A food handler going to work with a cough, a parent sending a sick child to school, an emergency room nurse making snap decisions through the fog of a flu. It doesn’t take a medical degree to appreciate the counterproductive consequences of these decisions — yet far too often, these are the stories of our patients and countless others like them.

For far too many Canadians struggling to make ends meet, afraid to lose even a day’s pay, going to work sick is the only choice they have.

Understanding why requires swapping stethoscopes for statutes and looking upstream for answers.

With the exception of Prince Edward Island, no province or territory guarantees a minimum number of paid sick days for employees. Across the country, young people, seniors and low-wage workers are the hardest hit. Less than half of young and older employees work in jobs that provide paid sick days. The lower an employee’s pay, the less likely they are to be covered by a voluntary sick days policy.

Even in Canada’s single exception, the birthplace of Confederation, legislation is woefully inadequate. Prince Edward Islanders are entitled to a single day of paid sick leave — but only after five years of continuous service with the same employer. Worse still, not only do countless Canadians lack paid sick days, many are at risk of losing their job over an unexpected illness. In Ontario alone, 1.6 million people cannot rely on any labour legislation for protection against losing their jobs for taking a sick day without pay.

The phenomenon of ‘presenteeism’ — people coming to work despite being sick — is endemic in our work culture and is estimated to cost Canadian businesses $15-25 billion per year. The phenomenon of ‘presenteeism’ — people coming to work despite being sick — is endemic in our work culture and is estimated to cost Canadian businesses $15-25 billion per year.

The news is not all bad. San Francisco, a city many associate with high-tech start-ups and the innovation economy, has been a leader on using paid sick days to keep its residents healthy.

Since 2007, the Golden Gate City has mandated that all employers provide their workers with one hour of paid sick leave for every 30 hours worked. After surveying more than 700 employers and nearly 1,200 employees, researchers found employees were better able to care for themselves and family members, including being able to stay home with a sick child. Even more encouraging, two-thirds of employers supported the new mandated policy and the vast majority reported that their profitability did not suffer.

Despite being eligible for five or nine paid sick days per year, the typical employee used only three, and a quarter used none.

San Francisco’s success should come as no surprise. Research has shown that a paid sick days policy reduces the duration of sickness and the risk of aggravating minor conditions, and is associated with higher return-to-work rates for those recovering from serious illnesses such as heart attacks.

Though this has been a long-standing problem, calls for change are growing ever louder.

In Ontario, the provincial government has commissioned a review of the Employment Standards Act, legislation that has seen no major revisions since the end of the Second World War. There, a coalition of doctors, nurses, researchers and workers have launched a campaign for change along the lines of the San Francisco model.

Across the country, other groups of health care providers and workers are starting to come together to push for change.

The phenomenon of ‘presenteeism’ — people coming to work despite being sick — is endemic in our work culture and is estimated to cost Canadian businesses $15-25 billion per year. Protecting sick time is part of sending a message to employers and employees to rethink our approach to work. When we take care of ourselves, and take the time we need to recover when ill, it improves the short and long-term health of workers and the bottom line of the businesses that employ them.

It’s high time we had policies guaranteeing sick time for Canadian workers.

Dr. Danyaal Raza is a family physician at St. Michaels Hospital in Toronto and a member of the Decent Work and Health Network. Dr. Ryan Meili is a family physician in Saskatoon, an expert advisor with Evidence Network and founder of Upstream.

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