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payday advance However, firm conclusions about coverage, equity and effects cannot be drawn due to the dearth of published studies on the topic.What do the new findings implyIncome security during periods of ill health needs to become a more prominent part of global health research and action.With income security contributing to better health outcomes, illness related social protection needs to be integrated into health policies beyond UHC, allowing for a more nuanced understanding of indirect medical costs.IntroductionThe advent of the United Nations Sustainable Development Goals (SDGs) has placed holistic, multisectoral development strategies in mainstream policy making spaces.1 Correspondingly, this shift has breathed fresh life into the field of public health by emphasising the range of social, economic, environmental and cultural determinants of health.2 Of these, poverty is both a determinant and consequence of ill health.3 As such, SDG 3 ‘Good Health and Well being’ aims to reduce a range of adverse health outcomes and the associated financial burden of them, primarily through the realisation of Universal Health Coverage (UHC).1 4 5 However, while UHC has the potential to minimise impoverishment due to high out of pocket healthcare costs, it does not inherently protect against income loss for individuals who cannot participate in gainful work due to ill health.6 9 This relationship has become apparent in the current context of the COVID 19 pandemic, which has seen a staggering number of illness related unpaid leaves of absence.10 Of the population who are affected, many do not have access to social safety nets, leaving them vulnerable to poor health and poverty.10Indeed, a cursory exploration of the SDGs and broader policies from WHO demonstrates a lack of analysis on income loss due to short term and long term illness.6 9 11 Further, despite WHO’s leading role in The Coalition of the Social Protection Floor Initiative,11 a decade has passed since their last publication on income security and health.12 As such, this study aims to refocus the attention on this topic, by consolidating the range of existing policies and practices which protect income during periods of ill health, specifically in low income and middle income countries (LMICs).Defining income securityAccording to the International Labour Organization (ILO) guidelines, income security denotes ‘adequate income, either earned or in the form of social security and other benefits (which also) encompasses the level of income (absolute and relative to needs), assurance of receipt, and expectation of current and future income, both during working life and in old age or disability retirement’.13 Expanding on this definition, the ILO highlights that income security requires a ‘replacement of income which has been lost temporarily as a result of injury, disability or sickness’, among other reasons.14Defining ill healthWhile seemingly straightforward, the language surrounding income reducing health conditions is vague and inconsistent.15 Indeed, the above definition of income security references ‘injury, disability or sickness’, all of which can be non discrete and, by definition, overlap.12 15 The term ‘ill health’ is used in this study as an umbrella descriptor for these terms and is defined as: ‘a condition of inferior health in which some disease or impairment of function is present’.16Further, periods of ill health can lead to income loss when impaired function reduces ability to participate in gainful work, or when opportunity to work is lost for other health related reasons, such as limitations caused by infectious disease legislation6 or when work time is lost due to healthcare utilisation. Therefore, within the context of this study, the term ‘ill health’ specifically refers to any condition, short or long term, which reduces a person’s ability to participate in gainful work. This definition is constructed on principles of the of the 2001 International Classification of Functioning, Disability and Health (ICF) model, which accounts for medical, social, environmental and individual perspectives on health.17 19The health benefits of income security during periods of ill healthIncome loss during periods of ill health can greatly reduce an individual’s resilience to health shocks.payday advance

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