Earned sick leave, defined as short-term, paid time off granted to employees who are ill, injured, or responsible for caring for a sick or injured family member, has been shown to reduce the transmission of infectious diseases within workplaces and increase access to preventive healthcare services. Since 2019, seven more US states have enacted laws requiring employers to offer earned sick leave, raising the total number to 18 states, in addition to Washington, D.C. Despite this positive policy trend, until recently, relatively little was known about how these laws affect worker health and safety across various sectors. The general assumption has been that paid sick leave is uniformly beneficial, but new research reveals a more nuanced reality, particularly when considering differences across industries and among vulnerable populations.
Dr Hannah I. Rochford, a health policy expert at the Texas A&M University School of Public Health, highlighted the significance of examining earned sick leave through an industry-specific lens. “This is important because both the short- and long-term benefits of earned sick leave might vary by industry,” she noted. For example, in sectors like construction, where injury rates are high, paid leave might encourage workers to take time off for recovery, potentially preventing more serious musculoskeletal injuries from developing. Conversely, in lower-risk industries, such policies may have different implications, possibly improving access to preventive care or reducing presenteeism—when workers come in sick and risk infecting others.
To investigate this, Rochford collaborated with Dr Aurora B. Le, a fellow occupational health and safety researcher. Their study, recently published in Safety and Health at Work, applied quasi-experimental methods. It used natural policy variation and nationally representative datasets to examine how earned sick leave laws influenced reportable, nonfatal illness and injury rates across major industry sectors. They relied on data from the Bureau of Labor Statistics, organised by the North American Industry Classification System, and legal policy data from Temple University’s Law Atlas. Notably, they excluded states implementing these laws after 2020 to avoid confounding effects from the COVID-19 pandemic, significantly disrupting work environments and health reporting patterns.
Their findings were revealing. States that had implemented earned sick leave laws before 2019 experienced a marginal but statistically meaningful increase in reporting workplace illnesses and injuries following policy adoption. According to Dr Le, this increase is not necessarily a sign of worsening workplace conditions. Still, it reflects a greater willingness among employees to report health issues once they feel secure. “We found that employees were more likely to report being ill or injured when they knew they wouldn’t face punishment or risk losing their jobs,” she explained. In other words, earned sick leave laws may foster a safer reporting environment in which workers feel empowered to disclose health problems without fear of retaliation.
However, the study also revealed that these benefits were not shared equally across the workforce. Workers without health insurance or those facing financial, legal, or social barriers to care—including undocumented immigrants—were found to be less likely to utilise earned sick leave. In high-risk industries such as agriculture, construction, and transportation, male workers especially may be desensitised to frequent injuries or illnesses and feel less inclined to seek time off. Moreover, undocumented workers might avoid taking leave altogether to prevent drawing attention to their employment status or to avoid breaching workplace norms. These findings point to structural inequalities that prevent some groups from fully accessing the protections such policies are intended to provide.
The study further found that union membership played a significant role in determining access to earned sick leave. Unionised employees were 10 per cent more likely to have access to such leave than their non-union counterparts. This disparity highlights the broader consequences of declining union influence in the US, a trend exacerbated by corporate resistance to organised labour and the spread of right-to-work legislation. As union power wanes, so does the collective bargaining strength needed to secure essential worker protections. Dr Rochford concluded that earned sick leave policies are vital but insufficient in isolation. Expanding insurance access and providing culturally and linguistically appropriate education on worker rights—particularly for undocumented and marginalised workers—is essential to ensuring that earned sick leave achieves its intended outcomes across the workforce.
More information: Hannah I. Rochford et al, Impact of Earned Sick Leave Policy on Worker Wellbeing Across Industries, Safety and Health at Work. DOI: 10.1016/j.shaw.2025.01.007
Journal information: Safety and Health at Work Provided by Texas A&M University