Paid sick leave laws

Evidence Rating  
Some Evidence
Evidence rating: Some Evidence

Strategies with this rating are likely to work, but further research is needed to confirm effects. These strategies have been tested more than once and results trend positive overall.

Health Factors  
Community in Action

Paid sick leave laws require employers in the affected jurisdictions to provide paid time off to employees for use when ill or injured. Sick employees may use the time to see a health care provider or stay home until they are healthy enough to work again, without concern for lost wages. As of 2019, the US Bureau of Labor Statistics estimates that 24% of civilian workers in the US do not have paid sick leave1. Women, Hispanics, low-wage workers, and employees with lower levels of education are less likely to have paid sick leave than their counterparts2, 3, 4. Individuals with paid sick leave also tend to have higher incomes5, 6, 7 while those without it are more likely to have income below the poverty line8 and receive safety net services9. Some local governments cannot enact paid sick leave measures due to state preemption legislation10.

Expected Beneficial Outcomes (Rated)

  • Increased access to paid leave

  • Increased access to health care

Other Potential Beneficial Outcomes

  • Improved health outcomes

  • Increased use of parental leave

Evidence of Effectiveness

There is some evidence that paid sick leave laws increase access to paid sick leave (PSL)11, 12, 13, especially among women without a college education and workers in industries which have historically lacked access11. Access to paid sick leave can increase use of preventive health care services5, 14, 15, 16, 17, 18, 19, 20, 21. However, additional evidence is needed to confirm effects.

Access to paid sick leave can increase use of outpatient preventive care services including cancer and other health care screenings16, 18, flu vaccinations17, 21, and dental care16, as well as decrease emergency room use for children17 and adults14, 22. Workers who receive six days or more of PSL may be more likely to use preventive care services than those with two days or less, and those with ten or more days may be even more likely to15. Parental access to paid sick leave improves children’s access to health care17. Lack of access to paid sick leave appears to lead to lower levels of preventive health care use, including screenings3, 19, and delayed or forgone medical care3, 20, particularly among those with very low incomes20. Workers without access to PSL are more likely to report being in fair or poor health23, may be less able to afford needed health care services and goods (such as dental care and eyeglasses), and are more likely to incur elevated medical expenses8. Lack of PSL is also associated with increased psychological distress24 and financial worry25, while access to paid sick leave is associated with reduced financial hardship and improved quality of life26.

Access to paid sick leave is associated with an increased likelihood that employees stay home when they are ill or injured11, 27, 28, and to care for children who are ill or injured28, particularly among low income parents6. When workers gain access to paid sick leave, flu rates decrease approximately 10%, likely due to fewer employees coming to work while contagious29; PSL mandates in Connecticut and Washington, DC appeared to decrease illness-related leave taking by all workers, not just those directly affected by the change30. Lack of access to paid sick leave may increase the risk of illness for individuals and the spread of contagious illness among the wider population31.

Paid sick leave is associated with a decreased risk of mortality from all causes, particularly from heart disease and unintentional injuries32. Access to PSL is also associated with a decrease in nonfatal occupational injuries among private sector workers, particularly in high risk sectors and occupations33. For example, three years after implementation of Connecticut’s PSL law, occupational injuries and illnesses declined in the industries targeted by the law34.

A study of nine city- and four state-level PSL mandates, generally allowing workers to earn one hour of PSL per work week and up to seven days per year, suggest such laws do not significantly affect employment or wages35, while an initial assessment of Connecticut’s paid sick leave law suggests potential for small decreases in employment concentrated among older workers36. Access to paid sick leave may increase job stability for employees37 and may lead to positive effects for employers such as decreased turnover, increased productivity, and increased employee loyalty and morale4. An early study of Seattle’s Paid Sick and Safe Time Ordinance showed modest and smaller than anticipated costs to organizations following implementation38. Following implementation of the law, employer-offered leave increased in Seattle for both full and part-time employees, particularly in the hospitality sector12.

Early assessments of San Francisco’s paid sick leave ordinance suggest variable effects on profits13, 39, and some adjustments to employee benefit packages among employers who had not previously offered paid sick leave, along with some initial challenges in implementation13. One study indicates that six months after the implementation of New York City’s PSL law, workers with part-time jobs and workers without a college degree were least likely to be paid for sick days, least likely to access the benefit, and most likely to work while sick; over 1/3 of those not paid for sick leave worked in retail, food service, or health care40.

Available cost benefit analyses from advocacy organizations suggest that benefits outweigh the costs associated with PSL provision4, 41.

Responses to the Harvard School of Public Health’s 2006 Pandemic Influenza Survey suggest workers without PSL are more likely to believe they would lose their jobs or businesses if forced not to work for 7-10 days; lack of paid sick leave, inability to work remotely, and lower income levels are all associated with perceived ability to comply with stay at home orders during illness outbreaks42.

Impact on Disparities

Likely to decrease disparities

Implementation Examples

As of May 2020, 14 states and 38 municipalities including Washington, DC have enacted paid sick leave laws and ordinances43. State legislation pre-empts local laws related to leave in 22 states10. The federal Healthy Families Act, which would allow all employed Americans to earn paid sick leave, has been proposed on multiple occasions but has not been enacted.

California, Rhode Island, New Jersey, and New York have state-run public programs providing paid family or medical leave, while Washington State and Washington, DC have passed legislation2.

Implementation Resources

LAW-Resources - Legal Aid at Work (LAW). Work & family. San Francisco, CA.

NCSL-PSL - National Conference of State Legislatures (NCSL). Paid sick leave.

SF-PSLO - City & County of San Francisco. Paid sick leave ordinance (PSLO).


* Journal subscription may be required for access.

1 US DOL-PSL - US Department of Labor (US DOL), Bureau of Labor Statistics (BLS). Employee benefits in the United States - March 2017.

2 BLS-Bartel 2019 - Bartel AP, Kim S, Nam J. Racial and ethnic disparities in access to and use of paid family and medical leave: Evidence from four nationally representative datasets. Monthly Labor Review. US Bureau of Labor and Statistics (BLS); 2019.

3 Zhai 2018* - Zhai Y, Santibanez TA, Kahn KE, Black CL, de Perio MA. Paid sick leave benefits, influenza vaccination, and taking sick days due to influenza-like illness among US workers. Vaccine. 2018;36(48):7316-7323.

4 Chen 2016* - Chen ML. The growing costs and burden of family caregiving of older adults: A review of paid sick leave and family leave policies. The Gerontologist. 2016;56(3):391-396.

5 Cook 2011 - Cook WK. Paid sick days and health care use: An analysis of the 2007 National Health Interview Survey data. American Journal of Industrial Medicine. 2011;54(10):771-779.

6 Clemans-Cope 2008 - Clemans-Cope L, Perry CD, Kenney GM, Pelletier JE, Pantell MS. Access to and use of paid sick leave among low-income families with children. Pediatrics. 2008;122(2):e480-6.

7 CWF-Collins 2004 - Collins SR, Davis K, Doty MM, Ho A. Wages, health benefits, and workers’ health. New York: The Commonwealth Fund (CWF); 2004: Issue Brief #788.

8 Stoddard-Dare 2018b* - Stoddard-Dare P, DeRigne LA, Mallett C, Quinn L. How does paid sick leave relate to health care affordability and poverty among US workers? Social Work in Health Care. 2018;57(5):376-392.

9 Stoddard-Dare 2018a* - Stoddard-Dare P, Quinn L, Mallett C. Paid sick leave status in relation to government sponsored welfare utilization. American Journal of Orthopsychiatry. 2018;88(5):608-615.

10 Grassroots Change - Grassroots Change: Connecting for better health. Preemption Watch.

11 Upjohn-Callison 2017 - Callison K, Pesko MF. The effect of paid sick leave mandates on coverage, work absences, and presenteeism. W.E. Upjohn Institute for Employment Research. 2017: Working Paper 16-265.

12 Romich 2017 - Romich JL. Local mandate improves equity of paid sick leave coverage: Seattle’s experience. BMC Public Health. 2017;17:60.

13 Colla 2014 - Colla CH, Dow WH, Dube A, Lovell V. Early effects of the San Francisco paid sick leave policy. American Journal of Public Health. 2014;104(12):2453-2460.

14 Upjohn-Callison 2016 - Callison K, Pesko MF. The effect of mandatory paid sick leave laws on labor market outcomes, health care utilization, and health behaviors. W.E. Upjohn Institute for Employment Research. 2016: Working Paper 16-265.

15 DeRigne 2018b* - DeRigne L, Stoddard-Dare P, Quinn LM, Collins C. How many paid sick days are enough? Journal of Occupational and Environmental Medicine. 2018;60(6):481-489.

16 Hammig 2019* - Hammig B, Bouza B. Paid sick leave benefits and adherence to recommended screening tests among male labor workers in the United States. Journal of Occupational and Environmental Medicine. 2019;61(2):102-106.

17 Asfaw 2017* - Asfaw A, Colopy M. Association between parental access to paid sick leave and children’s access to and use of healthcare services. American Journal of Industrial Medicine. 2017;60(3):276-284.

18 Peipins 2012 - Peipins LA, Soman A, Berkowitz Z, White MC. The lack of paid sick leave as a barrier to cancer screening and medical care-seeking: Results from the National Health Interview Survey. BMC Public Health. 2012;12(1):520.

19 DeRigne 2017* - DeRigne L, Stoddard-Dare P, Collins C, Quinn L. Paid sick leave and preventive health care service use among US working adults. Preventive Medicine. 2017;99:58-62.

20 DeRigne 2016* - DeRigne L, Stoddard-Dare P, Quinn L. Workers without paid sick leave less likely to take time off for illness or injury compared to those with paid sick leave. Health Affairs. 2016;35(3):520-527.

21 Wilson 2014* - Wilson FA, Wang Y, Stimpson JP. Universal paid leave increases influenza vaccinations among employees in the US. Vaccine. 2014;32(21):2441-2445.

22 Bhuyan 2016* - Bhuyan SS, Wang Y, Bhatt J, et al. Paid sick leave is associated with fewer ED visits among US private sector working adults. The American Journal of Emergency Medicine. 2016;34(5):784-789.

23 Luckhaupt 2017* - Luckhaupt SE, Alterman T, Li J, Calvert GM. Job characteristics associated with self-rated fair or poor health among US workers. American Journal of Preventive Medicine. 2017;53(2):216-224.

24 Stoddard-Dare 2018c* - Stoddard-Dare P, DeRigne LA, Collins CC, Quinn LM, Fuller K. Paid sick leave and psychological distress: An analysis of US workers. American Journal of Orthopsychiatry. 2018;88(1):1-9.

25 DeRigne 2018a* - DeRigne LA, Dare PS, Collins C, Quinn LM, Fuller K. Working US adults without paid sick leave report more worries about finances. Journal of Social Service Research. 2019;45(4):570-581.

26 Albelda 2019* - Albelda R, Wiemers E, Hahn T, et al. Relationship between paid leave, financial burden, and patient-reported outcomes among employed patients who have undergone bone marrow transplantation. Quality of Life Research. 2019;28(7):1835-1847.

27 Ahmed 2020 - Ahmed F, Kim S, Nowalk MP, et al. Paid leave and access to telework as work attendance determinants during acute respiratory illness, United States, 2017-2018. Emerging Infectious Diseases. 2020;26(1):26-33.

28 Piper 2017 - Piper K, Youk A, James AE, Kumar S. Paid sick days and stay-at-home behavior for influenza. PLOS ONE. 2017;12(2):e0170698.

29 Upjohn-Pichler 2015 - Pichler S, Ziebarth N. The pros and cons of sick pay schemes: Testing for contagious presenteeism and shirking behavior. W.E. Upjohn Institute for Employment Research. 2015: Working Paper 15-239.

30 Stearns 2018* - Stearns J, White C. Can paid sick leave mandates reduce leave-taking? Labour Economics. 2018;51(May 2016):227-246.

31 Kumar 2012* - Kumar S, Quinn SC, Kim KH, Daniel LH, Freimuth VS. The impact of workplace policies and other social factors on self-reported influenza-like illness incidence during the 2009 H1N1 pandemic. American Journal of Public Health. 2012;102(1):134-40.

32 Kim 2017a - Kim D. Paid sick leave and risks of all-cause and cause-specific mortality among adult workers in the USA. International Journal of Environmental Research and Public Health. 2017;14(10):1-10.

33 Asfaw 2012 - Asfaw A, Pana-Cryan R, Rosa R. Paid sick leave and nonfatal occupational injuries. American Journal of Public Health. 2012;102(9):59-64.

34 Hawkins 2019* - Hawkins D, Zhu J. Decline in the rate of occupational injuries and illnesses following the implementation of a paid sick leave law in Connecticut. American Journal of Industrial Medicine. 2019;62(10):859-873.

35 Pichler 2018* - Pichler S, Ziebarth NR. Labor market effects of US sick pay mandates. Journal of Human Resources. 2020;55(2):611-659.

36 Ahn 2015* - Ahn T, Yelowitz A. The short-run impacts of Connecticut’s paid sick leave legislation. Applied Economics Letters. 2015;22(15):1267-1272.

37 Hill 2013* - Hill HD. Paid sick leave and job stability. Work & Occupations. 2013;40(2):143-73.

38 Romich 2014 - Romich J, Bignell W, Brazg T, et al. Implementation and early outcomes of the City of Seattle paid sick and safe time ordinance final report. University of Washington for City of Seattle, Office of City Auditor; 2014.

39 Urban-Waters Boots 2009 - Waters Boots S, Martinson K, Danziger A. Employers' perspectives on San Francisco's paid sick leave policy. Washington, DC: Urban Institute; 2009.

40 Hall 2018* - Hall GS, Walters S, Wimer C, et al. Workers not paid for sick leave after implementation of the New York City paid sick leave law. Journal of Urban Health. 2018;95(1):134-140.

41 Awuor 2011 - Awuor G, Arellano A. Costs and benefits of paid sick leave: Reviewing the research. The Bell Policy Center; 2011.

42 Blake 2010 - Blake KD, Blendon RJ, Viswanath K. Employment and compliance with pandemic influenza mitigation recommendations. Emerging Infectious Diseases. 2010;16(2):212-218.

43 FVW-Paid sick days - Timeline of paid sick days wins. Family Values at Work (FVW).

Date Last Updated