Introduction Employment and working conditions are key determinants of health and health inequities in middle and high-income countries like Chile. They are also key determinants of occupational health outcomes and occupational health inequities. Individual determinants of poor employment conditions and health have been abundantly studied, mainly related to the axes of inequalities and disadvantage in the labour market. Contextual determinants, however, including policies and regulatory frameworks, but especially macroeconomic conditions and economic structure, have seldom been analysed as determinants of health through the mediation of employment conditions. In Chile, questions pertaining to individuals and their eco-social context can be answered by comparing across the Chilean Regions given their differentiated economic structures and macro-economic outcomes.

Methods This study addresses these questions through the three following specific stages: i) a multilevel study assessing the association between employment precariousness and self-reported health in Chilean workers by region estimating regional risk ratios (RRR), with individual-level data from the first Chilean Work, employment health and quality of life survey (2009-2010); ii) assessing to which extent such association is varying across Chilean regions using the I² statistic; iii) investigating which regional-level macro-economic factors are associated with the magnitude of the RRR, performing random effects meta-regression analyses.

Results We found that there is a regional variation in the probability of reporting poor health across levels of employment precariousness (I² = 44%). We particularly found that GDP variability, especially during the 2008 economic crisis period, was associated with the magnitude of the RRR. Specifically, we found that the higher the economic crisis impact on regional GDP, the higher the impact of employment precariousness on workers’ self-reported health.

Conclusion Results show that macro-economic factors can play a role in employment conditions’ impact on occupational health, highlighting the necessity of designing occupational prevention policies that integrate macroeconomic conditions and economic structures.