Dalla Lana School of Public Health, Division of Social and Behavioural Health Sciences, University of Toronto, 155 College Street, Room 408, M5T 3M7, Toronto, ON, Canada.
Int J Equity Health. 2022 Jun 21;21(1):87. doi: 10.1186/s12939-022-01684-7.
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).
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.
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.
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.
本文报告了一项范围界定审查和一项针对专家的修改后的电子德尔菲调查的结果，旨在综合现有知识，并确定在中低收入国家（LMICs）和高收入国家（HICs）中非正式就业对健康和健康公平的影响的研究差距。
范围界定审查包括 2015 年 1 月至 2019 年 12 月期间以英文在线发表的同行评议文章。此外，还对专家进行了修改后的电子德尔菲调查，以验证我们从范围界定审查中得出的发现，并就其他研究和政策差距征求反馈意见。我们借鉴了就业条件知识网络制定的就业关系和健康不平等的微观和宏观框架，对现有文献进行了综合和分析。
共筛选出 540 篇文章，其中 57 篇符合本范围界定审查研究的资格标准，包括 36 篇微观研究、19 篇宏观研究和 13 篇政策干预研究。大多数纳入的研究都是在 LMICs 进行的，而全球对非正式工作和健康的研究兴趣有所增加。现有文献关于非正式就业对健康和健康公平的影响的研究结果喜忧参半：非正式就业并不一定会导致比正式就业更差的健康结果。尽管所有非正式工人都有一些共同的基本脆弱性，包括有害的工作条件和有限的获得健康和社会保护的机会，但相关的健康影响因工人的亚组（如性别）和国家背景（如福利国家或劳动力市场的类型）而异。在修改后的电子德尔菲调查中，参与者对非正式就业定义缺乏共识、非正式就业概念的有用性、需要进行更多比较政策研究、定性健康研究以及性别与非正式就业交叉问题的研究等方面表现出高度一致的意见。
我们的结果清楚地表明，需要进行更多的研究，以进一步了解非正式就业在不同国家和不同类型的非正式工人中影响健康的各种机制。
