In an economy based on the extraction of profit from the surplus value of workers, labour laws will always favour employers. Inevitably, workers' rights will be limited and curtailed where profits are threatened. But strong labour laws are not just about labour, nor just about workers. Public health, for instance, is correlated to workers' job security, a livable wage and the availability of paid sick and emergency leave. As a 2015 study from the Institute for Research on Public Policy states, "Helping individuals dealing with a sickness or a disability find, retain and return to work as soon as possible is important for everyone."
In a 2009 study, Canada was one of only three countries out of 22 nations ranked highly in terms of economic and human development without a national policy guaranteeing employees paid sick leave, leaving it up to private employers to provide it or not. Unsurprisingly, most don't. According to a 2013 Conference Board of Canada study, only a third of employees aged between 18 and 24 have paid sick days, while fewer than half of Canadians young and old are covered. The 2015 study cited above, titled, "Leaving Some Behind: What Happens When Workers Get Sick," also found that "Among private-sector employers, coverage ranges between 50 and 55 per cent depending on the type of leave policy." But even where there is coverage, lack of job protection and income support are additional aggravating factors that directly affect workers' earnings and therefore their capability "to make full use of the leave available to them," the 2015 study finds. As such, "non-coverage or delayed entry into short-term disability support is thus a key impediment to taking timely and necessary leave for care."
In other words, employees are having to choose between their health and their livelihood. Research shows that without "job protection, flexible work arrangements and income replacement while on leave," most choose the latter and, as a result, increase the likelihood of getting their coworkers sick as well. Schools tend to follow, as sick children are forced to attend classes by parents who, without paid sick days, can't afford to stay home to care for them. Carolina Jimenez, a registered nurse and organizer with the Decent Work and Health Network, says schools are a "high risk setting" where contagion travels fast. "This is the direct relationship with parents not having paid leave," she says.
The Decent Work and Health Network is a grassroots group of health-care workers that advocates "for better health by addressing working and employment conditions in Ontario," according to its website. Earlier this month, the group penned an open letter addressed to Ontario Premier Doug Ford, Minister of Health Christine Elliott and Minister of Labour, Training and Skills Development Monte McNaughton, signed by more than 175 health-care professionals demanding the reinstatement of paid sick days and the repeal of sick notes.
"The medical literature consistently states that employees with no sick leave are more likely to go to work and expose others to infection," the February 4 letter states. "A lack of paid sick days results in children and adults transmitting infections at school and work, exacerbating contagion throughout the province."
The research proving this is abundantly clear. In the United States, a study published by the Institute for Women's Policy Research in 2010 showed that during the H1N1 outbreak, the lack of universal paid sick days led to the infection of an additional seven million more coworkers. "Work attendance by infected employees is a public health issue due to contagion," the paper states. The fact that two out of five private sector employees in the U.S. don't have paid sick days, the paper continues, leaves "the nation ill-prepared for...future outbreaks of contagious diseases."
A more recent 2019 study from Ball State University in Indiana titled, "The Effects of Employment on Influenza Rates" found that for every one per cent increase in the employment rate, there was a 19 per cent increase in the number of flu-related doctor visits. While numbers would have to be adjusted to reflect Canada's much smaller population, the correlation remains.
Here in Ontario, the Doug Ford government moved swiftly once in office to proclaim the province "open for business" by dismantling workers' paid sick leave protections and reintroducing sick notes in January 2019. Those protections had only been in effect for a year, implemented by the previous Liberal government after decades of grassroots activism. Ford repealed the measures within months of taking office. It was a decisive step against labour and against public health, one which belied Ford's claims to be "for the people" by jeopardizing the public's health, particularly those in the private sector and in lower income brackets. Multiple and concerted calls from health-care professionals to reverse the decisions have continued to fall on deaf ears, resulting most notably in the swelling of hallway medicine and the spread of viral infections, including the annual flu.
According to the Public Health Agency of Canada's weekly FluWatch report, a particularly strong influenza strain, labeled "B," has been spreading at the same rate as the less dangerous influenza A. This is atypical, as strain B, which has been linked to increased hospitalizations and deaths of children, typically doesn't appear until late in the season. The FluWatch report links the higher-than-normal number of deaths and hospitalizations this year to the early circulation of that strain. PHAC members, who come from 12 pediatric hospitals, said the number of flu-related hospitalizations was above the average seen in the previous five years.
"Over all, there have been 370 pediatric hospitalizations linked to the flu in Canada so far this season," according to a Globe and Mail report. "Of those, 54 per cent were tied to influenza B. About two-thirds of hospitalizations were in children under five years old. No flu-related deaths have been reported in children this season." In the U.S., which is also seeing a surge of the virus, 27 children have succumbed to it, with 18 of those linked to the influenza B strain, according to the U.S. Centers for Disease Control and Prevention. Nine deaths were linked to H1N1, which is an influenza A virus.
While there is no immediately available data looking at how much workplace presenteeism -- attending work while sick -- has directly contributed to the unusual proliferation of the B strain this year, the research clearly shows that such a link exists. As mentioned above, seven million extra people in the US in 2010 were infected with the H1N1 strain directly as a result of coworkers attending work while sick because their employers did not offer paid sick leave. It is not necessary to wait to conduct another study to find out the numbers for this year. The data is available, and labour laws must therefore be made accordingly with the safety of workers and thus the public in mind.
This is what members from the DWHN have been fighting tooth and nail for with the Ford government. The DWHN advocates for the reinstatement of 10 days of flexible personal emergency leave days, seven of which need to be paid, and an end to mandatory sick notes.
Jimenez says that last component "contributes directly to hallway medicine," the massive overcrowding of Ontario hospitals which the Ford government has repeatedly promised to do something about. According to Jimenez, who works in a clinic, employees required to get sick notes for same-day services find themselves forced to access emergency departments and walk-in clinics rather than staying home and resting, which is the preferred advice of medical professionals, the Toronto Public Health Agency and the Ministry of Health.
Having to acquire sick notes to justify absenteeism to employers -- itself an ethical issue -- creates "a lot of congestion ... for undue reasons," Jimenez explains. In January of this year, Ford patted himself in the back for supposedly "putting a dent" in the issue of hallway medicine. Yet, as a CBC investigation shows, "hospital gridlock -- a phenomenon that used to be restricted to surges in patients during flu season -- is the new normal." Last month, Brampton city council declared a health-care emergency in the city, where its only hospital operated at over 100 per cent capacity in the first half of 2019 and where, according to at least one councillor, "patients are dying in the hallways."
When asked if they had considered the research correlating public health to strong labour laws -- namely, paid sick and emergency leave -- a representative from the Ministry of Health passed the buck to the Ministry of Labour, replying in an email that "all questions regarding paid sick days should be addressed" to them. When pressed further about whether the research was a concern, the representative mentioned a new government website with information on the coronavirus, now named Covid19, and the implementation of "protocols for (the) protection of health care workers and the public." Agreeing to only answer questions regarding health, the representative was then asked what advice the government had for employees who couldn't afford to remain at home when sick because they lacked paid sick days.
The representative suggested that people wash their hands, avoid "contact with people who are sick" and practice "proper cough and sneeze etiquette."
Indeed, to avoid the spread of diseases and viruses, one of the simplest measures people can take is heeding that advice: rest and fluids are essential. Jimenez says on average, people need two to three days to get better. "Higher-risk settings require an additional 24 to 48 hours after symptoms have cleared to go back to work," she explains. It's also what Toronto Public Health as well as the Ministry of Health have officially recommended through myriad announcements posted on their respective websites, through Twitter messages and on television commercials. But, as Jimenez says, public health recommendations "are one thing, but the actions of the government really contraindicate those, putting Ontarians at risk of contagion."
This is why it is not so much the coronavirus in and of itself that poses a danger to Canadians, but rather our weak labour laws which pose a greater risk. While it might be hard to tally the death or infection toll directly related to presenteeism, those numbers can arguably be placed on the hands of a government that has put business and profit ahead of the health of its citizens by refusing to heed reason and science. As Jimenez says, whether it's the coronavirus, the annual flu or any other type of gastrointestinal illness, "this specific moment in time provides an opportunity for us to really reflect on the intersection between health and labour and laws and how things can be best put in place so that the public can be protected...The public needs these protections in place."
While income has been proven to be one of the most important determinants of personal health, strong labour laws that protect workers also protect society at large. As Jimenez says, particularly around the issue of contagious diseases and the spread of illnesses, these protections go beyond what a higher income on its own could do to protect our collective health.
This isn't to undermine the importance of a livable wage. Rather, it is to re-assert that only through systemic labour reform which puts human dignity before capital wealth and which protects all aspects of work -- from wages to job security to workers' rights -- will the needs of the many be addressed. Until then, Ford's "open for business" model remains an attack against workers and our families, our physical and mental health and our common sense.
Fernando Arce is a freelance multimedia journalist based in Toronto and writes strictly from an anti-imperialist, anti-colonial stance. As a committed communist, his work is devoted to amplifying the voices of the grassroots and working classes as well as those of Indigenous Peoples resisting colonial projects around the world. He has a BA in political science from York University and an MA in journalism from Western University.
Image: Doug Ford/Twitter
Editor's note, February 24, 2020: A previous version of this story stated Canada was one of three countries worldwide without a national policy guaranteeing employees paid sick leave. In fact, the source study stated Canada was one of only three countries out of 22 nations ranked highly in terms of economic and human development without such a policy.
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