Paid time off for ill­ness, tak­en for grant­ed in pro­fes­sion­al sec­tors and much of the devel­oped world, remains out of reach for mil­lions of Amer­i­can work­ers. The Unit­ed States is the only major devel­oped coun­try that does not guar­an­tee paid sick days to all work­ers by law. Fed­er­al data show that more than one-third of pri­vate sec­tor work­ers through­out the Unit­ed States do not receive paid sick leave.

But if you’re a low-wage work­er and wake up sick, you’d bet­ter clock in on time or you risk los­ing your wages and even your job.

A dis­pro­por­tion­ate num­ber of those with­out paid sick days are women, peo­ple of col­or and peo­ple with low incomes. Though women are the pri­ma­ry care­givers in most fam­i­lies, they also make up the major­i­ty of work­ers in low-wage jobs that do not offer paid sick days. Access is par­tic­u­lar­ly bad for His­pan­ic work­ers—researchers have found that less than half get paid sick days, com­pared to 60 per­cent of work­ers over­all. And for both women and men, fed­er­al data show that the high­est paid work­ers over­whelm­ing­ly have access to paid sick days, while most of the poor­est work­ers do not.

But this month, the Cook Coun­ty Board of Com­mis­sion­ers in Illi­nois took a major step toward chang­ing that. The board approved leg­is­la­tion that guar­an­tees paid sick days to all work­ers in the coun­ty, bring­ing the Chica­go sub­urbs in line with the city. Chica­go passed its own paid sick leave ordi­nance in June.

Under the ordi­nance, Cook Coun­ty work­ers will be eli­gi­ble for 40 hours, or about five days, of sick time per year, the same as work­ers in Chica­go. The Chica­go Tri­bune reports that more than 900,000 work­ers in the coun­ty don’t cur­rent­ly have paid sick days, includ­ing 420,000 in the sub­urbs. The new laws in Chica­go and Cook Coun­ty will take effect July 1, 2017.

Melis­sa Josephs, direc­tor of equal oppor­tu­ni­ty pol­i­cy for the advo­ca­cy group Women Employed, helped cam­paign for the law.

“All employ­ees — no mat­ter their occu­pa­tion — should have the peace of mind to know they can take time off work for their own ill­ness or to care for a sick fam­i­ly mem­ber with­out fear of los­ing their job or a day’s pay,” says Josephs.

Cook County’s deci­sion is the most recent vic­to­ry in what seems to be a grow­ing move­ment for paid sick leave. Since 2006, 38 local­i­ties in the Unit­ed States have passed sick leave leg­is­la­tion. This year alone, 12 paid sick leave laws have been passed across the coun­try, includ­ing in Ver­mont and major cities like Los Ange­les and San Diego.

Also this year, the momen­tum for paid sick leave reached the Oba­ma admin­is­tra­tion. At the direc­tion of the Pres­i­dent, the Depart­ment of Labor issued new rules requir­ing fed­er­al con­trac­tors to pro­vide up to 56 hours, or more than a week, of paid sick leave per year, which will impact more than a mil­lion work­ers when they go into effect.

Tama­ra Green, 29, did not have access to paid sick leave until recent­ly. A few years ago, she was work­ing for a major fast-food chain in New York City. She was also tak­ing care of her moth­er, who is HIV pos­i­tive. One day, her moth­er fell ill unex­pect­ed­ly and Green asked her boss if she could leave. Her boss told her that if she left, she would con­sid­er it a walk-off and she would not be paid.

“How do you keep going if some­one you love is ill or, God for­bid, dies, and you’re not there because your boss said she need­ed you to drop some more fries?” asked Green. ​“That’s not OK.”

Paid sick leave ben­e­fits more than indi­vid­ual work­ers like Green. Research has found that giv­ing work­ers the abil­i­ty to stay home when they’re sick with­out sac­ri­fic­ing their wages ben­e­fits pub­lic health and the econ­o­my. Paid sick days lead to high­er rates of pre­ven­ta­tive med­ical care, includ­ing mam­mo­grams and Pap tests, decrease work­place injuries and reduce rates of ill­ness.

Oppo­nents have argued that sick leave laws bur­den busi­ness­es or force them to make pay cuts. But an analy­sis by the Insti­tute for Women’s Pol­i­cy Research found that sick leave pos­es min­i­mal costs to employ­ers. The cost of paid sick leave poli­cies to employ­ers in Seat­tle, for exam­ple, was less than one per­cent of rev­enue on aver­age. What’s more, research indi­cates that the costs of paid sick leave would be at least par­tial­ly off­set by ben­e­fits to employ­ers like reduced turnover, increased morale and increased productivity.

The build­ing momen­tum for paid sick days sug­gests that local law­mak­ers as well as the gen­er­al pub­lic are see­ing these ben­e­fits. Nation­al sur­veys have shown that the major­i­ty of the pub­lic sup­ports laws that would man­date paid sick leave.

But at the state and fed­er­al lev­el, it’s an uphill bat­tle. Between 2000 and 2013, state leg­is­la­tures in 10 states—the major­i­ty of which were con­trolled by Repub­li­cans — passed laws that pro­hib­it local gov­ern­ments from man­dat­ing paid sick days. The Healthy Fam­i­lies Act, which would man­date paid sick time to most work­ers nation­wide, has been stuck in Con­gress for years.

At her new job, Tama­ra Green final­ly has access to paid sick days. She says know­ing that she can care for her­self or her moth­er dur­ing an emer­gency means she no longer has to choose ​“health over wealth,” and she hopes to see the day when no one in the world has to make that choice.

“To know that I have that option to take the day off with­out los­ing a way to pay my bills, that’s a relief that some peo­ple can’t even under­stand,” Green says. ​“One missed doctor’s appoint­ment could be the last time to say goodbye.”