US Sick Leave In Global Context: US Eligibility Rules Widen Inequalities Despite Readily Available Solutions.

Research has demonstrated that paid sick leave reduces spread of COVID-19 and other infectious diseases and improves preventive care and access to treatment across a wide range of conditions. However, the U.S. has no national paid sick leave policy, and even unpaid FMLA leave-often viewed as a foundation for new paid leave legislation-is often inaccessible. We analyzed a nationally representative survey to determine the extent to which specific FMLA features produce gaps and disparities in leave access. We then use comparative policy data from 193 countries to analyze whether these policy features are necessary or prevalent globally, or whether there are common alternatives. We found that the FMLA's minimum hours requirement disproportionately excludes women, while its tenure requirement disproportionately excludes Black, Indigenous, and multiracial workers. Latinx workers face greater exclusion due to employer size. Of the 94% of countries that provide permanent paid sick leave, none broadly restrict leave based on employer size and 93% cover part-time workers without a minimum hour requirement. Enacting permanent paid sick leave accessible regardless of employer size, tenure, or hours is critical and feasible. [Editor's Note: This Fast Track Ahead Of Print article is the accepted version of the peer-reviewed manuscript. The final edited version will appear in an upcoming issue of Health Affairs.].