Millions of Americans face losing out on wages or going to work while sick.

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Women are more likely than men to show up to work while battling an illness. Getty Images

The United States is unique among developed nations. It’s the only industrialized country in the world that lacks universal access to paid sick leave.

This has important implications for public health, as well as workplace productivity.

When people don’t have access to paid sick leave, they’re more likely to go to work when they’re under the weather.

When they show up with a contagious illness, it puts their co-workers and other people at risk of getting sick, too. This contributes to the spread of infectious diseases, such as the flu.

“Going to work with an infectious disease, like the flu, puts your co-workers and customers at risk,” Nicolas Ziebarth, PhD, an associate professor of economics in the Department of Policy Analysis and Management at Cornell University, told Healthline.

“It could even be deadly for at-risk groups,” he added, “like young children or older and frail people.”

When Ziebarth and his colleague Stefan Pichler studied the relationship between paid sick leave and flu outbreaks, they found the rate of influenza decreases when workers gain access to paid leave.

“For the states and dozens of cities that passed sick pay mandates in the last decade, we find a reduction in infection rates,” Ziebarth said, “and no evidence that jobs were systematically destroyed or wage growth substantially lowered.”

Across the country, 10 states, Washington, D.C., and dozens of municipalities have passed laws that require employers to provide paid sick leave.

But many other states have passed laws that prevent municipalities from mandating sick pay.

To date, no federal laws have been passed to ensure that employees across the country have access to paid leave.

While some companies offer paid sick leave to all of their employees, others leave workers with a tough choice to make — go to work while sick or take unpaid time off?

In 2018, paid sick leave was available to 71 percent of civilians employed in the private sector. It was available to 91 percent of civilians working for state or local governments.

Among full-time civilian employees, 85 percent had access to sick pay. In comparison, only 40 percent of part-time workers received this benefit.

Low-income employees were significantly less likely than high-income workers to receive sick pay. Only 31 percent of the lowest-paid workers received it, compared to 93 percent of the highest-paid workers.

Sick pay coverage was particularly low in the service industry, as well as in construction, extraction, farming, fishing, and forestry jobs.

Nearly half of people who were employed in private-sector service jobs lacked access to paid sick leave in 2018.

“That includes food service workers and a lot of health service workers,” LeaAnne DeRigne, MSW, PhD, an associate professor of social work at Florida Atlantic University, told Healthline.

“Those are places where you don’t want sick people,” she continued, “rolling your burritos or pushing you down a hallway in a hospital.”

When Ziebarth and Philip Susser profiled the sick leave landscape in 2011, they found that women were nearly as likely as men to have paid sick leave.

But women were more than twice as likely as men to go to work while sick.

Low-income female employees with children were the most likely to work while ill.

This may reflect the role that many women play as primary caregivers, as well as the concentration of women in many low-paid jobs.

Even when they have access to paid sick leave, many women and other workers use some of that time to care for sick children or other relatives.

When they get sick themselves, they may not have enough paid leave left to take time off.

If they’re strapped for cash, they may not be able to afford an unpaid break.

Many people also worry they’ll lose their job or face other negative repercussions at work if they miss a scheduled shift.

“That’s one of the key interests in sick leave, is trying to understand how it supports financial security in a household,” DeRigne said.

“How do you get sick and how do you take care of this child if you don’t have any sick days and you’re working pay check to pay check?” she asked. “If you have access to a paid sick day, it can help you manage your work life, and your family life, and your financial life.”

In order to increase access to paid sick leave, DeRigne would like the federal government to pass a law that ensures that all employees have access to sick pay.

“We’ve got some local areas and progressive states that have already passed mandatory paid sick leave,” she said, “but in order to really provide coverage across the United States, we need a federal mandate.”

Research suggests that increased access to sick pay would help lower the number of people who go to work while sick. In turn, this could help limit the spread of infectious illness.

In a study published last year, DeRigne also found that providing at least 10 days of paid sick leave makes it easier for people to access preventive healthcare services, such as cancer screenings and flu shots.

However, increasing paid sick leave coverage may not be enough on its own. To stop people from working while sick, shifts in cultural norms and attitudes may also be needed.

“Many people go to work sick out of a wrong understanding of what a strong work ethic is,” Ziebarth said. “Having a good work ethic and working hard is something admirable, but going to work sick with contagious diseases is simply a wrong work ethic.”

For the sake of public health, employee safety, and workplace productivity, he believes that changes to workplace culture are needed.

“Employees and employers should be partners,” he said. “A good employer should encourage sick employees to call in sick and motivate them to work hard when they are healthy.”