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Informal work (IW) is a global phenomenon that affects more than two billion workers, according to the International Labour Organization (ILO), representing about 60% of the global workforce. In some countries IW reaches as high as 90% of the workforce. It is not just a complex issue for less developed countries; it is a global challenge linked to inequality where research and public policies focus on formal work, even though informal workers are an integral part of the workforce in high income countries as well.

It is characterized by job precarity, low income, hazardous economic activities and jobs that do not have legal and social protections. It has multiple causes, including the lack of sufficient formal jobs, training opportunities for the most vulnerable, especially for low-skilled workers, temporary jobs and institutional weaknesses and inappropriate labour regulation. In many areas, migration, especially from low- and middle-income countries boosts the informal sector, where women tend to be more predominant and less protected.

IW has historically been associated with the physical aspect of 4D jobs – dirty, dangerous, difficult and discriminatory: an updated terminology of the 3D job theory (which only focused on physical exposure) where we proposed a fourth D to account for the non-physical exposure viewing work as a social determinant of health. Although 4D jobs performed by informal workers (IWs) have always had a huge impact on their musculoskeletal system due to the nature of the biomechanical exposures, the causation of their work-related musculoskeletal disorders (WMSDs) is largely influenced by non-physical exposures i.e. work-related stress with constant high levels of cortisol, climate related physical stress, fast work pace with low autonomy. These examples of exposures in IWs work act as a synergistic concomitant exacerbating WMSDs with often very little opportunity to minimize exposures. We are also evidencing new generation of workers avoiding classical working structures and shifting towards digitally driven forms of IW where WMSDs are present but with new forms of exposures and impact, and also with the same lack of social protection, opportunities to prevent WMSDs and other occupational diseases and injuries.

As part of the solution, The Global Coalition on Informal Worker Health, Safety and Wellbeing has been created, dedicated to safeguarding the health and wellbeing of IWs globally, aiming to avoid framing IW as a “problem” or something “bad” but rather as a reality to be addressed and managed. Furthermore, the acknowledgement that IW is culturally influenced and driven by the history of different populations, which should be understood and respected, as an inherent aspect of human desire for work with a purpose. We also understand it is not realistic to expect "formalizing" 60% of the global working population, but rather to improve their lives, working towards their recognition, inclusion into social security, provide solutions to prevent occupational diseases and injuries with a focus on a future for decent work. Ultimately, we want to dignify the work done by IWs which has very little recognition and reciprocity despite the immense contributions they provide to the world.