Arts, Faculty of
Other UBC
Non UBC
Asian Research, Institute of
DSpace
BMC Public Health. 2020 Apr 19;20(1):524
University of British Columbia. School of Public Policy and Global Affairs
The Author(s)
Ko Ko, Thant
Dickson-Gomez, Julia
Yasmeen, Gisèle
Han, Wai Wai
Quinn, Katherine
Beyer, Kirsten
Glasman, Laura
Background: Globally, two billion workers are employed informally but there is limited research on the relationship between informal work and health. Existing studies have focused on informality as an employment condition, with little emphasis on the diversity of physical and social contexts in which informal work takes place. The study considers the diversity of informal workplaces and explores the ways in which this diversity might influence health and well-being of two informal occupational groups in Yangon, the former capital of Myanmar. Methods: We conducted 21 field observations and 47 semi-structured interviews with street vendors and home-based garment workers based in Yangon, Myanmar. A constant comparative method was used to identify and compare how the physical characteristics of their informal workplaces affect their health for these two informal subgroups. Results: Although both street vendors and home-based garment workers work informally, their exposure to occupational health and income risks are specific to the physical features of their informal workplaces. Street vendors, who work in public spaces with minimal coverage, are more likely to experience the direct effects of outdoor pollution, inclement weather and ergonomic risks from lifting, carrying and transporting heavy merchandise while home-based garment workers, many of whom live and work in unsanitary housing and deprived neighborhoods, are more likely to experience pollution in or near their homes, and ergonomic risks from poor posture. Similarly, although both groups face safety challenges, street vendors face urban violence and abuse during their commute and at vending points whereas home-based garment workers felt unsafe in their home-based workplaces due to the presence of crime and violence in their neighborhoods. Conclusion: While informal employment is universally characterized by lack of social protection, exposure to occupational health and income risks for subpopulations of informal workers is determined by the specific physical and social environments of their workplaces. Efforts to improve the health of informal workers should consider the contexts in which informal work takes place to develop tailored interventions for subpopulations of informal workers.
RESEARCH ARTICLE Open AccessInformal workplaces and their comparativeeffects on the health of street vendors andhome-based garment workers in Yangon,Myanmar: a qualitative studyThant Ko Ko1*, Julia Dickson-Gomez1, Gisèle Yasmeen2, Wai Wai Han3, Katherine Quinn4, Kirsten Beyer1 andLaura Glasman4AbstractBackground: Globally, two billion workers are employed informally but there is limited research on the relationshipbetween informal work and health. Existing studies have focused on informality as an employment condition, withlittle emphasis on the diversity of physical and social contexts in which informal work takes place. The studyconsiders the diversity of informal workplaces and explores the ways in which this diversity might influence healthand well-being of two informal occupational groups in Yangon, the former capital of Myanmar.Methods: We conducted 21 field observations and 47 semi-structured interviews with street vendors and home-based garment workers based in Yangon, Myanmar. A constant comparative method was used to identify andcompare how the physical characteristics of their informal workplaces affect their health for these two informalsubgroups.Results: Although both street vendors and home-based garment workers work informally, their exposure tooccupational health and income risks are specific to the physical features of their informal workplaces. Streetvendors, who work in public spaces with minimal coverage, are more likely to experience the direct effects ofoutdoor pollution, inclement weather and ergonomic risks from lifting, carrying and transporting heavymerchandise while home-based garment workers, many of whom live and work in unsanitary housing anddeprived neighborhoods, are more likely to experience pollution in or near their homes, and ergonomic risks frompoor posture. Similarly, although both groups face safety challenges, street vendors face urban violence and abuseduring their commute and at vending points whereas home-based garment workers felt unsafe in their home-based workplaces due to the presence of crime and violence in their neighborhoods.(Continued on next page)© The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License,which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you giveappropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate ifchanges were made. The images or other third party material in this article are included in the article's Creative Commonslicence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commonslicence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtainpermission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to thedata made available in this article, unless otherwise stated in a credit line to the data.* Correspondence: thantko90@gmail.com1Institute for Health and Equity, Medical College of Wisconsin, Milwaukee,USAFull list of author information is available at the end of the articleKo Ko et al. BMC Public Health (2020) 20:524 https://doi.org/10.1186/s12889-020-08624-6(Continued from previous page)Conclusion: While informal employment is universally characterized by lack of social protection, exposure tooccupational health and income risks for subpopulations of informal workers is determined by the specific physicaland social environments of their workplaces. Efforts to improve the health of informal workers should consider thecontexts in which informal work takes place to develop tailored interventions for subpopulations of informalworkers.Keywords: Informal employment, Occupational health and safety, Urban safety, Social determinant of health,Employment relations, Workforce, Low and middle income country, MyanmarBackgroundInformal employment constitutes a significant propor-tion of the workforce in many low and middle incomecountries (LMICs) but very little research has studied itseffects on health. Decades of research show that path-ways linking work and health are complex and operateacross multiple levels. Identified pathways encompassboth physical and psychosocial influences of employ-ment on health and underscore how they contribute tohealth patterns both at the individual and populationlevels [1–3]. Additionally, research shows that incomemay affect health by directly influencing ability to fulfilhealth and basic needs essential for biological survival orindirectly determining the degree of social participationand control over professional and personal lives whichmay affect stress levels [4]. Studies have increasingly fo-cused on the health effects of flexible employment thatoffers limited employment benefits and social protection[5, 6], finding that they are associated with adversehealth outcomes [5, 7–9]. While these studies depicthow the changing dynamics of labour markets affectworkers’ health, research is limited in LMICs where em-ployment is largely informal and social protection mech-anisms are weak or absent.Globally, approximately two billion workers are infor-mally employed and not covered by statutory social andemployment benefits [10]. Many aspects of their work in-cluding working conditions, work hours, wages and occu-pational health and safety (OHS) are unregulated whichmay have harmful effects on health. However, research onthe relationship between informal employment and healthin LMICs is scarce. Recent studies have explored how in-formal work configurations affect health in LMICs andfound that informal workers are more likely to reportpoorer health status [11, 12] and worse quality of life [13]compared to formal workers. Informal work is also associ-ated with a higher risk of experiencing mental illnesses[12, 14]. Similarly, qualitative studies showed that informalworkers tend to have poor working conditions, irregularincomes, difficulty accessing health services and are vul-nerable to catastrophic health shocks [15–17].One limitation in existing studies is that they have yetto recognise that informal workplaces are diverse andinclude various “non-standard” settings such as road-sides, homes and transportation hubs that often lackOHS measures. Such diversity dictates that althoughsome informal occupations may share similar work ar-rangements, factors influencing workers’ health are likelyto vary, depending on their place of work. For instance,while a family business owner who works at home and astreet vendor can both be working informally, their workexperiences and exposure to OHS risks are likely to dif-fer. However, research investigating how place of work islinked to health for informal workers is limited, exceptfor one study which highlights how place of work con-tributes to differential exposure to OHS risks among in-formal workers in Brazil and Ghana [18]. This studyexplores ways in which the physical work environmentaffects health and well-being of street vendors (SVs) andhome-based garment workers (HBGWs), two informaloccupational groups in Yangon, Myanmar. The studyhas two aims: (1) to describe the informal workplaces ofSVs and HBGWs in Yangon; (2) explore and compareways in which the physical characteristics of their infor-mal workplaces affect SVs and HBGWs’ occupationalhealth and exposure to work-related stress.Study context and populationThe study took place in Yangon, Myanmar. In Yangon,labour force participation for persons aged 15 years orolder was 59.5% for both genders (78.1% for males and43.3% for females) in 2015 [19]. The overall unemploy-ment rate was 4%, including informally employedworkers. Similar to figures in other LMICs, informal em-ployment constitutes approximately three-quarters ofthe total non-agricultural employment and is the domin-ant form of employment in Myanmar [19]. In urbanareas, approximately 70% of employment is in the infor-mal sector. Yangon has the largest proportion of internalmigrants (48.2%), almost 20% of whom reported migrat-ing for work [19].Since 2011, Myanmar has witnessed an increase in for-eign direct investment and industrial expansions [20].Some sectors such as the garment sector have grownrapidly. The government has initiated labour reformsand passed new laws that seek to offer social security,Ko Ko et al. BMC Public Health (2020) 20:524 Page 2 of 14labour rights and other employment-related benefits in-cluding healthcare. Yet, such efforts have largely beenlimited to formal workers although informally employedworkers are the majority in the workforce. In this study,SVs and HBGWs were chosen for comparison becausealthough both groups operate informally, their work-places differ in terms of workplace characteristics andorganisation, regulation, and access to space.Street vendorsIn Yangon, SVs who sell a variety of merchandise in-cluding food, clothing and other goods are highly visible.The study focused on four downtown townships in Yan-gon, namely Latha, Lanmadaw, Pabedan and Kyauktadatownships. According to data collected in 2016, approxi-mately 6400 SVs operated in these townships [21]. TheYangon City Development Committee (YCDC), the city’smunicipal body, is responsible for regulating street vend-ing activities. Street vending in Yangon is considered amarginal economic activity with negative externalitiesincluding obstruction to traffic and pedestrian safety,and food safety. However, governance on street vendingis focused on limiting, rather than eradicating it.In 2016, YCDC relocated SVs from the four downtowntownships to a designated night market, a roadside vend-ing zone sandwiched between the downtown StrandRoad and a raised road by the Yangon river primarilyused by container trucks. Concurrently, the governmentcreated another vending area near the centrally locatedSule Pagoda. Vending spaces were allocated using a lot-tery system and vending identification cards were issued.Basic facilities such as running water, waste collectionand electricity are provided in both sites although wea-ther protection is minimal. In return, SVs pay user feesand taxes. The study participants included both SVs sell-ing in these designated sites and those who continue tosell in other unauthorized public spaces.Home-based garment workersHome-based workers who produce textiles, artisans andcrafts, and other products in home settings are commonin LMICs [22]. Home-based workers typically fall intotwo categories: (1) self-employed and (2) subcontracted.The former incurs the cost of production (buying rawmaterials, supplies and other costs) and sell their fin-ished goods to local customers whereas the latter (alsocalled homeworkers) produces goods for firms in bothlocal and global markets using materials supplied bytheir contractors [22]. This study included both types ofHBGWs.Family-owned businesses (mostly unregistered) com-prise almost half of the total manufacturing firms inYangon while micro-firms, defined as enterprises with1–9 operators, represent 35% of all the enterprises inYangon [23]. While sub-national level data for sector-specific distribution of firms are not available, informalfirms and microenterprises comprise approximately 34and 70% of the total textile manufacturing firms respect-ively in Myanmar [23]. This study focused on four town-ships – namely Hlaingthayar, Shwepyithar, NorthOkkalapa and Thingungyun townships – where small-scale, home-based garment and textile enterprises areprevalent, and a diversity of housing and neighbourhoodsettings are observed.MethodsThis paper presents results from semi-structured inter-views with SVs (N = 24) and HBGWs (N = 23) and 21ethnographic observations conducted in Yangon,Myanmar between June 2017 and September 2017. Thefirst author conducted observations which lasted aboutan hour and wrote detailed field notes after each session.To observe SVs, downtown areas were canvassed to se-lect four vending sites where clusters of SVs sell. Theywere observed four times each (N = 16) on varying daysand times from a nearby food stall or a street-side café.No consent was sought as the observations were strictlyof public behaviour and were non-interactional in na-ture. However, verbal consent was obtained fromHBGWs and other household members prior to obser-vations (N = 5) as they took place in their homes. Fieldnotes documented day-to-day operations, workplacephysical arrangements (size, density, materials used),working (and living) conditions, neighbourhood charac-teristics, patterns of social interactions, and potentialhealth impacts of their workplaces. Fieldwork data weretriangulated with interviews to obtain additional infor-mation about settings and patterns not captured duringthe interviews. For instance, field notes describing thephysical attributes of the informal workplaces were usedto contextualise SVs’ and HBGWs’ own accounts of theirworkplaces and exposure to OHS risks.Inclusion criteria for both SVs and HBGWs were asfollows: (1) being at least 18 years of age at the time ofconsent, (2) having work experience of at least 3 monthsin respective occupations, (3) fluent in Burmese; and (4)willing and able to provide verbal consent. Given thathome-based garment production is a female-dominantoccupation in Myanmar, we expected our final sampleto primarily include female participants. Although streetvending is a common occupation for both genders, weoversampled women in our study to explore genderednotions of informal work. We used purposive samplingto recruit participants with a diversity of personal char-acteristics including age, migrant and marital statuses.Table 1 describes the characteristics of the partici-pants. About two thirds of SVs and HBGWs who partic-ipated in the study were internal migrants. The averageKo Ko et al. BMC Public Health (2020) 20:524 Page 3 of 14years of work experience as SVs and HBGWs were10.6 years and 6.2 years respectively. Most SVs identi-fied themselves as self-employed workers although adiversity of statuses in employment were foundamong HBGWs. Of the 24 SVs, five self-identified asmobile vendors; nine as semi-itinerant and ten werestationary vendors. Five identified their primary vend-ing location as YCDC-designated vending zones andthe rest vended in unauthorized public spaces. All buttwo HBGWs – one of whom worked in her em-ployer’s home and the other in her neighbour’s home– worked in their own homes. A majority of SVslived in rental housing, which also was the most com-mon form of housing among HBGWs. However, morethan a quarter of the HBGWs in the study lived ininformal housing.Participants were recruited either directly by the firstauthor who approached potential participants in theirworkplaces or through referrals from initial participants.A small incentive (2500 Kyats, approximately $2) was of-fered for study participation. An additional 1000 Kyats($0.75) was offered for referring up to three participantswho were not their family members or relatives. Verbalconsent was sought from both groups. During the con-sent process, participants were explained about thestudy. They were also assured that their participation inthe study is voluntary and will not affect their employ-ment. HBGWs were also explained that their participa-tion in observations will not affect their freedom toparticipate in interviews. Data collection took place invending sites (sidewalks, streets, stairwells) and partici-pants’ homes as chosen by the participants.Study protocols were approved by the Institutional Re-view Boards at the Medical College of Wisconsin andthe Department of Medical Research, Ministry of Healthand Sports, Myanmar. Interviews lasted between 45 and90min. An open-ended topic guide covering the samecontent areas for both groups was used (See add-itional file 1). They included participants’ backgrounds,work history, the process of starting their work andchanges over time, employment and workplace arrange-ments, physical features of and access to their work-places, factors influencing OHS and income stability,characteristics and safety of the neighbourhoods wherethey work/live, and self-reported health and quality oflife. Identifiable data such as participants’ names andworkplace locations were not asked in the interviews.Digital recordings of interviews were transcribed ver-batim and imported into MAXQDA software for codingand analysis. Analysis focused on identification ofthemes related to the physical contexts of informalworkplaces and how they shape workspace arrangementsand related OHS and income risks for SVs and HBGWs.A preliminary codebook was developed by open-codingof the field notes and interviews. It was then supple-mented with key constructs from the literature. As theanalysis progressed, the coding scheme was refined itera-tively and continually revised through the addition ofemergent codes and themes until the research teamagreed that thematic saturation was reached. We used aconstant comparative method in our analysis [24]. Wefirst looked for similarities and differences among thetwo groups separately to explore variability within eachgroup. For instance, we looked for similarities and differ-ences in ergonomic risks among stationary, semi-itinerant and mobile vendors. We then compared SVsand HBGWs in terms of their workplace environments,and workers’ experiences of OHS and income risks. TheTable 1 Participant CharacteristicsSV (N = 24) HBGW (N = 23)Mean [range]Age (years) 34.54 [18–57] 36.26 [20–56]Length of employment (years) 10.61 [1–40] 6.24 [0.5–25]Number of Children 1.51 [0–5] 1.3 [0–4]N (%)GenderFemale 16 (66.67) 22 (95.65)Male 8 (33.33) 1 (4.35)EducationElementary or lower 13 (54.17) 5 (21.74)Middle school 5 (20.83) 7 (30.43)High school or higher 6 (25) 11 (47.83)Marital StatusSingle 6 (25) 7 (30.43)Married 15 (62.5) 13 (56.52)Divorced or widowed 3 (12.5) 3 (13.05)Migrant StatusYangon resident 8 (33.33) 8 (34.78)Migrant 16 (66.67) 15 (65.22)Housing TypeRental 17 (71.9) 14 (60.87)Informal Housing 0 (0) 6 (26.09)Family-owned 7 (29.1) 3 (13.04)Family TypeNuclear 11 (45.8) 11 (47.83)Extended 13 (54.2) 12 (52.17)Employment StatusSelf-employed 22 (91.67) 10 (43.48)Wage-employed 1 (4.17) 2 (8.7)Contributing family Member 1 (4.17) 3 (13.04)Subcontracted 0 (0) 8 (34.78)Ko Ko et al. BMC Public Health (2020) 20:524 Page 4 of 14first author who speaks native Burmese coded all thedata. Coded transcripts were reviewed by the fourth au-thor, who also speaks native Burmese, for consistencyand accuracy. Discrepancies in coding and interpreta-tions were resolved through regular meetings and aconsensus-based team approach. Example quotes weretranslated into English for group discussions and pre-sented in the findings.ResultsPhysical features of the workplaceStreet vendorsA typical workplace for the SVs observed includes a publicor semi-public space (e.g. a storefront) located near down-town streets, markets, parks, enclosed alleys and publictransportation stations with high pedestrian traffic. Theratio of vendors to available space is high and vendorscluster to occupy space tightly. Street vendors interviewedhad varying working hours and days, but many workedfrom early morning hours (4-6 am) till evening hours (7-8pm). Some SVs who sold near offices and banks did notwork on weekends. Street vendors sell in open air settings,using transportable equipment including baskets, trays,containers, pushcarts, shoulder poles and tables. Streetvendors selling food use public space for cooking and pre-paring food, cleaning, waste collection, storage and servingcustomers. While many disposed waste and by-productsin city-provided bins, trash, overflowing waste bins andwastewater were observed.The use of space among SVs changes throughout theday. Lacking legal rights to sell in public spaces, SVsshare spaces based on mutual understanding and infor-mal rules. Although many SVs occupy “permanent” loca-tions, others canvass the streets on foot. Street vendorscarrying shoulder poles or merchandise on their headsfrequently stop near busy intersections and roads andsell next to stationary vendors. During the peak hours,this influx of “temporary” vendors adds more density tothe already crowded workplaces.While spatial arrangements vary, one common featureamong SVs is the use of cheap makeshift materials suchas umbrellas, poles and plastic sheets to reduce operat-ing costs and avoid confiscation and eviction since theyare relatively easy to hide and transport to another loca-tion. While economical and efficient in avoiding patrol-ling YCDC officials, they do not protect SVs fromphysical hazards such as outdoor pollution and inclem-ent weather, which may also cause damage to merchan-dise. During one observation session, heavy rainsblocked some storm drains, causing water to rise andprompting SVs to move their stalls. Others used bricksas weights to prevent their stalls from collapsing due tostrong winds and rain. Some also removed the waterstaying on the nylon coverings that served as temporaryroofs and drenched themselves in the process. Through-out the study period which took place during monsoonseason, SVs were often seen staying in wet clothes sittingby their stalls.Home-based garment workersParticipants in the study conducted their work in theiror their neighbours’ homes, which double as their work-places. Their work commonly took place in the livingrooms or partitioned spaces. The housing types observedincluded family-owned houses and shared accommoda-tions such as partitioned rooms and dormitory-style ren-tal rooms that accommodate multiple households withina building. Members of the same family typically occupydifferent rooms within a house although partitionedrooms, frequently observed in rental housing, accommo-date multiple families. Several HBGWs reported sharinghousing with their landlords.The house size and the number of co-residents for theHBGWs varied in the study. The number of residents ina household ranged from two to eight. Workplace sizevaries from a small extension from the landlord’s houseused for both living and working purposes (approxi-mately 40 square feet) to residential houses with separ-ate spaces for living and working (approximately 1000square feet). Besides size, housing quality and amenitiesalso vary, depending on the household income, tenurestatus and location. Home-based garment workers inmixed-income neighbourhoods tend to live in dwellingsconstructed with durable materials such as brick, con-crete, wood and tin roofs. They usually have access topaved roads, electricity, piped water, private clinics andsocial services. Others with fewer resources live in low-income neighbourhoods and informal settlements wherethe houses were built with low-quality makeshift mate-rials such as bamboo, recycled and salvaged materials,cardboard, and thatch roofs that do not provide ad-equate privacy and safety, and protection from climateconditions. Some houses observed were stilt housesunder which wastewater from cooking and householdwaste such as plastic bottles and discarded rice were ob-served. In general, the neighbourhoods where low-income participants live often have unsanitary and poorliving conditions.For both occupational groups, the physical features oftheir workplaces predispose them to OHS risks. Theserisk factors include environmental pollution, weatherand ergonomic risks. Beyond directly influencing phys-ical health, physical work environments lead to incomeand personal safety risks.Environmental pollutionUrban air pollution accounts for 50 to 70 million inci-dents of respiratory illness in developing countries [25].Ko Ko et al. BMC Public Health (2020) 20:524 Page 5 of 14Pollution is a serious threat to human health, particu-larly in overcrowded urban spaces and settlementswhere the poor in LMICs live and work. For both SVsand HBGWs, their workplaces lack proper infrastructureto protect workers from acute and chronic exposure toenvironmental pollution.For SVs, their work activities in open air settings andhigh traffic areas where they spend long hours outdoorsexpose them to occupational hazards. They reported thattheir ability to relocate is constrained by stiff competi-tion for vending spaces and the fear that relocationmight hamper their income and loss of an establishedcustomer base. Consequently, they accept pollution asan inevitable part of their work.In the street where I used to sell, there was a stormdrain and the lid covering it was usually open…thebad smell was there all the time. [I was there] for 3years. During the monsoon season, the drain got fulland garbage came up to the ground. I had to dealwith that. Last year, there was a lot of flooding. [25-year-old SV, Male]Street vendors also complained that they are regularlyexposed to urban noise as they sell near other vendorsand high vehicular traffic. Since Yangon’s traffic controland regulations are weak, vehicles compete for right ofway, leading to incessant honking. Although noise levelsvary depending on location, downtown areas tend tohave a high concentration of vehicles which createschronically noisy work environments that may negativelyaffect their health and quality of life.When there are traffic jams, I can hear the noise be-cause I’m selling right next to the street. Noises likepeople angrily honking at other cars and other vendorsarguing and fighting or just calling out loud for cus-tomers to buy from them. [24-year-old SV, Female]Similarly, many SVs reported exposure to vehicularfumes and pollutants due to heavy traffic congestion indowntown areas of Yangon. The city has seen more ve-hicles and traffic congestions since 2011 with theliberalization of the automotive industry.I experience it [exposure to traffic fumes and noise]every day. Sometimes those car owners parked theirvehicles near me and sat inside comfortably withthe air conditioner on. For us, we suffer from theheat [exhaust fumes]. That’s the life of a streetvendor. [27-year-old SV, Male]Another common source of air pollution is cooking out-doors using charcoal, which releases harmful smokecontaining toxic chemicals and heat. The use of charcoalas a cooking source is very common in LMICs [26] andlinked to respiratory infections, chronic obstructive pul-monary disease (COPD), lung cancer, tuberculosis,asthma, cardiovascular events and all-cause mortality inboth adults and children [27]. In Yangon, some SVs, par-ticularly those who prepare made-to-order dishes usinglarge woks or flat pans, use charcoal stoves for cookingoutdoors. One SV selling made-to-order dosa (Indianpancakes) using charcoal fuel discussed that her dailyfood preparations cause frequent eye irritations.I usually keep the fire running until I run out of in-gredients […] So the heat [and smoke] comes intomy eyes and sometimes I get irritations and swolleneyes and also headaches. People warned that it’s be-cause I stand close to the heat source. [24-year-oldSV, Female]She also added that although she has not faced serioushealth problems, her mother, who started the businessand worked for about 20 years, has been experiencingobstructive lung disease, likely from chronic exposure topollutants from burning charcoal.Like SVs, HBGWs face OHS risks at their workplacesbut the ways in which they are affected differ. As theyprimarily work indoors, they are less exposed to traffic-related air pollution compared to SVs. Instead, HBGWsface pollution from living in overcrowded, low-qualityhousing. They identified improper waste disposal andthe presence of garbage near their houses as sources ofpollution. Because the municipal waste collection systemis unreliable, especially in neighbourhoods in the periph-ery of the city [28], residents typically dispose garbage ei-ther at unregulated dumpsites near their houses orwithin the neighbourhood. For residents living in stilthouses, some choose to conveniently discard their wasteunder the floor to the ground. This improperly disposedwaste accumulates over time, emitting foul smells andcreating a breeding space for disease vectors such as rats,flies and mosquitoes.When it rains, the smell is terrible. My neighboursare so dirty […] they just dump leftovers, rottenfood and the polluted water to the ground. Becausethe houses are close, you can smell it […] when itrains, all the smell comes out. [52-year-old HBGW,Female]Home-based garment workers who live in crowdedresidential settings are frequently affected by toxic fumesfrom welding and machinery noise from other home-based enterprises such as metal workshops. Althoughthey did not report experiencing specific illnesses due toKo Ko et al. BMC Public Health (2020) 20:524 Page 6 of 14these exposures, it has been shown that toxic fumes andparticles from welding can negatively affect respiratoryhealth [29].The bike shop [next to my house] does welding so Ifrequently get the burning smell. Not all the timebut whenever they use welding machine or do metalcutting for a repair work […] There is noise too, butthe main problem is that burning smell. [33-year-old HBGW, Female]Besides environmental pollution from proximate sourcesmentioned above, HBGWs living near factories are af-fected by pollution including dust, pungent smell fromindustrial waste, emissions, and side products. As theyrely on natural lighting and few houses have proper win-dows to block undesirable smells, They are constantlyexposed to the pollution in both working and non-working hours.Sometimes, when the alcohol factory dumped theirwaste, I got bad smell. In the summer, it’s also pun-gent smell from the fish sauce factory. When itcomes, we simply can’t avoid it. It affects the entireneighbourhood…day and night…With that smell,we can’t eat. [46-year-old HBGW, Female]Finally, HBGWs are exposed to dust and particlesfrom the textile materials they use. Chronic exposure tocotton dusts has been shown to increase risks for asthmaand COPD and eye problems [30]. For HBGWs in Yan-gon, this is exacerbated by the crowded living conditionsand poorly ventilated workplaces. One HBGW with twodecades of work experience shared how it affects herhealth:The dust from the garments obstructs my airway.When I spread the garments, it releases small dusts.I couldn’t breathe well. I recovered from it but nowit’s back. I need to see a doctor often and she givesme an injection which lasts 3 months […] When itgets worse and I can’t continue [working]. I justtake a rest. And when I feel better, I just resume.[55-year-old HBGW, Female]Weather effectsWeather affects both SVs and HBGWs whose work-places typically are not properly outfitted for weatherprotection. Because SVs spend long hours outdoors,weather visibly affects them. Street vendors discussedthat heavy monsoon rains in Yangon negatively affecttheir daily operations from sourcing merchandise atthe wholesale markets, setting up stalls to storing un-sold items.Sometimes when the rain is heavy, I have to stay inwet clothes the whole day. Although it’s raining alot outside, I get up at 3am [and go the wholesalemarket] to get my merchandise. When it stops rain-ing, my clothes get dry. Then it rains again and theyget soaked again. I get sick from that and also getheadache and nasal problems. [25-year-old SV,Female]Since transportability is key to a SV’s survival from lawenforcement, some vendors see little purpose in addingextra clothes and protective gear to their daily transport.They instead choose to take shelter under the trees,staircases or entrances of private properties during heavyrains and winds. However, they often stay close to themerchandise to prevent damage and theft. One SV ex-plained that he usually prioritises covering up his perish-able fruits over himself as he cannot afford to lose hisdaily capital. For others, they do not use weather protec-tion because it might make them visible to the author-ities. Some discussed that when weather is harsh, theirprotective gear does not provide sufficient protection.When there is a downpour. I use an umbrella whenit’s heavy. But the wind is strong too. Gusty winds[…] I can’t use the umbrella. I end up gettingdrenched in the rain, but I try to cover the fruits.[24-year-old SV, Female]The effects of weather are particularly challenging forsome SVs experiencing difficult life transitions such aspregnant SVs or elderly vendors whose health and func-tional ability are compromised by years of working inpoor conditions. Despite these health conditions, theyreported that they must continue to work for their sur-vival. While income levels vary among SVs with somereporting earning relatively decent incomes (approxi-mately $200 per month in high-selling seasons), SVswho earn low or erratic incomes from selling severaltrays of vegetables per day on a small margin do notearn sufficient savings. Thus, they cannot afford takingdays off despite their health conditions because they donot have access to social security or sick leave.My back hurts and my legs also ache [from working].With my pregnancy, it’s worse. In recent days, my bodyaches every day. It doesn’t help that I’ve been selling inthe rain. I can’t sleep at night. I get back home around10pm, have dinner and go to bed around 11pm. But Icannot fall asleep easily… I sometimes doubt if I cancontinue [working] the next day because my body hurtsa lot, but I have no choice. It won’t make it easy for meeither [if I don’t work]. I need to worry about makingmy ends meet. [34-year-old SV, Female]Ko Ko et al. BMC Public Health (2020) 20:524 Page 7 of 14Comparatively, HBGWs are less affected by monsoonrains as they work indoors. Their home-based work-places, while poorly constructed and maintained, at leastprovide relatively better shelter and weather protectioncompared to makeshift coverings SVs use in open air.While some HBGWs discussed that heavy rains some-times cause leaking roofs and flooding, they downplayedthe direct effects of monsoon weather on physical health.However, their home-based workplaces present healthchallenges in the summer when a combination of poorventilation, high humidity and indoor temperatures, andheat-absorbing construction materials such as tin roofsthat trap heat creates unfavourable working conditions.In comparison, while SVs are also affected by the directsunlight and heat, some shared that their mobile work-ing lifestyles enable them to employ adaptive strategiessuch as selling under tree shades. For HBGWs, optionsare limited, and they work in their poorly ventilatedworkplaces.I had to be creative and made holes to the [bamboo]wall to make it better. In the summer, I get reallysweaty as the room is filled with the pillow stuffingmaterials [that retain heat]. The only way to relievethis is to bring some air in. [20-year-old HBGW,Female]Weather also poses income risks for both groups byinterrupting daily routines and income which in turn in-crease their stress. Both groups mentioned that mon-soon months, from mid-May to September, areassociated with lower sales while the ‘dry’ season offersbetter economic prospects. Most SVs prefer sunny wea-ther which encourages people to spend time outdoors.Monsoon has an opposite effect as it forces customers tostay indoors or away from makeshift stalls. A shoulder-pole vendor complained that rainy weather perenniallyexposes him to financial uncertainty and affects his abil-ity to pay for housing rent and household expenditures.I struggle a lot during the rainy season. It’s been atrend for a while now. The sales are meagre, and Iborrow money from others […] Summer is usuallybetter because it’s hot and people spend more timeoutside and buy from me […] in the monsoon sea-son, I use my savings [from the summer] to pay forbasic needs at home. [44-year-old SV, Male]In fact, some SVs mentioned that they utilise riskpooling strategies such as renting and sharing a flat (ap-proximately 1000 squared feet) among 15–20 peoplewho came from the same village to afford high rent andliving expenses in Yangon. They also reported stayinglonger hours in poor working conditions when sales arepoor. These struggles not only increase their risks forphysical health problems but also elevate stress and re-duce time spent with family or engaging in social activ-ities that improve their quality of life.When the rain is heavy, it’s not great for me. I haveto stay longer. Sometimes I cannot finish sellingeverything…I just have to sell it the next day. Some-times, if I haven’t made my daily income, I just sitand wait whether customers come or not, and onlygo back home once they are finally sold out. [34-year-old SV, Female]For SVs selling perishable items, they scale down theirdaily stock to lessen the financial risk. Even with a calcu-lated approach, poor sales still amount to income risks.Not only does weather affect daily sales but it also ham-pers their ability to reinvest in their daily capital.When the sales are poor [because of weather], fruitsripen and get rotten quickly. Because I’m sellingperishables [there is always a risk]. After one or twodays, they change colour and after 3-4 days, you cansee the blemishes. Then I have to lower the price orjust discard the unsold ones. [36-year-old SV,Female]The stress of dealing with financial uncertainties is amp-lified when heavy monsoon rains cause flooding indowntown areas which invades SVs’ stalls and makes itdifficult for them to continue daily activities. Some ven-dors cope with this interruption by relocating to less af-fected areas while others who lack that option halt theirwork until flooding subsides.When it [flooding] happens, I move to a differentplace and leave my shoulder pole …If it’s not rain-ing heavily, I just try to sell. If flooding happensafter I’m already out, there is nothing I can do aboutit. I can’t pack up and go back either so I just sitsomewhere. [25-year-old SV, Male]Home-based garment workers also reported experien-cing income-related stressful experiences. They dis-cussed that although their home-based workplacesgenerally offer protection from direct effects of weatherduring monsoon season, they are also prone to floodingwhich interrupts their work and reduces income.When water comes in, I cannot do my work any-more. I made a concrete floor and added bricks toprevent flooding. Even with that, water still came inthe other day. The flooding was quite high that day[…] When it happened, I couldn’t do work anymoreKo Ko et al. BMC Public Health (2020) 20:524 Page 8 of 14and had to reschedule my order appointments. [55-year-old HBGW, Female]Another way in which weather can affect productivityand income and trigger stress among HBGWs is throughpower outages, a common occurrence during monsoonseason. Both shortage in energy supply and external dis-turbances caused by severe weather can cause poweroutages. Typically, weather-induced outages are unpre-dictable and may last the whole day. While these issuesare not limited to neighbourhoods where HBGWs live,they are more likely to experience it frequently becauseof poorly maintained electric grids in deprived neigh-bourhoods. As many HBGWs use electric sewing ma-chines, their work is delayed when weather triggerspower outages. This is particularly stressful for subcon-tracted HBGWs who are working on a bulk order thatrequires working around the clock to meet deadlines.I usually set a target on how many pieces I wantto finish but with power outages it’s challenging.We have to finish 500 pieces this month and thisspecific design is complex. So, I need to be work-ing pretty much all the time to get it done. Addto that my small child and other householdchores, it becomes very stressful. [34-year-oldHBGW, Female]Home-based garment workers cope with this by per-forming other tasks that do not require electricity whilesome use manual machines or sew by hand. Even forthese workers, it is a challenge to work without electri-city during monsoon season as natural lighting is inad-equate and their work demands precision.When it rains, the power is gone. Mine is a man-ual machine so I don’t need electricity. So, I canstill do work if there is enough lighting. If theorder is not urgent, I stop working but if it is, Iuse candle light…[it’s] better than just sitting andnot doing anything. If I just stop working, I’ll bebehind my work…When I do with candle light,it’s not as productive. I have to concentrate moreand do it slower to avoid mistakes. [25-year-oldHBGW, Female]This quote illustrates how, in addition to increasingwork stress, weather-induced disruptions can potentiallyaffect physical health among HBGWs. Some participantsdiscussed that they compensate for the time lost byworking well beyond their regular hours (typically 8–10h per day). When such episodes become frequent, theynegatively affect their health by disrupting their sleeppatterns and elevating stress levels.ErgonomicsExposure to musculoskeletal risk factors among SVs islinked to their use of transportable materials and ergo-nomically poor equipment to avoid confiscation andevictions. They often sit on plastic stools or on theground without back support for extended hours and liftheavy loads on their shoulders or heads. Stationary SVscomplained that they frequently experience pain andstrains due to sitting in improper posture.Because I sit all the time, my neck gets tense and Ifeel drowsy. Sometimes I just take a nap leaning onthe long container you see over there. Or if I feeltoo drowsy, I just sleep anywhere possible. Some-times, [I nap] on the light truck parked behind me.[25-year-old SV, Female]Shoulder-poles and headload vendors complained thatthey experience pain due to carrying heavy loads thatoften include their daily merchandise, utensils for foodpreparation and in some cases, buckets of cleaningwater. While some become used to the pain, chronicpain takes a toll on those doing these activities for years.One thing I notice is previously I carried things onmy head but now I can’t do it anymore. Even for asmall load, my head and back hurt and I get pain inmy chest. I feel strange. I don’t feel good about my-self because I used to be able to do these things.[51-year-old SV, Female].In addition, repetitive and overuse of a body part in-creases ergonomic risks for some SVs. The aforemen-tioned dosa vendor discussed that besides pain frompoor posture, her work that requires pouring the battermixture into the hot pan with one hand while stirringwith the other leads to muscle strain due to repetitivemotions.For HBGWs, exposure to ergonomic risks primarilycomes from sitting in poor posture or awkward positionssuch as leaning forward for extended periods without abreak.I don’t feel it [the pain] while working but I feel itwhen I get up. My legs feel tense and I get neckpain and headache. I usually sit on the floor to cutgarments. Perhaps it might be better to do it on adesk. But I have to do it there because the space issmall. [27-year-old HBGW, Female]Several HBGWs also reported that they suffer from eyestrains, blurred vision and headaches due to a combinationof factors including poor posture, sitting for long hours, sus-taining high concentration levels and poor lighting.Ko Ko et al. BMC Public Health (2020) 20:524 Page 9 of 14My neck usually feels tense and I get headaches. Ialso had eye problems. I couldn’t open them […]My hands hurt too because I cut garments. Also, Ihave stay focused all the time because the designsare complicated. I also get headache from that. [50-year-old HBGW, Female]Neighbourhood safetyThe physical characteristics of the neighbourhoods wherethey work influence their perceptions and experiences ofsafety for both groups and affect their stress levels. For SVs,the scope of workplace neighbourhoods is broad as theirday-to-day life often begins at home and involves commutingto wholesale markets and vending sites in downtown neigh-bourhoods. Because they work long hours almost every day,they barely spend time in their own neighbourhoods. Thus,their experience of neighbourhood safety primarily comesfrom their daily commute and vending sites. Several femaleSVs cited that their daily commute in early mornings andlate evening hours on poorly lit streets with few pedestriansposes a safety concern. Many SVs choose to go to wholesalemarkets early in the morning so that they can select from agreater variety of produce. As a safety measure and a cost-effective strategy, they typically commute with fellow ven-dors. Despite that, several female SVs reported encounteringharassment and stressful experiences.I was waiting at the bus stop with my older sisterearly in the morning. And there was a driver. Itwas still dark at that time and he thought wewere something [prostitutes]. He made attemptsto harass us but luckily there were people nearbyand they defended us […] Now we leave a bitlater when we can see light. [18-year-old SV,Female]Although the participant downplayed the incident asan unfortunate event, it is clear that such experiencescan affect physical and mental health of female SVs whohave to commute and work in unsafe neighbourhoodsfrom early morning to late evening hours.Other SVs mentioned that the presence of police andwell-lit downtown neighbourhoods generally discouragecriminal activities. Street vendors also sell in clusters toguard themselves against violence and threats. Yet, theyoccasionally face harassment and verbal abuse fromsome pedestrians under the influence of substances es-pecially in late evening hours.I have had some experience with drunk people…One guy asked me how much one basket of straw-berries is, and I said 1000-1500 kyats. He then re-plied, “is it enough? How much is it if I upend theentire stand?” [32-year-old SV, Male]Home based garment workers’ perceptions of neigh-bourhood safety are primarily based on their residentialneighbourhoods. Many HBGWs felt safe working athome but those living in low-income neighbourhoodslocated on the periphery of the city where law enforce-ment and public safety measures are weaker mentionedthat the prevalence of crime and violence poses safetyconcerns. These concerns were particularly commonamong HBGWs whose houses lack proper doors, wallsand privacy and are located close to other houses.In this street, it’s not safe during the monsoon sea-son. There is theft and most people don’t havejobs… a lot of guys also are alcoholics and they keepmonitoring other households [to steal things]. [25-year-old HBGW, Female]The same participant discussed that women are athigher risk and how harassment and unwanted ap-proaches from strangers in her own neighbourhood hadbeen part of her life throughout her teenage years to herearly 20s until she became married.Other HBGWs discussed that although they are notpersonally affected by crime and violence, living andworking near street corners and intersections wheremale causal workers and motorbike-taxi drivers congre-gate puts them on constant alert regarding their per-sonal safety. They also discussed that frequent newsabout theft, robbery, fights, murder and harassment inor around the neighbourhoods in which they live affecttheir perception of safety and heighten their stress.Because I live close to a street corner, I am worried[about my own safety] … I encounter all kinds ofpeople. Nothing terrible has happened to me so farbut I usually see people who are drunk or yelling atothers…I try not to go out to dangerous areas in theevening because I hear all the bad things happening.[At night] I block the door with a bike and then setthe lock. When I sleep, I have something [a self-defensive tool] next to me. [46-year-old HBGW,Female]Some expressed a desire to relocate to avoid these is-sues but are also aware that their chances are slim, giventhe scarcity of affordable housing options elsewhere andpotential interruptions to their work. Lacking alterna-tives, they devise self-defensive strategies in case theyface an unfortunate criminal event.DiscussionResearch indicates that precarious employment, charac-terised by variable work schedules, lack of a written con-tract and limited provision of employment benefits, isKo Ko et al. BMC Public Health (2020) 20:524 Page 10 of 14linked to poor health [6]. Informal work, a form of pre-carious work, is also linked to negative health outcomes[31]. One limitation of existing studies is that they havenot considered how diverse informal workplaces carrydifferent levels of exposure to certain health risks. Thisstudy highlights how the physical contexts of informalworkplaces (public spaces and homes) differentiallyaffect health and well-being among SVs and HBGWs inYangon, Myanmar.Findings in the study are consistent with previousfindings on OHS outcomes among SVs and HBGWs inother settings. Studies in other LMIC cities showed thattraffic-related air pollutants led to work related illnessesor injuries including upper and lower respiratory symp-toms, headache, eye irritations and musculoskeletalproblems for SVs [32–34]. A study in Accra, Ghana,found that traffic-related air pollution was positively as-sociated with impaired foetal growth and low birthweight among pregnant SVs. A qualitative study withcross-border women street traders in Accra, Ghanashowed that they faced physical health challenges in-cluding musculoskeletal pain, swollen feet, body aches,back pain due to long journeys, poor rood networks andworking in hazardous work environments [35]. A studybased in Phnom Penh, Cambodia, showed that SVs facedpersonal safety risks in their commute to wholesale mar-kets early in the morning due to theft and robbery [36].Similarly, our findings on HBGWs are consistent withprevious findings. Unhygienic home environments, longworking hours and ergonomically poor workplaces werefound to pose health and income risks among femalehome-based workers in India and Pakistan [37]. Simi-larly, Tipple (2006) found that home-based workers infour different LMIC cities worked for long durations inhigh intensity work which increased their risk of experi-encing poor work-related health outcomes [38].To date, very few studies have directly compared infor-mal workers in different settings to identify if variationsin risk profiles exist across different occupations. To doso is important for three reasons. First, place of work de-termines the degree of exposure to certain occupationaland income risks which may in turn translate into vary-ing levels of vulnerability to specific health outcomes.Second, informal subgroups have different levels of con-trol and autonomy over their workplaces and are subjectto different regulations [18] which demands tailored in-terventions. Third, weak labour institutions in LMICsmean that designing a comprehensive labour protectionscheme for all workers including informal workers canbe a challenge in practice. Such schemes will likely ex-clude small-scale informal workers in ‘atypical’ work-places which could perpetuate their marginal status andpoor working conditions. Thus, it is important to recog-nise the diversity of informal workers and theirworkplaces and study their characteristics to generateevidence for formulating future interventions and strat-egies to engage with stakeholders involved in regulationof ‘atypical’ workplaces.This study identifies “entry points” to intervene to im-prove the income security, OHS and general health ofSVs and HBGWs. Some of these suggestions may berelevant to informal workers in other contexts, althoughas seen in our results, context matters. First, provision ofbetter infrastructure could promote safer and healthierwork environments for both groups. Basic urban servicessuch as clean water, sanitation and storage facilities,proper drainage and waste disposal systems would re-duce certain OHS risks in polluted public spaces whereSVs work. Efforts to improve the working conditions ofstreet vending in other parts of the world are often ac-companied by mass relocation that disrupts regular workpatterns including spatial arrangements and income[39]. Due to the unpredictable nature of their urban live-lihoods, SVs tend to prioritise income stability overavoiding health risks in choosing their locations. Thus,interventions to improve their health need to take prod-uctivity and incomes into consideration. Such provisionsare more likely to be sustainable if participatory ap-proaches that involve SVs as stakeholders in decisionmaking processes are employed. For instance, in Bhuba-neshwar, India, a multi-stakeholder partnership involv-ing the public and private sectors and SVs co-developeda strategy to finance the project through funding fromthe private sector who will receive advertising rights inreturn and build aesthetically pleasing, organised andprotected workplaces [40]. A similar financing plancould be an option in Yangon where private actors havealready used SVs as an advertising venue. However, itshould be acknowledged that not all interventions, how-ever well-intended, may interest or be perceived by SVsas beneficial. Thus, it is imperative that their voices areidentified and incorporated in policy dialogues.Home-based garment workers, especially those livingin deprived neighbourhoods and informal settlements,would benefit from improved residential and neighbour-hood services including waste disposal and collectionsystems, proper monitoring and control of industrialpollution, and electricity. Future work should explorethe cost effectiveness of different residential upgradingstrategies including improving basic physical infrastruc-ture and services (roads, health services), incrementalupgrading of shelter, and sustainable strategies that pro-mote residents’ livelihoods and community capital [41].These efforts can serve as an alternative to relocation,which often contributes to economic instability.Second, although SVs and HBGWs differ in terms ofvisibility, they are similar in that they lack access to aformal mechanism to participate in social dialogue withKo Ko et al. BMC Public Health (2020) 20:524 Page 11 of 14stakeholders who regulate their workplaces because theyare unorganised labour. Collective bargaining can helpSVs negotiate with the local governments on issues suchas the legal use of public space and law enforcement[39]. Similarly, collective bargaining can help HBGWsgain access to better services and infrastructure, creditand skill development trainings, OHS rights and healthservices. In Thailand, a national home-based worker or-ganisation, HomeNet Thailand, participated in policy di-alogues to ensure home-based workers’ access touniversal health coverage [18]. However, given the every-day challenges SVs and HBGWs face including longworking hours and financial constraints, they may havelittle opportunity to organise. Non-government organisa-tions and trade unions could act as intermediaries anduse their resources to stimulate grassroots movements.Admittedly, one major caveat in following these inter-national examples is that they are from contexts withmore advanced and better functioning labour institu-tions and legal frameworks to protect workers thanMyanmar, where labour reforms have only recentlybegun. Yet, lessons learned from these examples couldserve as a starting point in identifying organising strat-egies for informal workers in Myanmar.Third, the state’s recognition of SVs’ and HBGWs’ con-tributions to the economy and the need to improve theirworking conditions is imperative for expanding OHSrights and social protection to informal workers. National-level policy and legislative reforms are needed to promotetheir livelihoods and health. These efforts should be com-plemented by reform at the local level. Local governmentsdirectly influence day-to-day livelihood activities of infor-mal workers [18, 42]. In Yangon, SVs in downtown areasare subject to constant monitoring and regulation. Simi-larly, the local government’s limited action on improvingthe unsanitary workplaces of home-based enterprises indeprived neighbourhoods due to their informal statusnegatively affects HBGWs’ health. There should be greatertransparency on how local authorities regulate informalwork activities and how public resources are allocated forprovision of urban infrastructure and services. Further-more, existing policies should be reviewed to make thembetter align with on-the-ground economic realities of in-formal workers.Limitations of the studyThe study has several limitations. First, the qualitativestudy design and the small sample size limit assessing theburden of OHS health outcomes. Second, generalisabilitymay be limited because it focuses on four downtowntownships for SVs and four industrial townships forHBGWs. For SVs, the social contexts of work may be dif-ferent for those who operate outside downtown areaswhere regulation may be less stringent. Similarly, HBGWsworking in other parts of the city or in other cities mayhave different experiences. However, prior studies in otherLMIC cities reported similar findings, suggesting that pol-luted urban spaces and deprived neighbourhoods with lowlevels of urban services are not unique to Yangon. Futureresearch should recruit a more diverse study populationworking in different settings to identify potential within-group variations. In addition, findings from this researchdo not represent the experiences of other informalworkers such as waste pickers and day labourers whose in-formal workplaces are different from those of SVs andHBGWs. The findings are based on the experiences andperspectives of workers and future work should identifythe views of stakeholders who regulate informalworkplaces.ConclusionThis study highlights the importance of considering thediversity of informal workplaces to improve work-relatedhealth outcomes among informal workers in LMICs. Itshows that approaches that conceptualise informal em-ployment strictly as an employment condition, may notfully capture the notion of informality and should berevisited to incorporate context. Future studies focusingon other informal subpopulations should consider bothmacro- and micro-social contexts of informal work andworkplaces to examine how contextual factors at mul-tiple levels of social influence shape experiences of workand health of informal workers globally.Supplementary informationSupplementary information accompanies this paper at https://doi.org/10.1186/s12889-020-08624-6.Additional file 1. Interview Guide; Open-ended interview guide usedfor interviewing street vendors and home-based garment workers.AbbreviationsLMIC: Low and middle income country; OHS : Occupational health andsafety; SV: Street vendor; HBGW: Home-based garment worker;YCDC: Yangon City Development Committee; ILO: International LabourOrganisationAcknowledgementsWe would like to acknowledge the study participants for their time andsharing their opinions and experiences.Authors’ contributionsTK and JDG conceived the study. TK conducted the field work, coded theinterviews and field notes, and drafted the manuscript. JDG supervised TK’swork, provided guidance for study design, data collection, analysis andmanuscript preparation. WWH assisted with recruitment, reviewed codedinterviews, and contributed to manuscript preparation. KQ, KB, GY and LG allcontributed to study design and manuscript preparation. The author(s) readand approved the final manuscript.FundingThis study is supported by the Civil Society Award (Grant Number IN2016–29165) from the Open Society Foundations, New York. This grant wasprovided to the first author to conduct his dissertation research. The OpenKo Ko et al. BMC Public Health (2020) 20:524 Page 12 of 14Society Foundations was not involved in the design, conduct, data analysis/interpretation or manuscript writing. The views expressed here are those ofthe authors only and do not necessarily reflect the views of the OpenSociety Foundations.Availability of data and materialsThe datasets generated and/or analysed during the current study are notpublicly available due to the possibility of breaching participants’ privacy andconfidentiality. In addition, the participants did not consent to make thetranscripts of the interviews publicly available. However, excerpts of theinterviews are available from the corresponding author on reasonablerequest.Ethics approval and consent to participateStudy protocols were approved by the Institutional Review Board at theMedical College of Wisconsin and the Ethics Review Board, Ministry of Healthand Sports, Myanmar (ERC Number: 003617, Approval Number: Ethics/DMR/2017/067). Verbal consent was obtained from the participants prior to thestudy. Given that informal work activities are not legally recognised inMyanmar, written consent may lead to discomfort or breach ofconfidentiality for study participants. Thus, only verbal consent was obtained.The ethics committees at the Medical College of Wisconsin and theDepartment of Medical Research, the Ministry of Health and Sports Myanmar,approved this procedure.Consent for publicationNot applicable.Competing interestsThe authors declare that they have no competing interests.Author details1Institute for Health and Equity, Medical College of Wisconsin, Milwaukee,USA. 2Institute of Asian Research, School of Public Policy and Global Affairs,University of British Columbia, Vancouver, British Columbia, Canada.3Department of Medical Research, Ministry of Health and Sports, No 5,Ziwaka Road, Dagon Township, Yangon 11191, Myanmar. 4Center for AIDSIntervention Research (CAIR), Medical College of Wisconsin, Milwaukee, WI,USA.Received: 11 September 2019 Accepted: 31 March 2020References1. Siegrist J, Marmot M. Health inequalities and the psychosocialenvironment—two scientific challenges. Soc Sci Med. 2004;58:1463–73.2. Marmot M, Wilkinson RG. 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Article
eng
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Vancouver : University of British Columbia Library
BioMed Central
Attribution 4.0 International (CC BY 4.0)
Faculty
Informal employment
Occupational health and safety
Urban safety
Social determinant of health
Employment relations
Workforce
Low and middle income country
Myanmar
Informal workplaces and their comparative effects on the health of street vendors and home-based garment workers in Yangon, Myanmar: a qualitative study
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