When you’re too sick to go to work, you shouldn’t be punished for taking time to recover. That simple truth has driven many cities to enact paid leave policies in recent years, guaranteeing paid sick days, or some kind of paid medical- and family-leave time, as standard workplace policy. But those vital policies are still not available to everyone, which is having wide public-health ramifications: Working families most in need of paid time off are both disproportionately poor and more vulnerable to illness, and it costs everyone collectively an extraordinary amount of time and money.
A case study of a children’s hospital in Cincinatti, a racially divided city hit hard by the recession, has linked respiratory health, concentrated poverty, and days spent in hospital. Over a period of several years, 2011 to 2016, young children spent a disproportionate amount of time not at home or in school, but confined to a hospital ward, isolated and struggling just to breathe. A periodic episode of hospitalization might seem like a small inconvenience, but over time, when spread across a community, the struggle to breathe can consume years of the lives of local children.
Comparing poor and wealthy census tracts in one urban area, researchers concluded, “If children from all of the county’s census tracts spent the same amount of time in the hospital each year as those from the most affluent tracts, approximately twenty-two child-years of hospitalization time would be prevented.”
With millions of parents across the country unable to take a single paid day off work to care for a sick child—and working poor women have the least access to paid leave time—the Cincinnati study illuminates a pervasive unmet medical need; not just an occasional day off with a cold, but the cost of monthly emergency-room visits, the strain of rushing from work to pick a child up when she’s discharged, missing a night shift to tend to a wheezing preschooler overnight. In neighborhoods plagued by tragically preventable illnesses, high concentrations of (perhaps unnecessary) hospitalization means the city pays one way or another: spending more to deal with poor households’ added medical needs, or investing in policies focused on prevention and management of chronic conditions. When illness is concentrated in a neighborhood, the accumulated medical burden depletes overall community wealth and erodes public health.
In this social context, paid sick days make sense as a basic policy that alleviates health and wealth inequality, by addressing the long-term demand for care in communities where poor health is rife, and ensuring that individual families dealing with a medical crisis that stems in part from poverty aren’t forced to lose income in order to recover efficiently and with dignity. According to one of the coauthors of the study, Andrew Beck, associate professor of pediatrics at the University of Cincinnati College of Medicine, “a sick leave policy, or a policy that more effectively allows parents [or] caregivers to ensure completion of preventive services for their children, could have an effect on disparities in hospitalization rates.”