A public health approach to reducing health disparities across economic lines involves looking for “upstream solutions.” By walking upstream and understanding why people are falling in the river in the first place, we can be more effective in saving lives than by focusing all our resources on pulling the drowning people out of the river downstream.

Applying this “upstream” approach to the public’s health should involve examining social structures and policies that encourage or discourage individuals in complying with scientifically-based disease prevention guidelines. And one of the most scientifically supported facts is that the spread of many contagious diseases can be mitigated when sick people don’t go out in the public.

This is straightforward logic, and yet not so simple in action when millions of workers in the United States have no paid sick days coverage for themselves, and over three quarters of the employees in our workforce do not have polices that allow them to stay home with a sick child. (1) Without paid sick days, sick kids will either be left home alone or sent to the classroom with other children; and sick adults will either be at home losing pay or showing up at work and unintentionally exposing co-workers and the public at large.

People who incur a financial penalty for missing a day on the job, or risk losing their jobs, are less likely to follow health guidelines to stay home when ill. Likewise, parents are more likely to send sick children to school if staying home to provide care means losing income.

Intertwined with concerns for public health in general is a major social justice component. Poor families, on the whole, are sicker than affluent families – this is a well established fact. Certainly there are many factors that contribute to health disparities in our nation, yet insufficient attention is given to the link between health disparities and the fact that 79% percent of low wage workers do not have the ability to earn paid sick days. (1)

There is consistent reverberating racial and social justice interplay between income status, family health and workplace policies such as paid sick days, or the lack thereof. Mothers in particular are severely affected given that women comprise the majority of low wage earners and continue to bear the primary responsibility for child rearing.

Consider this study that looked at closures of day care facilities and schools due to influenza outbreaks: in such situations, 64% of Hispanic parents and 56% of African American parents said that they would likely lose income and have money problems compared to 34% of white parents. Projections of job or business loss due to such school closures were also higher for Hispanic and African American parents, 49% and 40% respectively, as compared to 14% of white parents. (2)

Two Americas: In the first, you’re sick, you take time off work, you get better faster. In the second, you’re sick, you can’t take time off work, you stay sick longer, the illness likely spreads faster in your community.

In the first, your child is sick, you stay home with her. In the second, your child is sick, you have to send her to school because you can’t stay home with her, she stays sick longer, more kids in her school get sick, your community gets sicker.

It’s not just that the rich get richer. Without leveling the playing field with paid sick days policies for all, the sick get sicker as well.

1. Won, K. C. and Heller, J. A health impact assessment of the Healthy Families Act of 2009. Human Impact Partners. September 2009 http://www.humanimpact.org/PSD/NationalPaidSickDaysHIA_report.pdf.

2. Blendon, R. et al. Influenza A(H1N1)/swine flu survey III. Harvard School of Public Health. June 2009. http://www.hsph.harvard.edu/news/press-releases/2009-releases/national- survey-americans-influenza-a-h1n1outbreak-fall-winter.html