Informal employment and health status in Central America Health behavior, health promotion and society

Mariá López-Ruiz, Luciá Artazcoz, José Miguel Martínez, Marianela Rojas, Fernando G. Benavides

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


Background: Informal employment is assumed to be an important but seldom studied social determinant of health, affecting a large number of workers around the world. Although informal employment arrangements constitute a permanent, structural pillar of many labor markets in low-and middle-income countries, studies about its relationship with health status are still scarce. In Central America more than 60 % of non-agricultural workers have informal employment. Therefore, we aimed to assess differences in self-perceived and mental health status of Central Americans with different patterns of informal and formal employment. Methods: Employment profiles were created by combining employment relations (employees, self-employed, employers), social security coverage (yes/no) and type of contract-only for employees-(written, oral, none), in a cross-sectional study of 8,823 non-agricultural workers based on the I Central American Survey of Working Conditions and Health of 2011. Using logistic regression models, adjusted odds ratios (aOR) by country, age and occupation, of poor self-perceived and mental health were calculated by sex. Different models were first fitted separately for the three dimensions of employment conditions, then for employment profiles as independent variables. Results: Poor self-perceived health was reported by 34 % of women and 27 % of men, and 30 % of women and 26 % of men reported poor mental health. Lack of social security coverage was associated with poor self-perceived health (women, aOR: 1.38, 95 % CI: 1.13-1.67; men, aOR: 1.36, 95 % CI: 1.13-1.63). Almost all employment profiles with no social security coverage were significantly associated with poor self-perceived and poor mental health in both sexes. Conclusions: Our results show that informal employment is a significant factor in social health inequalities among Central American workers, which could be diminished by policies aimed at increasing social security coverage.

Original languageEnglish (US)
Article number698
JournalBMC Public Health
Issue number1
StatePublished - Jul 24 2015
Externally publishedYes


  • Central America
  • Health inequalities
  • Informal employment
  • Mental health
  • Occupational health
  • Self-perceived health
  • Social security coverage

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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