Going to work sick is often a financial necessity for many hourly workers in the United States. A offers evidence that state-mandated paid sick leave (PSL) laws can modestly help to address the problem, despite limitations. Researchers Tyler Woods, Malcolm Wiener Professor of Social Policy Daniel Schneider, and Kristen Harknett analyzed over 68,000 U.S. service sector workers between 2017 and 2023. Their research showed that PSL laws improve workers’ access to paid sick time and slightly reduce incidences of people working while ill. However, the study did not reveal broader benefits such as better worker health or greater job satisfaction.
The United States remains one of the few industrialized countries without a federal mandate for paid sick leave, leaving the issue up to states and cities. In this fragmented policy landscape, service sector workers, such as those in food service, retail, and hospitality, are among the least likely to have access to PSL and most likely to work while sick. The Shift Project researchers examined what difference PSL made in states that have adopted these laws. They focused on two key outcomes: whether workers had access to PSL and whether they worked while sick, a phenomenon known as “presenteeism.”
The researchers found that states that implemented PSL laws saw a 14 percentage-point increase in access to paid sick time among service workers, and the rate of presenteeism dropped by about 3 percentage points. The researchers suggest that, while modest, even small reductions in sick workers showing up to high-contact jobs can make a meaningful difference for public health.
“This research has notable implications for public health,” the authors write. “We offer evidence that state PSL laws increase PSL coverage among service sector workers and reduce presenteeism, suggesting that PSL laws pay dividends for public health. If more workers have access to PSL and fewer attend work while sick, then they are less likely to spread illnesses to their coworkers and customers.”
One of the most common arguments against mandating PSL is that it might push employers to cut back elsewhere—for example, by lowering wages, reducing hours, or cutting other benefits. However, the study found no evidence to support these fears. Workers in states with PSL laws did not see declines in hourly wages, employer-provided health insurance, or retirement benefits. Nor did their schedules become more unstable—an issue common in many low-wage service jobs.
Where the PSL laws fell short, however, was in delivering broader improvements to workers. The researchers looked at a wide array of downstream outcomes, such as mental health, overall happiness, sleep quality, and job satisfaction. In these areas, the laws had little measurable impact. The study suggests that occasional benefits like PSL may not be enough to address more chronic stressors tied to shift work—such as irregular hours, low pay, and lack of autonomy. Other reforms may be necessary to improve overall worker well-being.
Nevertheless, the researchers argue that the benefits both to workers and to public health are important, and that PSL works as intended in terms of increasing coverage and reducing the number of sick people on the job.
“[B]ecause PSL access has historically been stratified by socioeconomic status,” the authors write, “service sector workers have typically lacked access to PSL, forcing them to choose between staying home while sick and earning money to support themselves and their families. Guaranteeing PSL offers one solution to this dilemma, exemplifying how labor policies can benefit both workers and public health.”
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