Ensuring a healthy and productive workforce: comparing the generosity of paid sick day and sick leave policies in 22 countries.
ABSTRACT National paid sick day and paid sick leave policies are compared in 22 countries ranked highly in terms of economic and human development. The authors calculate the financial support available to workers facing two different kinds of health problems: a case of the flu that requires missing 5 days of work, and a cancer treatment that requires 50 days of absence. Only 3 countries--the United States, Canada, and Japan--have no national policy requiring employers to provide paid sick days for workers who need to miss 5 days of work to recover from the flu. Eleven countries guarantee workers earning the national median wage full pay for all 5 days. In Ireland and the United Kingdom, the full-time equivalent benefits are more generous for low-wage workers than for workers earning the national median. The United States is the only country that does not provide paid sick leave for a worker undergoing a 50-day cancer treatment. Luxembourg and Norway provide 50 full-time equivalent working days of leave, while New Zealand provides the least, at 5 days. In 6 countries, paid sick leave benefits are more generous for low-wage workers than for median-wage workers.
Workplace Health and Quality of Life:
ENSURING A HEALTHY AND PRODUCTIVE
WORKFORCE: COMPARING THE GENEROSITY
OF PAID SICK DAY AND SICK LEAVE
POLICIES IN 22 COUNTRIES
Jody Heymann, Hye Jin Rho, John Schmitt,
and Alison Earle
National paid sick day and paid sick leave policies are compared in 22
countries ranked highly in terms of economic and human development.
The authors calculate the financial support available to workers facing two
different kinds of health problems: a case of the flu that requires missing
5 days of work, and a cancer treatment that requires 50 days of absence.
Only 3 countries—the United States, Canada, and Japan—have no national
policy requiring employers to provide paid sick days for workers who
need to miss 5 days of work to recover from the flu. Eleven countries
guarantee workers earning the national median wage full pay for all 5
days. In Ireland and the United Kingdom, the full-time equivalent benefits
are more generous for low-wage workers than for workers earning the
national median. The United States is the only country that does not
provide paid sick leave for a worker undergoing a 50-day cancer treatment.
Luxembourg and Norway provide 50 full-time equivalent working days
of leave, while New Zealand provides the least, at 5 days. In 6 countries,
paid sick leave benefits are more generous for low-wage workers than for
International Journal of Health Services, Volume 40, Number 1, Pages 1–22, 2010
© 2010, Baywood Publishing Co., Inc.
Why Paid Sick Days and Paid Sick Leave Matter
to the Health of Workers and Their Families
When policies for taking paid time off from work in case of illness are lacking,
many workers continue to go to work even when they are sick (1), jeopardizing
their own recovery and health. In this section we review research that demon-
strates that the availability of paid sick days for short-term illnesses and paid
sick leave for longer-term health issues contributes to a variety of important
health outcomes for workers and their family members (1, 2).
If working adults are able to stay home when they are sick, they are less likely
to spread infectious diseases to coworkers (1, 3). This risk has been broadly
recognized; as just one example, the spread of infectious disease at the workplace
is the reason that the U.S. Centers for Disease Control and Prevention recom-
mended that Americans with influenza—a disease that leads to 200,000 hospital-
izations and over 36,000 deaths in an average year (4)—stay home when they are
sick (5). Conservatively estimated, at least 20 million Americans go to work
sick because they are not entitled to sick leave.1With the recent outbreak of
H1N1 influenza, public health officials are again recommending that adults stay
home from work and children stay home from school if they have symptoms.
The ability to follow these recommendations is dramatically affected by whether
the infected adult or the sick child’s parent has paid sick days.
Paid sick day policies affect the ability of working adults to meet the health
needs of their children (8). Parents with paid sick days are five times more likely
to be able to care for sick children at home than similar parents without paid
sick days (9). Sick children have shorter recovery periods, better vital signs, and
fewer symptoms when their parents share in their care (8). Parents with paid
sick days are also more likely to provide preventive health care (9). Without paid
sick days, parents, especially resource-poor parents, may have little choice but
to miss needed doctors’ appointments or to leave sick children home alone, where
2/Heymann et al.
1National data show a 15 percentage-point gap in the number of workers who go to work
sick betweenthose who reported thattheir companyprovided paid sick leaveandthose who did
not; those entitled to paid sick days were less likely to go to work when ill. However, many
Americans whose companies provide paid sick days are nevertheless financially penalized at
work, and thus are more likely to work when sick. In the same national survey, 11 percent of
respondents reported job loss because of taking time off for illness, and 11 percent confirmed
that they or a family member have been “fired, suspended or otherwise penalized for taking
time off for illness” (6). A two-state survey in Florida and Ohio directly asked employed adults
whether they had ever gone to work sick because of fears of financial penalties. Nearly half
said yes. If these figures hold for the national population, it would mean that over 70 million
Americans whose sick leave could be covered by social insurance and 57 million Americans
who could be covered by an employer mandate are going to work sick (7).
they risk missing or improperly managing medications and may not be able
to obtain emergency help. Lack of paid sick days puts not only the health of
a worker’s own children at risk, but that of other children as well (8). When
parents lack paid sick days, they are far more likely to send their sick children
to child care or school (10). Children sent to daycare when they are sick with
contagious diseases exacerbate the higher than average rate of observed infec-
tions in daycare centers, including higher rates of respiratory and gastrointes-
tinal infections (8).
Paidsickdaysand sickleavealsoenableworkers tocarefor theiraging parents.
When sick adults receive support from family members, they have substantially
better health outcomes from conditions such as heart attacks (11, 12) and strokes
(13). Elderly individuals also live longer with family support (14, 15).
Finally, in health care and service settings, providing paid sick days to
employeesalso helps to protect the health of patients and customers. For example,
nursing homes that provide their employees with paid sick days experience lower
Why Paid Sick Days and Sick Leave Matter
for the Health of the Economy
Paid sick days and sick leave have an equallysubstantial impacton the finances of
working adults and their families as on their health. Lacking the right to take paid
leave from work when sick, working adults are placed at risk financially when
they take time off to care for their own health or that of family members (8). An
immediate effect is wage loss; many households, already economically unstable,
cannot afford the 1 to 2 weeks of wage loss that typically occur in a given year
due to illness of the wage earner and immediate family members. Long-term
effects include the risk of job loss due to absence.
While companies incur some costs from providing paid sick days and sup-
porting paid leave, they also accrue financial benefits. Firms that provide paid
sick days and sick leave tend to have lower job turnover rates, lower recruit-
ment and training costs, lower unnecessary absenteeism, and a higher level of
productivity than firms that do not offer these benefits (17, 18). This occurs
because individuals who are ill cannot work at full capacity, and thus output
and production are reduced (19). When workers do not take time off to address
illnesses at their onset, they often end up taking longer absences as conditions
worsen (20). Moreover, when employees come to work with contagious ill-
nesses, they spread them to coworkers, thereby increasing the pool of absent or
While the value of paid sick days and sick leave is clear, how universally
available they are has been less well documented. This study analyzes paid
sick day and paid sick leave policies in 22 countries that are highly ranked
according to the United Nations Human Development Index (HDI).
Paid Sick Days and Sick Leave in 22 Countries/3
Our sample consists of the top 22 countries as ranked by the 2008 HDI, an
using GDP (gross domestic product) per capita; health, measured in terms of
life expectancy; and human development, quantified using literacy and enroll-
ment rates (21). The HDI is calculated yearly by the United Nations for 177
countries and areas with sufficient data, and is reported in their annual
“Human Development Reports.” The top 22 countries in the 2008 report, with
an HDI of at least 0.94, are: Australia, Austria, Belgium, Canada, Denmark,
Finland, France, Germany, Greece, Iceland, Ireland, Italy, Japan, Luxembourg,
Netherlands, New Zealand, Norway, Spain, Sweden, Switzerland, the United
Kingdom, and the United States (22).
To assess each country’s current paid sick day and paid sick leave policies, we
reviewed a range of primary and, where necessary, secondary sources. Our
primary sources were original labor codes and other labor-related legislation.
The vast majority of the legislation reviewed was accessed through NATLEX, a
global database of labor, social security, and human rights legislation maintained
by the International Labor Organization (ILO). We also reviewed legislation,
labor codes, and official summaries of the main features of leave laws located
on national government websites, as well as summaries posted by well-respected
international organizations including the ILO, the Organization for Economic
Cooperation and Development (OECD), the European Union, and the United
States Social Security Administration (which produces the “Social Security
Systems Throughout the World” country reports). We also consulted a small
number of academic studies. To the best of our knowledge, the policies described
here are those in effect in each country at the beginning of 2009. Further
information on sources and details is available upon request and in our earlier
In most cases, we assessed national paid sick day and paid sick leave policies.
In the few countries where no national policy exists, either because the country
has not passed national paid sick days or leave legislation or because labor
policy is under provincial or state jurisdiction, we examined policies in place
at the relevant subnational level. As with national policies, our primary source
was original labor-related legislation. Furthermore, our dataset includes only
nationally or subnationally guaranteed sick day and sick leave provisions, and
excludes voluntary employer policies and collectively bargained agreements
covering paid sick days and sick leave.
4/ Heymann et al.
We use the term “paid sick days” to refer to short-term leave for health care
appointments, short-term illnesses and injuries, and periodic short-term health
needs related to chronic health conditions. The term “paid sick leave” is used to
refer to longer-term medical leave needed to address serious health conditions
that require lengthier treatment and recovery periods. We use the term “paid sick
days and leave” to refer to both of these policies together.
Policies covering short-term illnesses are complex and differ widely across the
countries we examine. To simplify our presentation of national laws and to
allow an assessment of the adequacy of each nation’s policy to address a range of
health issues a worker might face, we concentrate on how national paid sick
day and paid sick leave policies affect workers in two distinct situations. We
first look at the support available to a worker suffering from the flu who must
miss 5 days of work, and then what is available to a worker with a more serious
illness, such as cancer, who must undergo a treatment that requires a 50-day
absence from work.
Standardized Paid Sick Days and Leave
In order to enable accurate comparisons of the benefits available to workers
as well as different wage replacement rates during this time, we standardize
leave duration by calculating the full-time equivalent (FTE) number of days
available to workers in each country. In short, the amount of full-time equivalent
paid sick days and leave is calculated as the number of days of paid time off
multiplied by the wage replacement rate, or the percentage of total wage or
salary that the worker is paid during his or her absence from work. For example,
if a country requires employers to compensate sick workers with full pay for
5 days, the full-time equivalent duration of leave would be 5 days. If a country
withholds payment for the first day, but mandates that the following 4 days
be compensated at 100 percent, then the full-time equivalent duration would be
4 days. If 70 percent of pay is guaranteed for 5 days, then the number of FTE
sick days would be 3.5.
To facilitate the discussion of leave duration, leave in each country is stan-
dardized to a single time unit of “working days.” We assume that there are 5
working days per week except when legislation specifies otherwise. In countries
where a social insurance fund provides sickness benefits on a calendar-day basis,
we convert the benefits into working days. For example,if a worker is paid a daily
sickness benefit of $100 per day for a calendar week, the worker would receive
a total of $700 in sickness benefits per week. Accordingly, when determining
full-time equivalent paid sick days, we calculate that the worker receives $140
of sickness benefits per working day ($700 divided by 5 working days).
Paid Sick Days and Sick Leave in 22 Countries/5