Few indigenous peoples are employed in the formal sector, which means that few have access to the potential health benefits that work in the formal sector provides. However, there is a marked gap in income levels between indigenous and non-indigenous populations. " All the surveyed indigenous peoples lived below the officially established monthly subsistence wage for this region". Low income forces indigenous peoples to turn to a subsistence economy, which has a negative effect on nutrition and health.598 Additionally, low income may lead to decreased health care access in situations where out-of-pocket payments are required, for example, if they travel to larger residential areas.