Cecille Joan Avila is a policy analyst at Boston University School of Public Health. She tweets at @cecilleavila.
Almost all countries have paid sick leave except for the United States. While often combined with family and medical leave, the two are distinct. Sick leave is for short-term absences (e.g., illness) whereas family and medical leave is for long-term serious and chronic illnesses, or to take care of a family member or new child.
President Biden’s American Families Plan prioritizes paid family and medical leave. While his address did not explicitly include paid sick leave, his statement does call on Congress to pass the Healthy Families Act, which focuses on it. Both are needed to make the other succeed, and to also address longstanding inequities. Without a federal policy, it’s up to states or individual employers to decide to offer paid sick leave and how much; a move that could make income-based disparities (among others) even worse.
Both paid family and medical leave and paid sick leave are necessary to truly build back better. Without access to both benefits, sick individuals might not even be able to take advantage of long-term paid family and medical leave. While evidence does show that paid family and medical leave benefits maternal health, just prioritizing paid family and medical leave can fuel the narrative that women’s health is valuable only if they are mothers and/or caregivers and not simply as women.
Who has paid sick leave, who doesn’t?
While more individuals gained paid sick leave over the last decade either through local, state, or employer policies, an estimated 32.5 million still do not have access. Who has paid sick leave varies greatly, and depends on factors such as full-time versus part-time, whether an employer is private or public, as well as significant variation among occupations, income levels, and even geography. A 2016 report from the Center for American Progress shows that availability of flexible paid sick days was lowest among Black workers, and access to any paid sick days at all was lowest among Hispanic workers, when compared to their white counterparts.
Considering how race and ethnicity also relates to occupation and income (i.e., wage gaps), paid sick leave would be especially beneficial for those who cannot afford to take even a single unpaid day to deal with health care needs. A national policy should also recognize that not everyone has the luxury of accumulating 30 hours a week at a single job, the current minimum many states set to accrue an hour of paid sick leave. However, more individuals report working multiple jobs to survive financially.
Individual benefits, communal benefits
Numerous studies show relationships between paid sick leave (or the lack of it) and use of preventative services or screenings, which can help reduce rates of heart disease and diabetes and other chronic conditions.
For example, in Connecticut, the first state to implement paid sick leave, rates of Pap smears increased after the law went into effect. In a study conducted among labor workers, a typically lower-income population with lower rates of paid sick leave, paid sick leave was again associated with higher odds of utilizing preventive care services, including going to the dentist.
Conversely, studies show that no paid sick leave can be detrimental. One study showed workers without paid sick leave were less likely to receive preventative health care screenings in the previous 12 months, even knowing they might be at higher risk for high cholesterol, high blood pressure, or high blood sugar. Another found that those without paid sick leave were more likely to skip prescription refills or be unable to afford eyeglasses. Both studies control for household level of income.
Much of the research around paid sick leave focuses on how much it can help more than just the individual, assuming that individuals are well enough to even care for others. A study published in Health Affairs found that those without paid sick leave were more likely to delay medical care, both for themselves and their family members. Yet another study shows that if at least one parent had access to paid sick leave, it increased the likelihood of their children having seen a primary care physician in the last year or receiving a flu vaccination.
Complementary policies for long-term good
While the Affordable Care Act helped individuals with health insurance gain access to preventive services with minimal out-of-pocket costs, it didn’t ensure everyone could access those services. Economic stability is a known social determinant of health and paid sick leave could allow more people to take the time needed to access preventative services without foregoing wages. In turn, this could reduce the rates of people using emergency services for issues that could have been avoided if caught earlier through primary care visits, which could help reduce health care costs.
Federally authorized paid sick leave could also help reduce some of the class-based structural inequities that affect an individual’s health. Regardless of how much money a person makes or what jobs they occupy, it would allow for all individuals to feel empowered and able to take care of themselves in the short-term. It could also help them be healthy enough to be around for those who might depend on them in the future.
Research for this piece was supported by the Laura and John Arnold Foundation.