Analysis

Case Study: Healthy Families Act - Paid Sick Days

Photo of young woman holding thermometer
Many people choose to come to work even when they’re sick. One important reason for this, according to an HIA performed by the San Francisco Department of Public Health and the nonprofit HIA group Human Impact Partners, is that many employers do not offer their workers paid sick days. Nearly half of workers in the United States—about 60 million people—receive no paid sick days.

The HIA, released in June 2009, predicted that the Healthy Families Act, proposed federal legislation mandating seven sick days a year for companies with 15 or more employees, would reduce the spread of illness, and even save lives as a result. The HIA pointed out that a third of flu cases in America each year are transmitted in the workplace and at schools. The assessment concluded that encouraging workers and their children to stay home when sick, via paid leave, should therefore reduce the likelihood of a pandemic. The assessment stated that without paid time off and other preventive techniques, a serious flu outbreak could kill more than two million people in the United States. The report also noted that the Act would induce more restaurant workers—the majority of whom are not compensated for time missed because of sickness—to stay home and thus would reduce food-borne illnesses.

Subsequent research for similar legislation in Massachusetts also found that, among workers with health insurance, those who did not have paid sick days used the emergency room (ER) 15% more than those who had the benefit. Reducing ER usage would lead to significant cost savings.

Disease also takes a financial toll that ripples through the economy—with workers, their employers and their insurers all suffering. Although paid sick days would require employers to incur the cost of absence due to illness, the HIA pointed out sometimes less-obvious costs that result from disease transmission to other workers and illness-related lost productivity.

The HIA’s findings received national attention shortly after publication, when members of the U.S. House Committee on Education and Labor discussed them at a hearing on the public health impacts of the Healthy Families Act. Prior to the HIA, decision makers had viewed the issue mostly in terms of labor and workers’ rights policies, but the HIA helped expand the discourse to include the important public health implications of this policy. A series of HIAs addressing paid sick day policies in Wisconsin, Massachusetts and California have also influenced lawmakers to consider the importance of such policies to health.