Have you ever woken up at 3 a.m. with that lump in your throat?

It's that consuming worry, that seemingly endless anxiety: What will happen if I don't have a job tomorrow? How will I pay the bills if I get sick? What will happen to my children? If this has ever happened to you, I assure you that you are not alone, and that this feeling, even if it seems like just tiredness, has profound implications for your health and the health of millions of people in Peru and throughout Latin America.

According to the latest figures from the National Institute of Statistics and Informatics (INEI), in Peru, 70.7% of people work in the informal economy. This means that 7 out of 10 workers do not have a permanent contract, don't know if they will be able to continue working tomorrow, and do not have access to social protection, such as health insurance or a pension. These are people who, despite their best efforts, live in constant uncertainty.

But what does this mean for our mental health? The SALURBAL project (Urban Health in Latin America), in which the Cayetano Heredia University of Peru participated, analyzed more than 5,000 workers in 11 Latin American countries and found that working in the informal sector increases the risk of experiencing depressive symptoms by 27%. In other words, job insecurity directly impacts our emotional stability.

This happens because our brain needs to feel secure to function properly. When we work in precarious conditions, without stability, without knowing what tomorrow will bring, our brain enters a state of constant alert. It's like having an alarm that never turns off. This continuous tension can wear us down, affect our mood and sleep, and, in some cases, lead to disorders such as depression.

Pero hay algo aún más importante que destacar. La misma investigación revela que las mujeres que trabajan en empleos informales enfrentan un 36% más de síntomas depresivos en comparación con las mujeres en trabajos formales. ¿Por qué? Porque muchas de nosotras cargamos con una doble jornada: al trabajo afuera, sumamos las tareas del hogar y el cuidado de los hijos. Esa doble carga, que se ha normalizado en nuestra cultura, puede ser muy agotadora para la mente, y si además no contamos con seguridad laboral o una red de apoyo, la tensión se vuelve aún mayor.

Este no solo es un problema individual; es un desafío estructural. Los gobiernos, las empresas y la sociedad debemos pasar a la acción para lograr cambios reales. Aquí algunas ideas clave que podemos impulsar basadas en la evidencia de esta investigación.

1. Reducir la informalidad laboral: Formalizar no solo significa pagar impuestos, sino ofrecer estabilidad y tranquilidad emocional a las familias. Un contrato formal nos da derechos y protección, y también nos da calma mental.
2. Implementar la protección social universal: Independientemente del tipo de trabajo, todas y todos necesitamos acceder a un seguro de salud, una pensión o una red de seguridad que nos acompañe en momentos difíciles. Esto ayuda a reducir la ansiedad y el estrés.
3. Ampliar los programas de salud mental: La depresión no discrimina. Por ello, necesitamos que los servicios de salud lleguen a los mercados, a las calles y  a las comunidades.  Es vital acercar el apoyo psicológico y emocional a los espacios donde día a día se desenvuelven los trabajadores informales. 
4. Implementar políticas con enfoque de género: Debemos derribar la barrera principal que impide a las mujeres formalizarse: la carga de cuidados no remunerada. Para lograrlo, es crucial:
   • Crear sistemas de cuidado infantil: Implementar cunas y guarderías accesibles para que la maternidad no sea un obstáculo laboral.
   • Ofrecer incentivos económicos: Brindar beneficios a las empresas que contraten mujeres.
   • Garantizar la paridad salarial: Eliminar la brecha de género; actualmente, por realizar el mismo trabajo, percibimos menos ingresos que los hombres, una realidad que impacta enormemente nuestra estabilidad y salud mental.
5. Fomentar la organización y la asociatividad Finalmente, es crucial impulsar la unión de los trabajadores informales a través de sindicatos o asociaciones. ¿Por qué esto es efectivo? Porque estar organizados les otorga "voz y voto" para negociar mejores condiciones y salarios. Además, el sentido de pertenencia reduce la vulnerabilidad y la soledad: las redes de apoyo actúan como un amortiguador fundamental contra el estrés y la depresión.

Si sientes que la carga del trabajo y la vida te pesa demasiado, no te juzgues: esa sensación es real y tiene una explicación científica. No es que estés exagerando. Apóyate en tu familia, habla con tu comunidad; compartir el peso ayuda a aliviar la tensión. Tu salud mental y tu tranquilidad deben ser siempre tu prioridad.

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Based on the article: Association between informal employment and depressive symptoms in 11 cities in Latin America by Tran B Huynh, Vanessa M Oddo  Bricia Trejo, Kari Moore, D Alex Quistberg, Jannie J Kim, Francisco Diez-Canseco, Alejandra Vives.     https://pmc.ncbi.nlm.nih.gov/articles/PMC9187523/ 

My commitment to equity stems from a deep understanding that the health challenges we face are not only medical but also social. Inequity, rooted in economic, social, and geographic differences, shapes the health of entire communities, and addressing it is critical for any health professional who aspires to have a significant impact.

In my work and throughout my personal and family life, I have observed how inequity gives rise to tangible problems, such as citizen insecurity and limited access to essential health services. These problems not only perpetuate cycles of poverty and disease, but also threaten social cohesion and progress.

Health inequity, in particular, has ripple effects, exacerbating the vulnerability of many communities, especially the most impoverished, to outbreaks of infectious diseases, such as tuberculosis or dengue, or to a higher incidence of chronic diseases such as diabetes and hypertension, which are among the leading causes of death worldwide.

So, what is equity for me? Well, it means going beyond superficial equality. It means striving to level the playing field, recognizing and addressing the specific needs of each community in order to address challenges with equally effective tools for all. In this context, my role as a physician, researcher, and public health specialist is twofold: to provide direct care to populations based on their specific needs, since the needs of a family in a rural area are not the same as those of a family living in the capital, and to advocate for policies and practices that promote a more equitable distribution of health resources.

From the field, in projects like "Mamás del Río," I have learned that health equity also means education, access to information, and empowering communities to make informed decisions and take actions that improve their well-being. These experiences reinforce my belief that health professionals must look beyond symptoms and diseases to the social conditions that influence them.

Health equity is ultimately a matter of social justice. It is recognizing that every person deserves the opportunity to live a healthy life, regardless of their origin, place of birth, or life circumstances. As a physician, researcher, and public health professional, I see myself working to empower communities in vulnerable situations with the tools and resources they need to achieve better health and facilitating dialogue between them and the health system.

It is necessary for us to recognize and act on the inequalities we face, regardless of your area of ​​work or profession, and to commit to concrete actions that promote equity. This challenge, although great, is a shared one, and together we can make health equity a reality for all. It is time to act collectively to build a more just and healthy future.

Health is a right, not a privilege!

A few months ago, a list of the most published researchers in our country was released, and as expected, I knew I wouldn't be on it. Most of the names on the list were men, and the few women who appeared were probably already over 50, the time needed to recover from the ups and downs in academic production that women face after giving birth and raising children.

Women face various challenges; according to research, we do three times more housework than men. In my case, the day I started breastfeeding my oldest daughter, I realized I would never be equal to male researchers. Breastfeeding is a full-time job, and academic institutions are not structurally prepared to mitigate its impact or the impact of everything that motherhood entails on women's work. Aware of this, I decided to prioritize my research, focusing on the studies I considered most relevant. In that process, I learned to identify those projects that fulfilled me as a person, that gave my life purpose, and that could have a profound impact on the communities that needed it most. I learned a lot on this journey, to discern which research to pursue and which to let go. Because a researcher's path is not linear; there are always detours that teach us valuable lessons.

However, it's important to recognize that not all researchers choose to be mothers, and even then they face an uneven and winding path for other reasons. The lack of representation, implicit bias, and constant pressure to prove their worth in a predominantly male environment are significant challenges. These structural and cultural barriers also impact the career paths of many women who, regardless of their personal decisions about motherhood, must navigate a system that doesn't always value or support their contributions equally.

The outside world tends to focus on quantification: how many publications you have, what journals they're published in, how many awards you've won. But we should stop measuring people by these standards and reflect on the following: Are we making a positive impact on our environment? Are we addressing issues that are important to communities and contributing to the well-being of our society? Does our work make us feel better people? If the answer is yes, you should feel fulfilled. In conclusion, being a researcher, and especially a female researcher, involves navigating a path full of unique challenges. Whether balancing the responsibilities of motherhood or confronting other forms of inequality, it is crucial that we recognize and value the diverse paths to success. What truly matters is not just what we achieve individually, but how we transform our environment and the lives of the people we touch.