Most of us know that if you’re sick, you should stay home from work so that you don’t get your coworkers sick. But for those who have to choose between going to work sick and receiving a reduced paycheck, the decision to stay home is not always easy to make. In “The pros and cons of sick pay schemes: testing for contagious presenteeism and noncontagious absenteeism behavior” (National Bureau of Economic Research, Working Paper 22530, August 2016), authors Stefan Pichler and Nicolas R. Ziebarth find that the general flu rate decreases significantly when employees have access to paid sick leave.
The authors cite the United States as the only industrialized country without universal access to paid sick leave. According to the U.S. Bureau of Labor Statistics, nearly a third of U.S. workers have no access to paid sick leave at all. These workers, many of whom are low-income and service sector workers, are not guaranteed pay when they take time off from work because of an illness. As a result, many go into work despite being sick—a phenomenon that Pichler and Ziebarth have dubbed "contagious presenteeism." Because contagious disease is easily spread to coworkers and customers, the authors consider contagious presenteesim a “major public health issue.”
The authors imply, without saying directly, that financial pressures drive contagious presenteeism. When people bring their infectious illness to work, it spreads. When the financial pressure is strong enough, people are likely to bring their infectious illness to work. These two sentiments underlie the authors’ ultimate belief: if you provide sick workers a financial incentive to stay home from work, they will stay home and not infect others.
The researchers used Google Flu Trends data from 2003 to 2015 to study, at the city and state levels, U.S. cities with paid sick-leave mandates. They looked for changes in flu rates after those mandates went into effect. The cities that adopted paid sick-leave mandates during that period saw flu cases drop by about 5 percent after the laws took effect. In their analysis, the researchers found that in the seven major U.S. cities with relatively comprehensive paid sick leave—San Francisco, Washington, Seattle, Philadelphia, Portland, Newark, and New York—the law may have prevented “about 100 influenza-like infections per week” per 100,000 residents.
If too little paid sick leave increases contagious presenteeism, it would hold that too much paid sick leave increases the opposite, noncontagious absenteeism (i.e., workers staying home when they aren’t actually sick). A nation’s paid sick leave policies can affect the balance between contagious presenteeism and noncontagious absenteeism.
The authors examined Germany, a country with one of the most generous sick leave systems in the world. They found that, on a given day, 4 percent of the workforce is on sick leave while only 1.5 percent actually suffers a contagious illness. When they studied reforms to Germany’s sick pay system that reduced mandated sick leave pay, they found that these reductions decreased noncontagious absenteeism, but increased the infectious disease rate (attributable to contagious presenteeism). Moreover, the reduction in noncontagious absenteeism was smaller than the increase in contagious presenteeism. Whether this was a positive outcome is debatable, but it is clear that policymakers can influence both contagious presenteeism and noncontagious absenteeism.
The authors’ research suggests that paid sick days could pay off for everyone. By staying home when we’re sick, we not only can get better faster, but the rest of the workplace can remain productive and healthy. By giving employees sick leave, they’re less likely to arrive at work sick, which means they’re also less likely to spread that sickness around the office.