Paid sick leave is good for workers and good for public health

TThe fight to expand access to paid sick leave continues even after President Biden decided not to include more than one day of paid sick leave in the recently “settled” contract for railroad workers.

Last week, more than 70 members of Congress sent a letter to Biden urging him to use an executive order to grant seven days of paid sick leave to railroad workers. Unions across the country, including those representing pilots and college graduates, are putting sick and family leave at the center of their negotiations.

Paid sick leave is the right thing for individual and public health. Yet the United States is unique among high-income countries in not requiring employers to provide their workers with access to it. Of course, the Family and Medical Leave Act provides unpaid sick leave for workers, and 16 states have laws that can be used for sick leave. But that leaves millions of American workers forced to forgo pay when they’re out sick.


In response to the Covid-19 pandemic, the Families First Coronavirus Response Act, which went into effect in mid-March 2020, made limited paid sick leave available to workers employed in establishments with fewer than 500 workers and some public sector workers. It expired at the end of 2020, meaning that even in the midst of the huge waves of the Covid-19 pandemic, many workers had no guarantee that they would be paid while sick.

A study published earlier this year estimated that in 2018, only 62% of private sector workers had access to paid sick leave. Even with the state laws that went into effect during that time, this proportion was only a 5% increase in access to this type of support compared to 2006. The study also revealed disparities in access. In particular, Hispanic workers and workers with lower levels of education are the least likely to have paid sick leave.


I recently completed a similar analysis using data from the 2020 National Health Interview Survey. Despite the passage of the Families First Coronavirus Response Act, many workers in 2020 still report that they do not have access to paid sick leave and this access varies greatly by occupation. In particular, workers in vital occupations such as agriculture, construction, food preparation, building cleaning, transportation, and health care had lower access to supported sick leave than the average for all workers. Workers in many of these occupations experienced higher death rates from Covid-19 during the pandemic.

Graphic based on author’s analysis of data from the 2020 National Health Interview Survey Courtesy of Devan Hawkins

This potential link between access to paid sick leave and Covid-19 is not surprising. Giving workers access to it allows them to quarantine while sick to prevent the virus from spreading to their colleagues and those who use public transport. When such protection is not provided, many workers, especially the most economically vulnerable—who also tend to be at higher risk for other negative health events—will choose to work and avoid losing their wages.

Paid sick leave protects against problems other than the spread of Covid-19 and other infectious diseases. A growing body of literature shows that workers with access to it have a variety of positive health outcomes compared to workers without it, including fewer emergency room visits, lower levels of psychological distress, lower rates of occupational accidents, and more frequent use of preventive medical services. One study even found that workers with access to paid sick leave had lower death rates, which may be due at least in part to lower rates of drug overdoses and suicides among workers in occupations with higher access to paid sick leave. sick-leave.

Lack of access to paid sick leave in the US is an important public health issue. The motivation for denying workers access to paid sick leave is often to protect profits. In the case of the railroad industry, giving workers a few days of paid sick leave is seen as a threat to the precision scheduling system that essentially requires workers to be on call for weeks at a time. The system allows the rail industry to support fewer employers and therefore reduce its labor costs, resulting in record revenues for the industry. At the same time, the cost of the harm this policy inflicts on employees falls on the workers themselves, their families, and society as a whole.

Paid sick leave is not the only leave policy to which workers in the United States are not federally entitled. Another is paid parental leave. The health impact of not having access to parental leave falls on workers as well as their children. With regard to maternity leave in particular, studies have found that female workers with paid maternity leave have better mental health as well as higher rates of breastfeeding, especially when the leave is of longer duration. As with paid sick leave, workers without access to paid maternity leave are more likely to be black or Hispanic and to have a lower level of education.

The federal government has the authority to act to mandate both paid sick leave and paid parental leave — after all, paid sick leave was made available during the pandemic and Congress has considered proposals for paid family leave. The president said “every worker in America deserves” access to paid sick leave, though it’s hard to gauge the strength of that commitment given that he didn’t strongly advocate for the House resolution , which passed to add seven days of sponsored sick leave to the railroad contract, and so far has not acted on calls for an executive order to provide seven days of it to railroad workers.

US rules on paid sick leave and family leave should represent what Americans value as a society. It’s a major choice between allowing workers to recuperate when sick or injured, take themselves or a family member for a medical check-up, and spend essential time with a newborn child versus higher profits for the business. For working people and their families, the best choice is clear.

Devan Hawkins is an assistant professor of public health at MCPHS University in Boston.

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