer health outcomes than formal employment. Although all informal workers share some fundamental vulnerabilities, including harmful working conditions and limited access to health and social protections, the related health implications vary according to the sub-groups of workers (e.g., gender) and the country context (e.g., types of welfare state or labour market). In the modified e-Delphi survey, participants showed a high level of agreement on a lack of consensus on the definition of informal employment, the usefulness of the concept of informal employment, the need for more comparative policy research, qualitative health research, and research on the intersection between gender and informal employment. CONCLUSIONS: Our results clearly identify the need for more research to further understand the various mechanisms through which informal employment affects health in different countries and for different groups of informal workers.

Association between informal employment and depressive symptoms in 11 cities in Latin America.

Background: Mental health is an important contributor to the global burden of disease, and depression is the most prevalent mental disorder in Latin America and the Caribbean (LAC). Informal jobs, often characterized by precarious working conditions, low wages, and limited employment benefits, are also highly prevalent in LAC and may be associated with poorer mental health. Our study tests the association between informal employment and major depressive symptoms in LAC cities. Methods: We used individual-level data collected by the Development Bank of Latin America via their "Encuesta CAF" (ECAF) 2016, a cross-sectional household survey of 11 LAC cities (N = 5430). Depressive symptoms were measured using the 10-item Center for Epidemiologic Studies Short Depression Scale with possible total score ranging from 0 to 30. Scores were dichotomized, with a score > ‾ 16 indicating the presence of major depressive symptoms. Informal employment was defined based on self-reported lack of contribution to the social security system. We used generalized estimating equation (GEE) log-binomial models to estimate the association between informal employment and depressive symptoms overall and by gender. Models were adjusted for age, education, and household characteristics. Results: Overall, individuals employed in informal jobs had a 27% higher prevalence of major depressive symptoms (Prevalence Ratio [PR]: 1.27; 95% Confidence Interval [CI]: 1.00, 1.62) compared to those in formal jobs. The prevalence of depressive symptoms among individuals with informal jobs was higher compared to those with formal jobs in both women (PR: 1.36, 95% CI: 1.06, 1.74) and men (PR: 1.22; 95% CI: 0.90, 1.65). Conclusions: Informal employment in LAC was associated with a higher prevalence of major depressive symptoms. It is important to develop policies aiming at reducing informal jobs and increasing universal social protection for informal workers.

Initiatives Addressing Precarious Employment and Its Effects on Workers' Health and Well-Being: A Systematic Review.

The prevalence of precarious employment has increased in recent decades and aspects such as employment insecurity and income inadequacy have intensified during the COVID-19 pandemic. The purpose of this systematic review was to identify, appraise, and synthesise existing evidence pertaining to implemented initiatives addressing precarious employment that have evaluated and reported health and well-being outcomes. We used the PRISMA framework to guide this review and identified 11 relevant initiatives through searches in PubMed, Scopus, Web of Science, and three sources of grey literature. We found very few evaluated interventions addressing precarious employment and its impact on the health and well-being of workers globally. Ten out of 11 initiatives were not purposefully designed to address precarious employment in general, nor specific dimensions of it. Seven out of 11 initiatives evaluated outcomes related to the occupational health and safety of precariously employed workers and six out of 11 evaluated worker health and well-being outcomes. Most initiatives showed the potential to improve the health of workers, although the evaluation component was often described with less detail than the initiative itself. Given the heterogeneity of the 11 initiatives regarding study design, sample size, implementation, evaluation, economic and political contexts, and target population, we found insufficient evidence to compare outcomes across types of initiatives, generalize findings, or make specific recommendations for the adoption of initiatives.

Is There an Informal Employment Penalty in Food Security? Evidence from Rural Vietnam.

In this paper, we investigate the association between informal non-farm wage employment and household food security in rural Vietnam. The data for our analyses come from a nationally representative panel dataset of 1390 rural households from Vietnam Household Living Standards Survey. We conduct multivariate regression analysis using robust quantitative tools to show that informal employment is associated with a reduction in the consumption of nutritious foods. Our analysis also shows that informal employment reduces consumption of vegetables and fruits, using both the calorie- and expenditure-based shares of food groups.

Dans cet article, nous étudions l'association entre l'emploi salarié informel non agricole et la sécurité alimentaire des ménages dans les zones rurales du Vietnam. Les données utilisées pour nos analyses proviennent d'un ensemble de données de panel, représentatif au niveau national, de 1 390 ménages ruraux ayant participé à l'enquête sur le niveau de vie des ménages au Vietnam. Nous conduisons une analyse de régression multivariée à l'aide de solides outils quantitatifs pour démontrer que l'emploi informel est associé à une réduction de la consommation d'aliments nutritifs. Notre analyse montre également que l'emploi informel est associé à une consommation moindre de légumes et de fruits, que ce soit en termes de calories consommées et de dépenses financières pour chaque groupe d'aliments.

Differences in Subjective Well-Being between Formal and Informal Workers in Urban China.

This paper examines the relationship between different types of employment and subjective well-being with a focus on informal employment. The China Labor-force Dynamics Survey (CLDS) for three selected years (2012, 2014 and 2016) shows an upward trend in the subjective well-being of urban workers in the 2010s. However, although the gap in subjective well-being between formal and informal workers narrowed, informal workers' subjective well-being was still lower than their formal counterparts. Factors affecting the subjective well-being of formal and informal workers and their different effects were revealed to explain this difference. The subjective well-being of informal workers is significantly related to their informal status of employment, economic conditions (such as income and working hours), human capital, social capital (such as perceived social justice and perceived community connectedness) and urban environment. The paper enhances the understanding of people's subjective well-being by differentiating informal/formal segments of working populations.

Autonomy or Working Conditions?-Research on Heterogeneity and Influencing Mechanism of Self-Employment on Job Satisfaction in China.

The development of globalization and information technology has been promoting informal work rapidly. In this process, self-employment is gradually becoming an important employment approach. As two of the key variables, self-employment laborers' work autonomy and work conditions are largely discussed as the potential determinants of their work satisfaction. Which of these two factors is actually influencing labors' satisfaction level? So far, relevant studies are insufficient to respond to this question, especially in developing countries. This study investigates the influence of work autonomy and working conditions on self-employed workers' job satisfaction in China. China Labor-force Dynamics Survey data is used to examine the impact of self-employment on workers' job satisfaction and the influence mechanism of work autonomy and working conditions. Propensity score matching and instrumental variable methods were applied to avoid sample selection bias and endogeneity. We found that self-employment has a significant negative effect on job satisfaction; poor working conditions are responsible for self-employed workers' lower satisfaction level, and self-employment behavior impacts job satisfaction differently in terms of the type and gender of self-employed workers. Therefore, stronger social security and better working conditions for the self-employed should be provided.

The COVID-19 pandemic: Narratives of informal women workers in Indian Punjab.

The COVID-19 crisis has translated into an unprecedented humanitarian crisis for the poor and marginalized groups in society. The countrywide lockdowns, quarantine measures, and mobility restrictions across 200 countries of the world have resulted in a host of negative manifestations for women. There have been unprecedented losses in the informal economy, which is dominated by women. Some scholars also contend that the pandemic will translate into heightened burden of unpaid domestic work, loss of economic autonomy and disruption to maternal health services. Despite these factors a gendered perspective is absent in the policy response to this crisis. It is against this background that the present paper employed a feminist intersectionality lens to conduct participatory field based research on the lived experiences of women in informal employment in Indian Punjab during the COVID-19 crisis. The research unearthed the specific pathways through which existing socio-economic inequities rooted in caste, class and occupational entities magnify the vulnerabilities experienced by women during such a health crisis. The research offers a contextualized framework for understanding the gendered impacts of the crisis. It also highlights the urgency of taking account of gender specific constraints during the health crisis so as to institute robust, effective and equitable policy interventions.

Associations Between Parental Employment and Children's Screen Time: A Longitudinal Study of China Health and Nutrition Survey.

Objectives: Parents are often torn between their parenting roles in the family and working roles at the workplace. This study focused on the associations of parental employment with children's screen time (ST) on weekdays, weekends, and during the entire week. Methods: Unbalanced panel data including 2,977 children (aged 0-17 years) from five waves of the China Health and Nutrition Survey data from 2004 to 2015 were utilized. Two-way fixed effects models were fitted to examine the associations of parental employment status, working hours, and overwork with children's ST. Results: Compared to unemployment status, maternal formal employment positively predicted children's ST on both weekdays and weekends, while maternal informal employment was associated with increased children's ST on weekends. The more hours they worked, the more time their children spent using screens. Neither employment status nor the overwork of fathers was significant. Conclusion: Parental employment, especially maternal employment, was linked with the ST of children. More childcare-friendly labor policies are needed to promote healthy lifestyles among the next generation.

Depressive Symptoms among Chinese Informal Employees in the Digital Era.

The mental health status of informal employees is rarely studied in China. Nowadays, new economic forms such as gig economy and platform economy are emerging with the rapid development of information and communication technology, which has brought great changes to the labor market, especially to the informal employment field. Thus, it is of great significance to investigate the depressive symptoms among informal employees in the digital era. Based on the cross-sectional data of CFPS (China Family Panel Studies, 2018), this study takes a quantitative analysis framework to explore and analyze the association between informal employment and depressive symptoms in the Chinese labor market. After screening, a data set of 8893 employees (60.5% male and 39.5% female) was established. Several statistical methods, including the Mann-Whitney test and probit regression model, were used in the sample data analysis. The results show that the prevalence of depressive symptoms among informal employees is significantly higher than that among formal employees. Depressive symptoms are highly related to informal work and other factors, such as education, physical health, household income, etc. The impact of Internet use on informal employees' depressive symptoms is not significant. The mental health inequality between formal and informal employees still exists in the digital era, and corresponding labor market regulations and social policies should be perfected to address this issue.

Breastfeeding knowledge and practices of working mothers in the informal economy in New Delhi: A formative study to explore new intervention pathways towards improved maternal and child health outcomes.

This was a formative study to yield evidence on the conceptual and empirical pathways to improve maternal and child health (MCH) outcomes among informally working mothers while securing livelihoods, and for this, explores how informally working women navigate time sensitive childcare practices such as exclusive breastfeeding (EBF) with their work, and how do the conditions and nature of informal employment shape it. This study was conducted in February-May 2017 using non-probability sampling for cross-sectional semi structured interviews (n = 92) and focus group discussions (n = 56) with working mothers with a child under 2 and 5 years respectively, having regular and stable working history in the informal economy. The study team partnered with Self-Employed Women's Association for site selection and recruitment of study participants across 4 sectors of work in New Delhi, India: home-based work, pheri or barter work, street vending and domestic work. While 65% women report EBF for 6-months, checks with infant feeding recall reveal several disruptions from customary practices and working conditions, and successful EBF only in home-based work, the least paying of all. 59% women reported returning to work under 6-months, leading to early weaning. 90% women were aware of the importance of EBF in the standard language of public health messaging, however, checks with non-standard language queries reveal a drop to 55-80% exhibiting lack of effective knowledge that women could use. The findings emphasise that conditions and nature of informal employment shape MCH outcomes in cities of the global south, where such employment dominates. Furthermore, we use the findings to suggest the following responsive approaches for intervention: delaying mother's return to work, increasing proximity between mother and child, deeper and engaged knowledge of breastfeeding and early child development practices, improving problem solving capacity and agency of the mother, and enabling home and workplace conditions.

Structural Changes and Quality of Women's Labour in India.

The primary objective of this paper is to look at the trends and pattern of changes in women's employment structure over years (1983-2018) consequent upon the structural changes in the Indian economy. It also attempts to analyse the quality of women's labour in terms of select parameters. The study finds that there is neither quantitative nor qualitative improvement in women's employment over time on account of structural changes in the economy. There is no 'U' curve of female labour supply in response to GDP growth and expansion of female literacy, implying that economic growth has not generated adequate jobs for women. It also signifies that women's entry or exit of labour market is influenced by non-economic factors also. There is no major occupational diversification in women's employment despite structural shift of the economy from primary to tertiary sector. Agriculture is still the leading sector in women's employment. The study further reveals that the quality of women's labour is poor. Overcrowding of workforce in agriculture largely as wage labourers, lower earnings, poor literacy levels, large-scale informal employment and most self-employment in the form of unpaid work are indications of women's disadvantaged position in the labour market.

Informal workplaces and their comparative effects on the health of street vendors and home-based garment workers in Yangon, Myanmar: a qualitative study.

BACKGROUND: Globally, two billion workers are employed informally but there is limited research on the relationship between informal work and health. Existing studies have focused on informality as an employment condition, with little emphasis on the diversity of physical and social contexts in which informal work takes place. The study considers the diversity of informal workplaces and explores the ways in which this diversity might influence health and well-being of two informal occupational groups in Yangon, the former capital of Myanmar. METHODS: We conducted 21 field observations and 47 semi-structured interviews with street vendors and home-based garment workers based in Yangon, Myanmar. A constant comparative method was used to identify and compare how the physical characteristics of their informal workplaces affect their health for these two informal subgroups. RESULTS: Although both street vendors and home-based garment workers work informally, their exposure to occupational health and income risks are specific to the physical features of their informal workplaces. Street vendors, who work in public spaces with minimal coverage, are more likely to experience the direct effects of outdoor pollution, inclement weather and ergonomic risks from lifting, carrying and transporting heavy merchandise while home-based garment workers, many of whom live and work in unsanitary housing and deprived neighborhoods, are more likely to experience pollution in or near their homes, and ergonomic risks from poor posture. Similarly, although both groups face safety challenges, street vendors face urban violence and abuse during their commute and at vending points whereas home-based garment workers felt unsafe in their home-based workplaces due to the presence of crime and violence in their neighborhoods. CONCLUSION: While informal employment is universally characterized by lack of social protection, exposure to occupational health and income risks for subpopulations of informal workers is determined by the specific physical and social environments of their workplaces. Efforts to improve the health of informal workers should consider the contexts in which informal work takes place to develop tailored interventions for subpopulations of informal workers.

Mental wellbeing among Hispanic female domestic cleaners.

BACKGROUND: The purpose of this study was to examine the mental wellbeing of self-employed, Hispanic female domestic cleaners in San Antonio, Texas. METHODS: We conducted a cross-sectional pilot study and administered a short questionnaire to 56 participants. Mental wellbeing was assessed using The World Health Organization Well-Being Index (WHO-5). We calculated the age-adjusted prevalence of poor mental wellbeing, both overall and stratified by socioeconomic, neighborhood, and health characteristics. RESULTS: Almost half of the participants screened positive for poor mental wellbeing (47.3%) with a mean WHO-5 score of 68.9 [standard error (SE) = 3.1]. We observed a high prevalence of poor mental wellbeing among participants with less than a high school education (56.0%), who worked less than 30 h per week (57.0%) and who sometimes or always felt unsafe at her cleaning job (69.1%). CONCLUSIONS: Female domestic cleaners, particularly those who work in the informal sector, are an overburdened and understudied population. This is particularly true regarding their mental wellbeing, which has largely been considered as an afterthought in epidemiologic studies of cleaning workers in general. Our results suggest that this group of domestic cleaners faces several psychosocial stressors, both in and outside of the workplace, and may have a high risk of poor mental health outcomes.