Paid sick leave laws

There is some evidence that paid sick leave laws increase access to paid sick leave (PSL) (Schneider 2020, Upjohn-Callison 2017, Romich 2017, Colla 2014), especially among women without a college education and workers in industries which have historically lacked access (Upjohn-Callison 2017). Access to paid sick leave can increase use of preventive health care services (Upjohn-Callison 2016, DeRigne 2018b, Hammig 2019, Asfaw 2017, Cook 2011, Peipins 2012, DeRigne 2017, DeRigne 2016, Wilson 2014). However, additional evidence is needed to confirm effects.

Access to paid sick leave can increase use of outpatient preventive care services including cancer and other health care screenings (Hammig 2019, Peipins 2012), flu vaccinations (Asfaw 2017, Wilson 2014), and dental care (Hammig 2019), as well as decrease emergency room use for children (Asfaw 2017) and adults (Upjohn-Callison 2016, Bhuyan 2016). Workers who receive six days or more of PSL may be more likely to use preventive care services than those with two days or less, and those with ten or more days may be even more likely to (DeRigne 2018b). Parental access to paid sick leave improves children’s access to health care (Asfaw 2017). Lack of access to paid sick leave appears to lead to lower levels of preventive health care use, including screenings (Zhai 2018, DeRigne 2017), and delayed or forgone medical care (Zhai 2018, DeRigne 2016), particularly among those with very low incomes (DeRigne 2016). Workers without access to PSL are more likely to report being in fair or poor health (Luckhaupt 2017), may be less able to afford needed health care services and goods (such as dental care and eyeglasses), and are more likely to incur elevated medical expenses (Stoddard-Dare 2018b). Lack of PSL is also associated with increased psychological distress (Stoddard-Dare 2018c) and financial worry (DeRigne 2018a), while access to paid sick leave is associated with reduced financial hardship and improved quality of life (Albelda 2019).

Access to paid sick leave is associated with an increased likelihood that employees stay home when they are ill or injured (Schneider 2020, Upjohn-Callison 2017, Ahmed 2020, Piper 2017), and to care for children who are ill or injured (Piper 2017), particularly among low income parents (Clemans-Cope 2008). When workers gain access to paid sick leave, flu rates decrease approximately 10%, likely due to fewer employees coming to work while contagious (Upjohn-Pichler 2015); PSL mandates in Connecticut and Washington, D.C. appeared to decrease illness-related leave taking by all workers, not just those directly affected by the change (Stearns 2018). Lack of access to paid sick leave may increase the risk of illness for individuals and the spread of contagious illness among the wider population (Kumar 2012).

Paid sick leave is associated with a decreased risk of mortality from all causes, particularly from heart disease and unintentional injuries (Kim 2017a). Access to PSL is also associated with a decrease in nonfatal occupational injuries among private sector workers, particularly in high risk sectors and occupations (Asfaw 2012). For example, three years after implementation of Connecticut’s PSL law, occupational injuries and illnesses declined in the industries targeted by the law (Hawkins 2019).

A study of 9 city- and 4 state-level PSL mandates, generally allowing workers to earn one hour of PSL per work week and up to 7 days per year, suggests such laws do not significantly affect employment or wages (Pichler 2018), while an initial assessment of Connecticut’s paid sick leave law suggests potential for small decreases in employment concentrated among older workers (Ahn 2015). Access to paid sick leave may increase job stability for employees (Hill 2013) and may lead to positive effects for employers such as decreased turnover, increased productivity, and increased employee loyalty and morale (Chen 2016). An early study of Seattle’s Paid Sick and Safe Time Ordinance showed modest and smaller-than-anticipated costs to organizations following implementation (Romich 2014). Following implementation of the law, employer-offered leave increased in Seattle for both full and part-time employees, particularly in the hospitality sector (Romich 2017).

Early assessments of San Francisco’s paid sick leave ordinance suggest variable effects on profits (Colla 2014, Urban-Waters Boots 2009), and some adjustments to employee benefit packages among employers who had not previously offered paid sick leave, along with some initial challenges in implementation (Colla 2014). One study indicates that six months after the implementation of New York City’s PSL law, workers with part-time jobs and workers without a college degree were least likely to be paid for sick days, least likely to access the benefit, and most likely to work while sick; over 1/3 of those not paid for sick leave worked in retail, food service, or health care (Hall 2018).

Available cost benefit analyses from advocacy organizations suggest that benefits outweigh the costs associated with PSL provision (Chen 2016, Awuor 2011).

Responses to the Harvard School of Public Health’s 2006 Pandemic Influenza Survey suggest workers without PSL are more likely to believe they would lose their jobs or businesses if forced not to work for 7-10 days; lack of paid sick leave, inability to work remotely, and lower income levels are all associated with perceived ability to comply with stay at home orders during illness outbreaks (Blake 2010).

Paid sick leave laws are a suggested strategy to reduce disparities in income, health, and access to leave for workers across racial and economic groups, as well as for women (ABB-Lankachandra 2022, Pomeranz 2022, Urban-Boyens 2022a, NPWF-HFA 2022, Rauhaus 2021). Paid sick leave laws can increase access to paid sick leave (PSL), especially for women and workers from industries that often lack access (Upjohn-Callison 2017). One study in the U.S. suggests recently passed PSL laws reduce disparities in access to paid sick leave for Hispanic workers and appear to be reversing a trend of declining paid sick leave access for Black workers (Johnson 2022).

While 79% of private-sector workers have access to PSL (US DOL-PSL), only 35% of the lowest paid workers do (Urban-Boyens 2022a). Both full and part-time workers without access to PSL are more likely to work when ill, and those with the lowest incomes were the most likely to delay or forgo needed care for themselves and their families (DeRigne 2016). However, access to PSL may increase Hispanic (Piper 2017) and low income parents taking needed time off work to care for themselves or others (Piper 2017, Clemans-Cope 2008). It may also increase part-time workers’ use of office-based health care (Hegland 2022). It may also reduce disparities in influenza-like illness among Hispanic populations (Kumar 2012). Those without PSL are more likely to earn lower incomes and be enrolled in supportive programs, and PSL may decrease the need for use of such benefit programs (Stoddard-Dare 2018).

To create more equitable paid leave, experts suggest programs include job protection and progressive wage replacement, and should cover part-time and gig workers, include all firms no matter their size, and have broad coverage and eligibility requirements (Urban-Boyens 2022a).

During the era of Jim Crow, employment laws excluded individuals from racial and ethnic minority groups from collective bargaining and allowed unions to discriminate, effectively barring these individuals from the benefits unions provided, including paid sick leave (Yearby 2020). Today, America’s low-wage work force is largely made up of women and people of color (Brookings-Ross 2019). Structural and historic racial inequities in U.S. economic systems mean that Black, Hispanic, Native American, and immigrant workers are more likely to work in lower-income, part-time jobs (Urban-Boyens 2022a). More than two-thirds of low-wage workers do not have access to paid sick leave (CLASP-Maye 2021a) and less than half of part-time workers do (Urban-Boyens 2022a). People of color, women, immigrants, and members of the LGBTQ community are less likely to be able to take needed sick leave (ABB-Lankachandra 2022, Urban-Marotta 2019).

The U.S. is the only industrialized nation without a national paid sick leave policy. The Healthy Families Act would create a minimum standard, providing up to 7 job-protected paid sick days each year for employees of businesses with 15 or more employees. It has been proposed multiple times but has not yet been enacted (NPWF-HFA 2022). During COVID-19 pandemic, the federal government created a temporary paid sick leave program through the CARES Act, granting 2 weeks of paid leave for workers with COVID-19, but the program expired at the end of 2020 (Rauhaus 2021).

The COVID-19 pandemic highlighted inequities in paid sick leave availability, as many essential workers are people of color (Pomeranz 2022). Workers from groups marginalized in U.S. society were more likely to miss work, and to go without pay due to the lack of paid leave, including workers with low incomes, people of color, women, and families with children. Additionally, women were disproportionately responsible for child care and other family obligations, and their absences were the least likely to be paid. The lack of universal paid leave combined with the COVID-19 pandemic compounded economic and health disparities between families with high incomes and most other families (Urban-Boyens 2022a).

In recent decades, local paid sick leave laws have been a subject of state-level policy preemption. Lawmakers have used state-level preemptions as a tool of structural racism, preventing the expansion of local policies that could reduce racial inequality (Melton-Fant 2022) and excluding low income workers, workers of color, and their communities from the health benefits and opportunities these laws could provide (ChangeLab-Haddow 2020). However, state or federal preemption can be used to protect and expand local policies that reduce health inequities, as in the case of civil rights laws (Carr 2020).

• Who doesn’t have access to paid sick leave in your community? Are there specific groups or industries that are most in need but lacking access?
• How do preemption laws impact your ability to implement paid sick leave?
• Who is opposed to paid sick leave expansion and what is at the root of that opposition? What role can public health play in (re)framing the discussion?"
• What community partners can assist in efforts to expand paid sick leave? Is there a history of labor organizing or labor partners in your community who could be involved?
• If you have paid leave laws in place, do the laws include job protection? Are all types of workers eligible? Are different industries or business sizes exempt from participating?

At the end of 2021, 16 states (Connecticut, California, Massachusetts, Oregon, Vermont, Washington, Arizona, Rhode Island, New Jersey, Maryland, Michigan, Nevada, Maine, New York, Colorado, New Mexico) and many municipalities, including Washington, D.C. have enacted paid sick leave laws and ordinances (ABB-Lankachandra 2022), covering an estimated 28% of U.S. jobs (Johnson 2020).

ABB-PST campaigns - A Better Balance (ABB). Tools and resources for paid sick time campaigns. 2022.

AIC-PSL - All-In Cities, an Initiative of PolicyLink. All-In Cities Policy Toolkit: Paid sick leave.

ChangeLab-Paid sick leave - ChangeLab Solutions. Understanding paid sick leave & preventive cancer screening: Resources to promote public health.

LAW-Resources - Legal Aid at Work (LAW). Work & family. San Francisco, CA.

NCSL-PSL - National Conference of State Legislatures (NCSL). Paid sick leave.

NPWF-HFA 2022 - National Partnership for Women & Families (NPWF). The Healthy Families Act (HFA). 2022.

SF-PSLO - City & County of San Francisco. Paid sick leave ordinance (PSLO).

* Journal subscription may be required for access.

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Chen 2016* - Chen ML. The growing costs and burden of family caregiving of older adults: A review of paid sick leave and family leave policies. The Gerontologist. 2016;56(3):391-396.

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CWF-Collins 2004 - Collins SR, Davis K, Doty MM, Ho A. Wages, health benefits, and workers’ health. New York: The Commonwealth Fund (CWF); 2004: Issue Brief #788.

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Hammig 2019* - Hammig B, Bouza B. Paid sick leave benefits and adherence to recommended screening tests among male labor workers in the United States. Journal of Occupational and Environmental Medicine. 2019;61(2):102-106.

Hawkins 2019* - Hawkins D, Zhu J. Decline in the rate of occupational injuries and illnesses following the implementation of a paid sick leave law in Connecticut. American Journal of Industrial Medicine. 2019;62(10):859-873.

Hegland 2022* - Hegland TA, Berdahl TA. High job flexibility and paid sick leave increase health care access and use among U.S. workers. Health Affairs. 2022;41(6):873-882.

Hill 2013* - Hill HD. Paid sick leave and job stability. Work & Occupations. 2013;40(2):143-73.

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Kim 2017a - Kim D. Paid sick leave and risks of all-cause and cause-specific mortality among adult workers in the USA. International Journal of Environmental Research and Public Health. 2017;14(10):1-10.

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Urban-Marotta 2019 - Marotta J, Greene S. Paid sick days: What does the research tell us about the effectiveness of local action? Washington, D.C.: Urban Institute; 2019.

Urban-Waters Boots 2009 - Waters Boots S, Martinson K, Danziger A. Employers' perspectives on San Francisco's paid sick leave policy. Washington, D.C.: Urban Institute; 2009.

US DOL-PSL - U.S. Department of Labor (U.S. DOL), Bureau of Labor Statistics (BLS). Employee benefits in the United States - March 2017.

Wilson 2014* - Wilson FA, Wang Y, Stimpson JP. Universal paid leave increases influenza vaccinations among employees in the U.S. Vaccine. 2014;32(21):2441-2445.

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