Are sick day policies making us sicker?

This year’s flu season has been particularly nasty. In primary care, this has meant months of waiting rooms teeming with influenza and an array of different viruses. However, relatively few of these patients actually benefit from further assessment and treatment. In many cases, it’s not patients’ health concerns driving them in, but an archaic approach to sick workers in Canada that unnecessarily burdens the health care system.

In many similar countries, when a worker becomes ill, they are provided some form of paid sick leave. The benefits of this are backed by evidence: an article in the International Labour Review identified many studies that showed that providing paid sick-leave reduces duration of illness, reduces risk of worsening minor conditions, is correlated with a higher return to work rate following heart attacks, and an overall lower burden on health care resources. Research involving long-term care facilities showed a significant reduction in the frequency of outbreaks when comparing sites with and without paid sick leave policies. A recent study in the American Journal of Public Health found workers with access to paid sick leave are 28 per cent less likely to be injured on the job than workers without such a benefit, and reduction of productivity losses associated with ‘presenteeism’ – when sick workers continue to show up at work despite their illness.

There are other benefits to paid sick leave policies that are not so immediately obvious. Authors of a study in BMC Public Health found that rates of preventive screening for breast, cervical, and colon cancer were significantly lower for individuals without paid sick leave, even after controlling for sociodemographic and health-care-related factors. This is likely because attending medical appointments require taking an unpaid sick day, an unaffordable option for many.

In Canada, we have a confusing collection of provincial legislation, none of which mandate pay for days missed while ill – only a guarantee that there will be a job to go back to. Quebec is well ahead of the pack with six months of job-protected leave per year. Saskatchewan provides up to 12 weeks of protected leave for serious illness, and both Saskatchewan and Yukon provide up to 12 days for non-serious illness. Ontario provides up to 10 days, Newfoundland up to seven, New Brunswick and the Northwest Territories up to five, and Manitoba, Nova Scotia, and Prince Edward Island permitting only three days of job-protected sick leave a year. British Columbia, Alberta, and Nunavut do not have any legislation addressing sick leave.

Of course, provincial regulations represent the bare minimum and many businesses provide paid sick leave as a benefit. It’s the employees without such benefits – people at the bottom of the wage spectrum who are dependent on every day’s income and who have the highest job insecurity – who are dependent on stingy provincial minimums. This situation is similar to that in the USA, where access to paid leave has been shown to be lower in low-income families. As expected, members of low-income families were less likely to take time away from work to care for themselves or others.

Canada’s current sick leave policies are not supporting the health of individuals and communities. First, employees are forced to choose between staying home when ill (losing income and potentially placing their job at risk) or to go to work (worsening their health and potentially infecting others). A CDC study of nearly 500 food service workers revealed that more than 50% had worked while knowingly ill. When asked why, half of the workers reported they did not want to lose income and a quarter did so for fear of losing their job. Obviously, those working in the food industry have a clear potential to transmit pathogens.

Second, sick workers are driven to clinics or emergency rooms: not for medical care but merely for proof they are ill – a paternalistic custom enshrined in business and many provincial sick leave rules. In delegating physicians into a policing role, clinical hours get chewed up by administrative tasks. When these illnesses are due to larger outbreaks, physicians are doubly burdened – by the sick who need treatment and the sick who need notes. The Ontario Medical Association discourages requiring sick notes for this reason, and also because of the real risk of transmission to others in the health care environment. Forcing infectious people into our waiting rooms who won’t benefit from treatment is burdensome for the patient and risky for all of those in the office.

Third, a comprehensive paid sick leave policy in Canada is economically sound. Missing work is costly, estimated to be $16.6 billion dollars annually in lost productivity, but research is beginning to show that being sick at work (presenteeism) is incredibly costly as well – up to three times as much as absenteeism for depression and pain.

Ultimately, it’s a matter of equity. All workers should have access to sufficient paid, job-protected sick leave to help them recover from illnesses without losing income and to reduce the risk of infecting others. As well, it’s a matter of respect: having an employee ‘prove’ an illness is nonproductive and onerous for all.

Mike Benusic is a Public Health and Preventive Medicine resident, Chantel Lutchman is a nurse, Najib Safieddine is a thoracic surgeon, and Andrew Pinto is a family physician and Public Health and Preventive Medicine specialist. All practice in Toronto and all are members of Health Providers Against Poverty (HPAP).