Health Services Use and Health Outcomes among Informal Economy Workers Compared with Formal Economy Workers: A Systematic Review and Meta-Analysis

Abstract

Background: There are approximately two billion workers in the informal economy globally. Compared to workers in the formal economy, these workers are often marginalised with minimal or no benefits from occupational health and safety regulations, labour laws, social protection and/or health care. Thus, informal economy workers may have higher occupational health risks compared to their formal counterparts. Our objective was to systematically review and meta-analyse evidence on relative differences (or inequalities) in health services use and health outcomes among informal economy workers, compared with formal economy workers. Methods: We searched PubMed and EMBASE in March 2020 for studies published in 1999–2020. The eligible population was informal economy workers. The comparator was formal economy workers. The eligible outcomes were general and occupational health services use, fatal and non-fatal occupational injuries, HIV, tuberculosis, musculoskeletal disorders, depression, noise-induced hearing loss and respiratory infections. Two authors independently screened records, extracted data, assessed risk of bias with RoB-SPEO, and assessed quality of evidence with GRADE. Inverse variance meta-analyses were conducted with random effects. Results: Twelve studies with 1,637,297 participants from seven countries in four WHO regions (Africa, Americas, Eastern Mediterranean and Western Pacific) were included. Compared with formal economy workers, informal economy workers were found to be less likely to use any health services (odds ratio 0.89, 95% confidence interval 0.85–0.94, four studies, 195,667 participants, I2 89%, low quality of evidence) and more likely to have depression (odds ratio 5.02, 95% confidence interval 2.72–9.27, three studies, 26,260 participants, I2 87%, low quality of evidence). We are very uncertain about the other outcomes (very-low quality of evidence). Conclusion: Informal economy workers may be less likely than formal economy workers to use any health services and more likely to have depression. The evidence is uncertain for relative differences in the other eligible outcomes. Further research is warranted to strengthen the current body of evidence and needed to improve population health and reduce health inequalities among workers.

Depressive Symptoms among Chinese Informal Employees in the Digital Era

“…From the perspective of the difference in depressive symptoms between formal and informal employees, we draw the conclusion that informal work will obviously increase the mental health risk of employees. The results of this study are basically consistent with most previous studies in China and abroad [ 5 , 6 , 7 , 8 , 9 , 10 , 12 , 34 ]. A typical exception is stated in [ 11 ].…”

“…Except for few individual cases, the vulnerability of informal employment has been verified in a number of literatures based on data from different countries [ 5 , 6 , 7 , 8 , 9 , 10 , 11 ]. A systematic review covering 12 studies in four WHO (World Health Organization) regions (Africa, the Americas, the Eastern Mediterranean, and the Western Pacific) shows that informal economy workers may be less likely than formal economy workers to use any health services and more likely to have depression [ 12 ]. Traditionally, the majority of the informal labor force in China is the surplus labor force migrating from rural areas to urban areas.…”

“…Res. Public Health 2021, 18, 5211 2 of 13 and the Western Pacific) shows that informal economy workers may be less likely than formal economy workers to use any health services and more likely to have depression [12]. Traditionally, the majority of the informal labor force in China is the surplus labor force migrating from rural areas to urban areas.…”

Clinical situation of Venezuelan migrants living with HIV in a hospital in Lima, Peru

“…The barriers for obtaining a legal status contribute to informal and "under the table" workers' status, limiting healthcare access. 28,29 Moreover, once the Venezuelan migration in Peru became noticeable, migrants might have encountered an increasing wave of xenophobia and discrimination. 30,31 Thus, beyond the burden of HIV stigma, Venezuelan PLWH might have faced xenophobia and negative context reception, 32 which directly affect their mental health 33,34 and hamper linkage to health services and retention in care.…”

Systematic reviews and meta-analyses for the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury

“…Our new methods for systematic reviews of prevalence studies can also be applied elsewhere, such as in exposure assessment for health risk assessment ( International Programme on Chemical Safety and Inter-Organization Programme for the Sound Management of Chemicals 2010 ). These new tools and approaches have rapidly been adopted and applied in systematic reviews outside of the WHO/ILO Joint Estimates ( Al Alawi et al, 2020 , Naicker et al, 2021 ), suggesting they fill a methodological gap and have potential to contribute to improving the quality of systematic reviews ( Bero 2020 ).…”