Published: 17-06-2020 10:38 | Updated: 17-06-2020 10:38

Income security important in times of ill health

While most countries have national policies in place, effective coverage is very low and often exclude those who have the greatest need. There are often several prominent barriers, especially for those outside the formal workforce who are affected by illnesses such as COVID-19, according to a newly published article by researchers at Karolinska Institutet and the SPARKS Network.

In the scoping review a total of 134 studies were included, providing data from 95% of low- and middle-income countries, to map the range, features, coverage, protective effects and equity of policies that aim to provide income security for adults whose ill health prevents them from participating in paid work. The included studies demonstrated that coverage of income-security schemes is low, especially for informal and low- income workers.

Professor Knut Lönnroth. Photo: Creo Media Group
Professor Knut Lönnroth. Photo: Creo Media Group.

The researchers conclude that scaling up and diversifying the range of income security interventions is crucial for improving coverage and equity.

“Income security needs to become a more prominent part of the response to global public health crises. People who lack income protection face immense challenges adhering to disease control measures, such as staying home from work to minimize risk of transmission.” says Knut Lönnroth, professor at the Department of Global Public Health and manager of the SPARKS network.

In a related commentary, authors from SPARKS, including staff off the International Labour Organization, highlight the lack of explicit mentioning of sickness benefits coverage in the sustainable development goals’ (SDG) and how the COVID-19 pandemic is putting the spotlight on this omission.

“COVID-19 has exposed coverage gaps with regard to sickness benefits in a very painful way. Workers should not have to choose between putting food on the table and safeguarding their own and others’ health. Urgent measures are needed to ensure income security for workers in all types of employment in case they cannot report to work due to sickness, quarantine or care for sick family members, during the crisis and beyond.” says Christina Behrendt, from the Social Protection Department, International Labour Organisation, Geneva, Switzerland


Income security during periods of ill health: a scoping review of policies, practice and coverage in low-income and middle-income countries.
Thorpe J, Viney K, Hensing G, Lönnroth K
BMJ Glob Health 2020 Jun;5(6):

Income security in times of ill health: the next frontier for the SDGs.
Lönnroth K, Tessier L, Hensing G, Behrendt C
BMJ Glob Health 2020 May;5(6):


Knut Lönnroth Professor/senior physician