Massachusetts Paid Sick Days

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Health Impact Project

This health impact assessment (HIA) addressed a Massachusetts-specific version of the federal Healthy Families Act. The pathways and health issues explored included: 1) the spread of communicable diseases, such as influenza and stomach flu through workers at restaurants, schools and nursing homes; 2) the income and stress-related impacts of loss of salary and employer retaliation for missing work; and 3) the potential effects on emergency room use and delayed medical care.

In 2006, Massachusetts became the first state to provide nearly universal health care. The overall uninsured rate for Massachusetts decreased to 2.6% in 2008. There are still a large number of preventable hospitalizations and emergency room visits in Massachusetts each year. There is no evidence that the number of these events is decreasing due to nearly universal health care in the state.

Through focus groups, the HIA found that workers are concerned regarding access to paid sick days and access to healthcare, delayed healthcare, and hospitalization; ability to care for dependents; infecting co-workers and customers; and overall feeling of not having basic rights as workers and feeling lack of trust from employers.


The HIA received significant press coverage in Massachusetts and helped shift the policy debate to include health outcomes. One of the HIA authors testified before a joint committee of the Massachusetts House and Senate.


This Health Impact Assessment Report first appeared in The Cross-Sector Toolkit for Health. The Cross-Sector Toolkit for Health was originally developed by the Health Impact Project, formerly a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. The creation of this resource was supported by a grant from the Health Impact Project. The views expressed are those of the author(s) and do not necessarily reflect the views of The Pew Charitable Trusts, or the Robert Wood Johnson Foundation.

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