California Healthy Families, Healthy Workplaces Act of 2008

Authors: San Francisco Department of Public Health, Human Impact Partners

Location: California, United States

One-third of seasonal flu is transmitted in schools and workplaces. Staying at home when infected could reduce the number of people impacted by pandemic flu by 15%-34%.

Completion Date: July 2008

HIA Report: A Health Impact Assessment of the California Healthy Families, Healthy Workplaces Act of 2008

Summary of the HIA

Proposed Policy or Project

The subject of this HIA was AB 2716, the Healthy Families, Healthy Workplaces Act of 2008. The bill entitles an employee who works in California for seven+ days in a calendar year to accrue paid sick time at a rate of no less than one hour of paid sick time for every 30 hours worked, up to 9 days p/year. After 90 days of employment, an employee would be entitled to use accrued time for diagnosis, care, or treatment of health conditions of the employee or an employee’s family member, or for leave related to domestic violence or sexual assault.

Background and Policy Context

In the United States, only 52% of private-sector employees receive paid sick day benefits and rates vary significantly by occupation (Hartmann 2007). For example, only 15% of workers in the food preparation occupation have paid sick days—the lowest rate among major groups of occupations (Hartmann 2007). In contrast, workers in “white-collar” occupations have far higher rates of coverage (e.g., 84% in legal, 83% in management, and 81% in computer and math occupations). Internationally, 137 countries mandate paid annual leave and 121 countries guarantee two weeks of leave or more. Regarding paid sick leave specifically, 145 countries require employers to provide paid sick days or leave for short- or long-term illnesses, and 127 countries provide a week of paid sick leave or more annually (Heymann et al. 2007b). In contrast, however, at the time that the HIA was conducted there was no right to paid sick days in the United States, except in the City and County of San Francisco. Such benefits, where available in the U.S., are provided voluntarily by employers. A number of U.S. state and local jurisdictions are now considering laws to require employers to provide paid sick days benefits to all employees.

Scope and Methods

This HIA focused on the following six questions:

  1. What is the availability of paid sick days in relationship to need and health status?
  2. Is the availability of paid sick days associated with taking sick days to recover from illness or care for a dependent?
  3. What is the effect of paid sick days on recovery from illness, primary care utilization and preventable hospitalizations for workers with and without paid sick days?
  4. What is the effect of paid sick days on recovery from illness, primary care utilization and preventable hospitalizations among dependents of workers with and without paid sick days?
  5. What are the effects of paid sick days on communicable disease transmission in workplaces and other community settings?
  6. What are the effects of paid sick days on wage loss, risk of job loss and employer retaliation?

The HIA employed mixed research methods to assess these research questions. Methods included developing logic frameworks, reviewing existing secondary data sources and empirical literature, conducting focus groups and surveys among workers in California, interviewing health experts, and conducting an original analysis of the California Work and Health Survey.

Summary of Findings

This HIA examined evidence on the potential health impacts of a mandatory requirement for paid sick days as proposed by the California Healthy Families, Healthy Workplaces Act of 2008. While limited published, peer-reviewed research focused specifically on the health impacts of paid leave for sickness, sufficient evidence exists to support the conclusion that the law would have significant positive public health impacts. The guaranteed availability of paid sick days would increase workers’ use of sick time to care for medical conditions and to care for sick dependents. A guarantee of paid sick days would reduce the hazard of communicable disease transmission in community settings including restaurants and long-term care facilities, with potential for reductions in infectious disease outbreaks. Paid sick days would have a particularly significant benefit in enabling established community mitigation strategies for pandemic flu. Finally, a guarantee of paid sick days would prevent potential hunger and loss of housing among low-income workers by mitigating wage loss during periods of illness.

Decisions/Actions following the release of the HIA

Though passing out of several legislative committees, the 2008 bill did not pass out of the Appropriations Committee. The bill was re-introduced in the 2009 legislative session and is currently pending. The HIA did, however, have numerous impacts. Over two-dozen media sources throughout California reported on the pending paid sick days bill and on HIA findings. The HIA helped change the dialogue around the issue – rather than being represented as a labor issue, the paid sick days policy frame shifted to a public health issue. For example, the Chair of the California Assembly Labor Committee, referring specifically to the HIA, asked the opposition to the bill if they condoned the spread of disease through restaurant workers. The HIA generated interest around the country in using HIAs to assess work and family issues. In 2009, HIP and SFDPH completed a HIA on the national paid sick days bill, the Healthy Families Act of 2009. Building off of this, HIP then partnered with groups in Maine, Massachusetts, Milwaukee, New Hampshire, and New Jersey to customize findings of the national report to local jurisdictions, and to collect locally relevant data to analyze the health impacts of paid sick days.

Project Inputs

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Report reviewers from local public health departments in California, UC Berkeley, Labor Project for Working Families, and other organizations; Communications support from Communications Consortium Media Center; and experts in the field.

Products Produced

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Background Reports


Lili Farhang

Associate Director

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