Where paid sick leave was provided on an emergency basis during the pandemic, such policies prevented approximately one COVID-19 case per day for every 1,300 workers.
The stark inequities in America's economic and health systems have been revealed again in a new Health Affairs study, which shows how the US continues to be one of the only countries in the world without a guaranteed paid sick leave option for many workers—including some deemed essential during a pandemic.
The paper compared the U.S. system, regulated by the 1993 U.S. Family and Medical Leave Act (FMLA), to paid sick leave policies in 193 countries around the world. FMLA provides job protections for sick workers but does not provide paid leave. The study found that FMLA's hourly work and tenure requirements fail workers by creating unequal treatment for women and people of color, because they are more likely to work jobs that are excluded from FMLA protections.
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"Research has demonstrated that paid sick leave reduces spread of COVID-19 and other infectious diseases and improves preventive care and access to treatment across a wide range of conditions," the report said. "However, the U.S. has no national paid sick leave policy, and even unpaid FMLA leave— often viewed as a foundation for new paid leave legislation—is often inaccessible."
The worst of all worlds
The study paints a grim picture of a regulatory structure that has lagged behind other economies in this area. It points out that the U.S. is one of just 11 countries in the world without a national, guaranteed paid sick leave policy.
The U.S. does have the FMLA, but the report points out the inadequacies of that system.
"The FMLA exempts workplaces with fewer than 50 employees. No other country in the world has broad restrictions on sick leave eligibility based on employer size," the report said. "Second, the FMLA requires a minimum of 12 months and 1,250 hours working for the same employer. Globally, 57% of countries that provide paid sick leave allow workers to access at least some paid sick leave regardless of employment history, while more than nine out of ten have no explicit minimum hour requirements. Finally, the FMLA is unpaid, making the U.S. the only country globally with a national policy providing only unpaid leave. In contrast, 103 countries guarantee workers with one year's tenure at least two weeks of paid leave at a high wage replacement rate, ensuring both widespread access and affordability."
In an opinion piece published in The Hill, two of the report's co-authors blast the current system for its bad health outcomes, especially during a pandemic. "We've already seen that when paid leave is available, COVID-19 transmission drops — and when it's not, people go to work sick and spread accelerates," wrote Jody Heymann and Aleta Sprague. "Lack of sick leave has also widened gaps in vaccine access: Nearly half of unvaccinated Americans — including 55% of unvaccinated Black adults and 64% of unvaccinated Latinx adults — report being concerned about missing work due to side effects."
The report found that where paid sick leave was provided on an emergency basis during the pandemic, such policies prevented approximately one COVID-19 case per day for every 1,300 workers who newly had the option to take 10 paid sick days.
The data compiled by the study also found that paid sick leave reduced rates of other infectious diseases such as the flu, improved preventive care, and reduced emergency room visits. "Paid sick leave likewise affects employment, a key social determinant of health," the study said. "Health issues commonly threaten job security for low-wage and contingent workers, and workers without paid sick leave are more likely to live in poverty and experience financial worries."
Excluding disadvantaged workers
In the U.S., many employers provide paid sick leave as a benefit—but many industries and employers do not, or only offer it to certain employees. And the unpaid FMLA protections are only available to about half of private sector and self-employed workers, the report noted.
The report found that the FMLA's minimum work requirement disproportionately affects women, who are more likely to work less than full time, and the minimum firm size requirement discriminates against minorities. "The minimum firm size requirement leaves large shares of workers across racial and ethnic groups uncovered, but has the most significant consequences for Latino men, 45% of whom are excluded by this rule alone," the report said.
"The exclusion of part-time workers not only disproportionately affects women and people of color but also exacerbates other labor market inequalities," the authors wrote. "While some workers work part-time by choice, an increasing share of the part-time workforce comprises 'involuntary' part-time workers unable to find full-time work: altogether, over 4.4 million workers are in involuntary part-time employment, which averages 23 hours per week. Black and Latinx workers are nearly twice as likely as White workers to be working part-time involuntarily."
In the Hill article, the authors said there is an urgent need for Congress to address the inadequacies of the current system. "Ensuring every worker has access to paid medical for a long enough period to cover cancer as well as COVID-19 matters to all Americans and is essential to addressing inequalities," they write. "The question is not whether we can afford it — but whether American workers and our economy can afford the consequences if we don't."
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