What began as a scrape quickly festered into a hand infection, a wound that would have easily healed if the low-wage Toronto dishwasher didn’t have to keep dunking it in dirty water. But without access to a paid sick day, Dr. Kate Hayman says her patient had no option but to keep working.

There are at least 145 countries, including 23 jurisdictions in the United States alone, which give workers the right to be compensated when they’re ill. Meanwhile, under Ontario law, the majority of employees are only entitled to unpaid leave — and an estimated 1.6 million workers in the province aren’t entitled to a single, job-protected, paid sick day. Critics say that reality is costing patients and the health-care system alike.

“We see so many people after hours with minor complaints who recognize that they could easily see their family physician,” said Hayman, a physician in a downtown emergency room. “But they’re unable to get time off during regular working hours, either because they have no paid sick leaves or because they’re afraid of losing their work and are precariously employed.”

Under the province’s outdated Employment Standards Act, workers are generally entitled to 10 emergency leave days. But that leave is unpaid — and bosses can legally require their employees to provide a sick note, which doctors complain clogs up clinics with cold-ridden patients who could have otherwise just recovered at home.

Moreover, small businesses with less than 50 employees don’t have to give workers any sick days at all — paid or unpaid — leaving more than a million workers who are often already trapped in low-wage jobs without any protection, according to a recent report by the Workers’ Action Centre.

Hayman, who is part of the Decent Work and Health Network funded by a $100,000 grant from the philanthropic Atkinson Foundation, now wants to see other doctors join the effort to link precarious work and poor health — and to lobby for policy change. The Ontario government is already reviewing its employment laws, and is expected to release its interim report on the reform process this spring.

Better sick-day coverage would have helped Winnie Ma, 57, who worked for eight years as a Toronto postal clerk in a small pharmacy. When struck by flu, she had to choose between losing out on her meagre minimum-wage salary and risking passing on her illness to customers.

“The doctors gave me notice for three days leave. I lost $200 for three days salary, because I’m not very high paid. I need to pay my hydro, utilities, property tax,” she said.

Ma said lack of paid emergency leave provisions also meant she struggled to take her aging mother, who was sick with cancer, to hospital checkups.

“If we had emergency sick leave, I could take care of my parents, and take care of my loved ones,” she said.

Low-wage workers, often concentrated in sectors like retail and food services where they interact regularly with the public, are more likely not to have any sick-day protection at all, raising concerns about disease control. A 2015 study by McMaster University and United Way showed that almost 90 per cent of the GTA and Hamilton’s most precarious workers did not get paid if they missed a day’s work.

“You’re likely to be actually spreading the illness around,” said Steve Barnes, director of policy at the Wellesley Institute, which focuses on urban health. “We’re sending people out to work when they really need to just rest up and recover.”

When sick workers cannot take a day off to visit their family doctor, it is after-hours emergency rooms that suffer, Hayman says. She says she regularly sees patients who don’t need to be at the hospital — but were unable to take time off during the day to get a sick note or see their GP.

“Without a doubt, having high volumes of patients in the emergency department affects the level of care provided,” Hayman said.

“The medical community is saying this is a waste of everyone’s time and we have the government reviewing this important piece of legislation,” added Barnes. “Now is an opportunity to expand the coverage that people have.”

At a time when precarious work is on the rise, Hayman says that task is more urgent than ever.

“I would struggle to think of a shift that goes by where I don’t have at least one patient where work is negatively impacting on their health.”

Taking care of sick workers:

Laws for paid sick days are, or will soon be, in place in 23 jurisdictions across the United States — four states, the District of Columbia and 18 localities. Here are a few of them:

San Francisco: Workers earn paid sick days after three months on the job, earning up to a maximum of five days per year in small firms and nine days per year in larger firms;

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Portland, Ore.: Employers with more than six workers must allow employees to accrue up to five paid sick days a year;

New York City: Employers with five or more workers must provide up to five paid sick days;

State of Massachusetts: Employers with more than 11 workers must provide up to five paid sick days;