Ontario's Bill 148 includes 10 Personal Emergency Leave (PEL) days, the first two of which are paid, and an end to sick notes for minor illnesses. But Ontario Premier Doug Ford considers these minor reforms "disastrous." With his government's proposed Bill 47, Ford wants to bring back sick notes, eliminate the paid days, cut PEL days to eight and restrict them further -- allowing only three for personal illness, three for family duties and two for bereavement. So you better get out your calendar and carefully plan out your medical emergency, family deaths and other unexpected crises for the year.
Health providers, backed by clear medical evidence, had lobbied for seven paid sick days; Bill 148 provided two. But Ford wants to cut these to zero, based on demands from the big business lobby (like the Ontario Chamber of Commerce and the Retail Council of Canada), who claim workers are "abusing" their paid sick days. These claims are based on the common myth that providing paid sick days invites widespread abuse and, therefore, requires medical surveillance.
For example, an article in the Financial Post claimed, "abuse of sick leave policies in the workplace is rampant," driven by every "employee with a sniffle" who wants to get "paid for staying longer at the cottage." It suggested a modest proposal: that employees "will think twice about taking a day off if it costs them a day's pay, or even costs them their job." The article also invoked medical surveillance: "The best way to diminish unwarranted absenteeism is to require those who are not 'totally' disabled from performing any task to show up at work to perform whatever duties the report establishes they are capable of. If the medical reports are still not credible, have an independent examination done."
Unfortunately, this punitive approach to illness is already the norm for minimum wage workers.
Until this year, those at workplaces with fewer than 50 employees could have been fired for taking a single unpaid day off work to deal with a personal emergency. By extending job-protected personal emergency leave to all workplaces, nearly 2 million workers will have job security if their child care falls through, or they have a medical emergency. Millions more gained the legal right to paid sick days for the first time, as Ontario became the first jurisdiction in Canada to provide two paid emergency leave days (sick days) for all workers after only seven days on the job. Among those benefiting from the new provision are thousands of unionized workers who did not previously have the right to paid sick days in their collective agreement.
Unsurprisingly, the opposition to expand paid sick days in Ontario is encountering the same opposition as in other jurisdictions. But where paid sick days have been given a chance, the myths against them have melted, and the evidence has shown that the real abuse doesn't come from employees taking advantage of them but employers not granting them.
Ideology vs. evidence
More than a decade ago, San Francisco became the first jurisdiction in the U.S. to mandate paid sick days for all employees. The big business lobby claimed the sky would fall, but a survey of more than 700 employers and nearly 1,200 employees found otherwise. Despite having access to up to nine paid sick days every year, the average employee used only three -- and a quarter used zero. The most common reasons for using paid sick days were to visit a doctor or dentist, or care for a sick child or other family member -- exactly as the paid sick days were intended -- and this helped parents stay home with a sick child rather than sending them to school to expose others to infection.
Six out of seven employers did not report any effect on profitability, and two-thirds of employers were supportive. "I thought the sick day ordinance could become an excuse for my servers or other employees to call in sick at the last minute and leave shifts unstaffed," said one restaurant owner. "Turns out, that hasn't been a problem at all." This is because paid sick days encourage people to access health care and recover at home, promoting faster and healthier return to work, and greater retention and productivity. Where there was abuse, it was on the employer side: nearly a quarter of employees reported that their employers responded punitively to their illnesses, threatening wage loss or giving fewer hours or worse tasks -- and these abuses disproportionately affected women, people of colour and low-wage workers.
In 2014, New York City expanded paid sick days to 1.4 million employees. This was against the wishes of a small but powerful group: the mayor predicted "deleterious impacts on businesses," and the Manhattan Chamber of Commerce claimed it would add "additional financial burdens." But as a follow up study explained:
"When it was first proposed, critics of the paid sick time law argued that it would lead to a loss of jobs in the City and impose a major cost burden on employers, especially small businesses. They also predicted that such a law would invite widespread abuse by employees. However, as this report shows, these fears have proven unfounded. By their own account, the vast majority of employers were able to adjust quite easily to the new law, and for most, the cost impact was minimal to nonexistent. Indeed, a year and a half after the law took effect, 86 per cent of the employers we surveyed expressed support for the paid sick days law."
As a former chamber of commerce official explained, "I don't know anybody that has actually had to cut people because of this policy. I also thought there might be abuse. But in our case there was absolutely no abuse." This experience was shared by 98 per cent of employers who reported no known cases of abuse, while only 0.3 per cent reported more than three cases. Once again, where there was frequent abuse it was on the employer side:
"While 87 per cent of the employers we surveyed made paid sick days available to some or all of their workers, 13 per cent failed to do so -- a surprisingly high figure given the fact that all those surveyed are covered by the law and required to offer paid sick days. A year and a half after the law took effect, among the employers that provided paid sick days, only 58 per cent offered them to all employees, as the law requires, while 42 per cent provided paid sick days only to some categories of employees."
Making Ontario open for sickness
Doug Ford was elected on a promise to listen to health providers and end hallway medicine. This would mean supporting Bill 148 -- which starts to expand paid sick days, end sick notes, and supports broader social determinants of health by raising the minimum wage and providing equal pay, fair scheduling and easier unionization. But with Bill 47, Ford wants to do the opposite: ending paid sick days, bringing back sick notes, freezing the minimum wage and rolling back healthy labour law. This is not based on medical evidence, but rather big business ideology -- the same ideology that leads Ford to guess that Bill 148 has led to tens of thousands of job losses, when unemployment is actually down.
The evidence is clear that paid sick days increase preventive care while reducing emergency department visits, and protect public health by making it easier for people to recover at home rather than spreading germs in the workplace, and for parents to keep their sick kids at home rather than spreading germs in school. Paid sick days are a key component of public health and there is no evidence that employees abuse them. Where there is abuse, it is by employers not providing them as mandated by law and as required by public health.
As a fourth temp agenda worker has been killed at Fiera Foods, Ford wants to reduce workplace inspections that uncover real abuse, while bringing back the red tape of sick notes to police a problem that doesn't exist. Forcing people with minor illnesses into doctor's offices and emergency rooms just to get a sick note is not only unnecessary but a drain on public health care and a threat to public health.
As the former head of the Ontario Medical Association explained, "you don't want to encourage people who have infectious diseases to go to their doctor's office when it's not necessary. They're in a waiting room with other people, some of them have very serious illnesses like cancer. There are pregnant mothers and children. They're putting those people at risk…[these visits] are expensive, they're unnecessary and they put other people at risk. We don't have the resources in the health-care system to police absenteeism for employers." This was reiterated by the current head of the Ontario Medical Association, who explained that "with flu season upon us, prolonged wait times and hallway medicine, we need to find ways to keep doctor's offices free for patients sick enough to need it. We need to find ways to let people stay home to recover for minor illnesses."
This means expanding rather than ending paid sick days, and policing abusive workplaces rather than sick workers. This starts with defending Bill 148, and revoking Bill 47.
Jesse McLaren is a physician, activist and blogger who believes that if medicine is to accomplish its great task, it must intervene in political and social life. He blogs at www.yourheartsontheleft.blogspot.com, and tweets @HeartsOnTheLeft.
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