Self-employment, work and health: A critical narrative review

BACKGROUND: Self-employment (SE) is a growing precarious and non-standard work arrangement internationally. Economically advanced countries that favor digital labor markets may be promoting the growth of a demographic of self-employed (SE'd) workers who are exposed to particular occupational diseases, sickness, and injury. However, little is known about how SE'd workers are supported when they are unable to work due to illness, injury, and disability. OBJECTIVE: Our objective was to critically review peer-reviewed literature focusing on advanced economies to understand how SE'd workers navigate, experience, or manage their injuries and illness when unable to work. METHODS: Using a critical interpretive lens, a systematic search was conducted of five databases. The search yielded 18 relevant articles, which were critically examined and synthesized. RESULTS: Five major themes emerged from the review: (i) conceptualizing SE; (ii) double-edged sword; (iii) dynamics of illness, injury, and disability; (iv) formal and informal health management support systems; and (v) occupational health services and rehabilitation. CONCLUSION: We find a lack of research distinguishing the work and health needs of different kinds of SE'd workers, taking into consideration class, gender, sector, and gig workers. Many articles noted poor social security system supports. Drawing on a social justice lens, we argue that SE'd workers make significant contributions to economies and are deserving of support from social security systems when ill or injured.