Guaranteed paid time off work for personal illness is an essential component of job quality and economic security for workers, but far too many people of color and low-income people in the United States have no protections against lost wages or employment termination due to illness. Paid sick leave policies allow workers to earn a minimum number of paid and protected hours off work each year that can be used for sick time purposes, which may include illness and medical care for the worker or for the worker's family members.

There is broad public support for policy action to guarantee paid sick leave for all workers: according to polling by the National Partnership for Women and Families, 75 percent of Americans favor such a law, with strong support across all demographic and political affiliations. More than 34 million private-sector workers do not have access to a single paid sick day, including 38 percent of Black workers and 54 percent of Latinx workers.

Low-wage workers who cannot afford to lose a day's wages due to illness are less likely to seek medical care (for themselves and for their families) than workers who do have paid sick leave, and are 1.5 times more likely to go to work with contagious illnesses. This means that lack of paid sick leave is not only a problem for individual workers, but also a public health threat.

In addition to improving job quality and stability for workers, guaranteed paid sick leave could also benefit employers and the economy as a whole, reducing employee turnover and increasing productivity, decreasing the spread of illnesses like influenza, and lowering health care costs.  But the federal government has yet to address this critical issue, so city and state governments have taken the lead in advancing this basic right for workers.

In addition to the PolicyLink resources listed on the right, see CEPR, National Partnership for Women and Families, and paidsickdays.org for more resources on paid sick leave.

• Elected and appointed city officials can institute paid sick leave through executive orders, ordinances, and resolutions, unless state law prohibits such actions.
• Unions, working people, advocates, and community organizations can organize campaigns to promote paid sick leave and build critical support among residents and voters.
• Business leaders can play important roles in advancing access to paid sick leave through corporate policies and public advocacy.

Strong paid sick days policies should cover all workers regardless of business size, industry, employment status, or the number of hours worked. Cities seeking to implement or strengthen paid sick leave protections for workers should consider the following issues.

• State preemption: Several states now preempt their cities' ability to establish local labor standards such as paid leave.
• Accrual rates: Laws can mandate the same rate of paid sick leave accrual for employers of all sizes — for example, one hour of paid sick leave for every 40 hours worked—or a tiered approach in which smaller businesses may provide fewer paid hours, unpaid hours, or a combination of paid and unpaid hours.
• Covered use: Most paid sick leave policies allow earned time to be used for personal illness, family illness, and routine medical care. Some policies also allow accrued sick days to be used for "safe" time by workers who need time away from work to seek services, care or safety related to domestic violence, sexual assault, or stalking. Policymakers should also consider adopting an inclusive definition of "family member" that recognizes the diversity of caregiving relationships.
• Making the business case: Securing the support of business leaders can be an important boost for coalitions advocating for paid sick leave. San Francisco has guaranteed paid sick leave to all workers in the city since 2007. Seven out of 10 employers have reported that the law has had no impact on their profitability. In Washington DC, the Office of the District of Columbia Auditor reported that the District's paid sick leave policy had no effect on business growth or retention.
• Enforcement provisions: City leaders should have strong mechanisms in place to ensure that workers are able to exercise their right to paid sick leave without interference, discrimination, or retaliation on the part of their employer.

Worker and community organizers are often the catalysts of policy change to protect worker rights and improve job quality. Coalitions and campaigns should engage in broad public outreach, use data to make the business case for paid sick leave, and work closely with policymakers to ensure deep community engagement and equitable policy design.

• In 2015, Philadelphia passed a paid sick and safe leave ordinance, part of a slate of legislation in the city to protect workers and improve job quality. But the provision was in immediate legal limbo, as a coalition of business owners had challenged a similar law in Pittsburgh on the grounds that municipal governments in Pennsylvania should not be able to determine "duties, responsibilities or requirements placed upon businesses, occupations and employers." Ultimately, however, the Pennsylvania Supreme Court ruled that guaranteeing paid sick days was a matter of public health, granting the city the authority to institute the policy. Philadelphia's paid sick leave ordinance applies to all workers who work at least 40 hours a year in the city in businesses with 10 or more employees, with few exceptions. Employers are required by law to notify workers that they are entitled to sick time.
• Seattle updated its paid sick leave ordinance in 2018, mandating paid sick leave for all full- and part-time workers in the city. Employees of businesses with fewer than 250 workers earn one hour of paid sick leave for every 40 hours worked, and those in businesses with 250 workers or more earn one hour of paid sick leave for every 30 hours worked. With no cap on annual accrual, employees can carry over up to 72 hours of paid sick leave each year. In 2017, the American Journal of Preventive Medicine published a study examining the association of paid sick leave laws with foodborne illnesses in San Francisco and Seattle, and found that such illnesses declined by about 22% after paid sick leave implementation in jurisdictions with laws that are supportive of employees actually taking paid sick leave. Paid sick leave laws in Seattle and neighboring Tacoma helped inspire a state-wide paid sick leave mandate which was enacted in 2018.