Health inequalities related to informal employment: gender and welfare state variations in the Central American region

People engaged in informal employment are not insured by any labour or social protection. Welfare state regimes could affect the relationship between informal employment and health. This study aimed to assess the relationship between informal employment and health status in the non-agricultural working population in Central America, by welfare state regime and gender. Based on a sample of 8680 non-agricultural workers (First Central American Survey of Working Conditions and Health), we conducted Poisson regression models with robust variance to obtain prevalence ratios (PR) and their confidence intervals (95% CI) of poor health status (self-perceived and mental health) of workers with informal employment versus those with formal employment. Models were adjusted by age and occupation and stratified by welfare state regime and gender. We found that prevalence of poor health status was highest among women and workers in informal employment. Positive associations between informal employment and poor self-perceived health were found in familialist and highly familialist countries for both genders, being highest in women in familialist countries (PR: 1.39, 95% CI: 1.08-1.80). Significant associations were only found for poor mental health among women in familialist countries (PR: 1.24, 95% CI: 1.01-1.53) and men in highly familialist countries (PR: 1.34, 95% CI: 1.00-1.79). Our results suggest that universal social protection policies could reduce the negative effects of informal employment on health status for both women and men. Future development of labour and social policies integrating a gender perspective might be crucial to address health inequalities related to informal employment in Latin American countries.