Informal employment as a social determinant of health: A conceptual framework and research agenda accounting for context

Despite most workers globally being informally employed, our understanding of the role of informal employment as a social determinant of health and health inequalities remains limited. Existing research tends to focus mainly on direct associations between informality and health and to some extent on how informality affects health through micro-level factors such as gender and working conditions. This research has produced mixed results on the relationship between informality and health. We argue that this is because most existing work has not sufficiently addressed how informality affects health. This holds especially for quantitative research. In this paper, we aim to provide a conceptual framework that addresses these limitations by emphasizing the role of contextual factors located at the macro- and meso-levels in shaping the health consequences of informality. Not only does attention to context allow comparisons to be made across settings despite heterogenous meanings of informality, but such an approach also enables more comprehensive explanations of when, where and for whom informality is harmful to health. We furthermore propose attention to the level of regulation and protection available to workers, as a strategy to analytically operationalize contextual factors. Based on this framework, we present a research agenda in which we suggest prioritized directions for future research that would contribute to a more comprehensive understanding of how informality is linked to health.