Thursday, November 1, 2018

Who's really abusing paid sick days?

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.
Follow @DecentWorkHlth and visit www.15andfairness.org to take action today.

Friday, October 19, 2018

To end hallway medicine, defend Bill 148


Doug Ford campaigned on a promise to end hallway medicine, but this can’t be done by implementing corporate demands to scrap Bill 148, along with further healthcare cuts. From a higher minimum wage and equal pay, to paid sick days and fair scheduling, to easier unionization, Bill 148 has many health implications—and is part of the process of rebuilding public healthcare and ending hallway medicine.


$15/hr minimum wage and equal pay

To end hallway medicine we need to prevent illness in the first place. As Juha Mikkonen and Dennis Raphael explain in Social Determinants of Health: the Canadian Facts, “Income is perhaps the most important social determinant of health. Level of income shapes overall living conditions, affects psychological functioning, and influences health-related behaviours such as quality of diet, extent of physical activity, tobacco use, and excessive alcohol use. In Canada, income determines the quality of other social determinants of health such as food security, housing, and other basic prerequisites of health…Increasing the minimum wage and boosting assistance levels for those unable to work would provide immediate health benefits for the most disadvantaged Canadians.”


But the minimum wage in Ontario was frozen for 12 of the 20 years between 1995 and 2015, and many have been denied equal pay for equal work—from temp agency workers to contract faculty. This undermines health and disproportionately impacts those concentrated in jobs that pay poverty wages and deny equal pay: Indigenous, migrant and racialized workers, especially women. By raising the minimum wage to $14/hr this year and 15 in 2019, and promoting equal pay for equal work, Bill 148 is an important step towards reducing income inequality and promoting health equity, which keeps people out of hospital. As the Canadian Centre for Policy Alternatives explained, “the minimum wage hike will produce a particularly large benefit for First Nations women in the workforce, 36% of whom will get a raise on January 1, 2019…The effect is similar to the strong impact a $15 minimum wage will have on the incomes of immigrant women, 42% of whom will get a raise.”


Paid sick days and fair scheduling

In order to help relieve overcrowded hospitals, we need to make it easier for people to access primary care, stay home when sick, and work in a healthy environment. Until this year, workplaces in Ontario with less than 50 workers could fire an employee for taking a personal emergency day, and many more workers would lose wages for staying home sick. Without paid sick days, workers are forced to go to work sick, which spreads infection to others. As the Canadian Medical Association Journal summarized, “The Public Health Agency of Canada, the World Health Organization and every major public health body recommend that people stay home from work when they have influenza. Leading medical and public health associations also recommend that people who handle food not go to work when they have gastroenteritis or other contagious diseases. However, many employees cannot follow these recommendations if it means forgoing their wages or risking their jobs… Employees who have access to paid sick leave are more likely to stay home when advised to do so by a physician; employees with no sick leave are more likely to go to work and expose others to infection.”


The lack of paid sick days encourages hallway medicine by making it more difficult to workers access preventive health like vaccinations and cancer screens, and more likely they will rely on off hours visits to the emergency department (ED) rather than their primary health providers during the work day. Which is why the American Journal of Emergency Medicine concluded that “to reduce ED utilization, health policymakers should consider alternative reforms including paid sick leave.”


Unpredictable schedules also make it difficult to keep medical appointments, and are a source of stress that undermines mental and physical health. As a World Health Organization report on psychosocial work hazards explained, “stress at work is associated with heart disease, depression, and musculoskeletal disorders and there is consistent evidence that high job demands, low control, and effort-reward imbalance are risk factors for mental and physical health problems, thereby leading to further strain on public spending for increased costs on healthcare.” These are exactly the sort of precarious jobs that have increased in recent years, especially temp agencies that combine low pay, unequal pay, erratic schedules and no paid sick days: a prescription for injuries and illness, which worsen hallway medicine.


Bill 148 provides 10 personal emergency leave days, the first two of which are paid, and fair scheduling. These are essential to provide a basic level of stability to reduce workplace stress, and to encourage workers to stay home when sick—which allows a faster recovery, prevents the spread of infection in the workplace and to the public, and makes it easier for workers to see their primary health providers rather than relying on the emergency department. As with a minimum wage increase and equal pay provisions, paid sick days especially benefit women—who disproportionately provide child care—and parents with paid sick days are more likely to keep their sick child at home rather than send them to school, which helps prevent infection.


Unionization

Unions have played important roles in supporting healthy wages, promoting environmental and workplace safety legislation that prevents injuries and illnesses, and defending public health systems like Medicare. That’s why governments intent on privatizing healthcare have attacked unions—from Ontario Premier Mike Harris who went after unions in his campaign to close hospitals in the 1990s, to BC Liberal premier Gordon Campbell who slashed wages of health workers in 2000s. As Mikkonen and Raphael explain, “a greater degree of unionized workplaces would most likely reduce income and wealth inequalities in Canada. Unionization helps to set limits of the extent of profit-making that comes at the expense of employees’ health and wellbeing.”


Bill 148 makes it easier for workers to join unions, which helps workers defend healthy wages and working conditions, and contribute to campaigns to defend public healthcare. Recently Gordon Campbell called for privatizing healthcare based on the claim that “health costs relentlessly escalate faster than population growth and far faster than economic growth.” But as the Ontario Council for Hospital Unions explained in their report Hallway Medicine: it Can Be Fixed, “in 2017, real funding per person was still less than in 2008—although the Ontario economy was about 17% larger than it was in 2008 in real terms. The hysteria about runaway health care costs is just that—hysteria. Two-thirds of this dollar cut came from cuts to hospital funding. Between 2010/2011 and 2017/2018 real provincial hospital expenditures were cut 8.3%” It is these cuts that created hallway medicine, combined with broader policies like income inequality, and Ford was elected on a promise to help the situation, not bring further harm.


Defend Bill 148

But the big business lobby Ontario wants to tear up Bill 148 and all of its health benefits. They want to freeze the minimum wage and reverse equal pay provisions—which would maintain poverty wages and income inequality, undermining a key social determinant of health. They want to revoke paid sick day and fair scheduling—which would force sick workers into their workplaces and sick kids into schools to spread infection, and divert patients into overcrowded hospitals rather than primary healthcare. They want to make it more difficult for workers to unionize—which would make it easier to cutback and privatize public services. All of these policies will worsen hallway medicine, under the guidance of Gordon Campbell, just as we head into flu season—and will disproportionately impact Indigenous, migrant and racialized people, especially women.


Bill 148 won’t end hallway medicine on its own, but it is part of broader efforts towards that goal—by promoting the social determinants of health like income equality, supporting public health measures like staying home when sick, and encouraging safe workplaces and public healthcare. If Ford wants to maintain his promises of ending hallway medicine and being premier for the people, then he should listen to the people—from the large majority in the polls who support $15 minimum wage, to the more than 50 actions on October 15 in support of Bill 148, to the rally for public healthcare October 23.