Leana Wen: How paid sick leave can save lives
Originally published at www.bizjournals.com on February 23, 2017.
By: Dr. Leana S. Wen
During a recent hearing in Annapolis, our State Senators once again debated the issue of paid sick leave. Much of the discussion focused on the potential impact to bottom lines or dismissed the issue as political posturing. As a public health official, paid sick leave is first and foremost an issue of health — of people’s lives.
As an emergency physician, I have seen my patients forgo needed treatment because they are afraid they will lose their jobs. I once treated a 24-year old construction worker who had scraped his leg but could not afford to take off work. By the time I saw him, the small wound that developed had become a severe infection. He remained in the hospital for days and eventually had to have his lower leg amputated. That moment forever changed his life.
Another patient, a 52-year old janitor, waited weeks before coming to the ER, where he was diagnosed with a missed heart attack. He now has permanent heart damage, is on disability and no longer able to work. His wife quit her job in order to care for him.
Then there are the hundreds of people I have treated who have the flu and infectious diarrhea who went to work anyway, and ended up infecting their coworkers and their coworkers’ families. My patients did not ignore these conditions out of carelessness, but because they had no other choice. They went to work to provide for themselves and their families.
These are not just my experiences. This is also what science and research tells us: that workers without paid sick days are more likely to go work sick and more likely to delay needed medical care. This is harmful to the individual worker and to those around them. One study found that 70 percent of all norovirus outbreaks — which causes infectious diarrhea, vomiting, and stomach pain — can be traced to sick food service workers. We have seen prominent cases in Maryland where food handlers who did not have paid sick leave went to work and spread diseases, including Typhoid fever, to restaurant patrons.
There are those who question the necessity of paid sick leave. Some cite state and federal regulations that restrict sick food service workers from coming to work. However, the CDC reports that more than half of food service works have gone to work when sick, even while they are actively having diarrhea and vomiting. It may be a worker’s own decision to go to work while ill, but that choice is predicated on privilege — a privilege low-wage employees do not have. Research has shown that the lowest-income workers without paid sick leave are most likely to attend work when ill and have the highest risk of delaying and forgoing medical care.
Others support versions of paid sick leave that apply only to larger companies or that exempt certain industries. This does not make public health sense. For example, nine out of ten restaurants have fewer than 50 employees, and such laws will not protect these employees, their families, or their patrons. Exempting companies like construction would not have helped my patient, the construction worker, who faces similar financial challenges to workers in other industries.
There are some who are concerned about the financial impact of paid leave policies. But any discussion of cost must also take into account the cost savings — and the cost of doing nothing. Delays in care lead to longer illness and expensive ER visits; conversely, prevention and early treatment save on costlier care. Universal paid sick time would reduce emergency room visits by an estimated 1.3 million a year, saving $1.1 billion in medical costs annually. The savings are not just in medical care alone, but also in increased productivity of workers who could have gotten ill but are not. A recent study found that flu rates declined in cities where paid sick leave was implemented.
Paid sick leave is a public health necessity. Not only does it allow employees to seek medical care promptly and appropriately, it reduces the chance of spreading infectious diseases to others and enables caregivers to provide for their loved ones. As importantly, it is one additional policy that is needed to level the playing field to reduce already rampant economic and health disparities. Paid sick leave is a humane, common-sense solution to prevent illness, save lives, and protect the health and well-being of every Marylander.
