As winter illnesses circulate and cost-of-living pressures continue to mount, taking a sick day is not simply a matter of health for many Australians. New research led by the University of Technology Sydney (UTS) suggests that the decision to stay home when unwell is strongly shaped by job security, financial circumstances and gender rather than illness alone. Published in Applied Economics, the study examined how workers’ health and economic conditions influence the number of sick days they take. “Employers and policymakers often focus on reducing absence, but workers who attend while unwell may recover more slowly, spread infection to colleagues, and be less productive,” said lead researcher Dr Nancy Kong, a Senior Research Fellow at the UTS Centre for Health Economics Research & Evaluation.

Using data from more than 15,000 Australians who participated in the Household, Income and Labour Dynamics in Australia (HILDA) survey between 2005 and 2016, the researchers analysed patterns of sick leave before the disruptions caused by the COVID-19 pandemic. Dr Kong, together with Dr David Rowell from the University of Queensland and Professor Peter Zweifel from the University of Zurich, deliberately focused on the pre-pandemic period to avoid the overlapping effects of changing public health measures, workplace practices and leave policies. This allowed the team to isolate the relationship between employment conditions and sick leave behaviour more accurately.

The findings revealed a sharp contrast between permanent and non-permanent workers. Employees in casual and fixed-term positions took only about one sick day each year on average, compared with around four days for permanent staff. Even after accounting for factors such as occupation, education, job satisfaction, household circumstances, marital status and location, workers in insecure jobs still took roughly three fewer sick days annually. According to Dr Kong, this gap is unlikely to reflect better health. Instead, casual and fixed-term employees often face greater financial risks when taking time off, have limited access to paid sick leave, and may fear that refusing work while ill could reduce future shifts or even threaten their employment. “For a permanent employee, staying home with influenza might be inconvenient; but for a casual worker it may trigger financial stress,” she said.

Economic conditions also influenced workers’ willingness to take sick leave. Employees living in areas with higher unemployment generally took fewer sick days, suggesting that workers become more reluctant to be absent when jobs appear harder to replace. Even a five-percentage-point increase in local unemployment was associated with a measurable decline in sick leave, representing significant lost recovery time across an entire workforce. Wages produced a more complex pattern. Higher pay alone did not consistently increase sick leave, but among workers already in poorer health, higher earnings were linked to taking more time off. Dr Kong said this likely reflects the greater financial security, workplace support and leave entitlements available to higher-income employees, enabling them to recover without worrying about lost income.

The study also identified a persistent gender gap. Across every analysis, men took fewer sick days than women, averaging about half a day less each year—a difference of roughly 23%—even after controlling for health, employment and personal circumstances. Dr Kong said the gap may partly reflect differences in health needs, caring responsibilities and healthcare-seeking behaviour. Still, it also highlights the influence of workplace culture and gender expectations that encourage men to demonstrate toughness and reliability by working through illness. These social pressures may discourage employees from taking legitimate leave even when doing so would benefit both their own health and the wellbeing of colleagues.

Overall, the research suggests that sick leave rates should not be viewed simply as a measure of workforce health or commitment. Low levels of absenteeism may instead indicate financial insecurity, fear of job loss or workplace cultures that discourage employees from staying home when they are ill. Dr Kong said employers should avoid rewarding presenteeism or treating legitimate sick leave as a sign of poor commitment. At the same time, efforts to reduce stigma could also help narrow the gender gap. For policymakers, the findings highlight the importance of secure employment, accessible paid sick leave and workplace practices that allow employees to recover without risking their income. “A fair and effective sick leave system should support productivity while ensuring workers do not have to choose between protecting their health and protecting their income,” she said.

More information: Nancy Kong et al, Understanding sick leave: the interplay between health and economic incentives, Applied Economics. DOI: 10.1080/00036846.2026.2682558

Journal information: Applied Economics Provided by University of Technology Sydney