The Washington PostDemocracy Dies in Darkness

Of course Hillary Clinton went to work sick. That’s the American way.

Both policy and culture keep us working while ill.

Hillary Clinton speaks at a rally at University of South Florida. (Andrew Harnik/AP)

As Democratic presidential nominee Hillary Clinton demonstrated when she nearly collapsed from the effects of walking pneumonia early this week, the benefits of running for elected office may include many things, but sick days are not among them.

This is perhaps unavoidable in light of the fact that the job of actually being an elected official doesn’t allow for much rest and recuperation, either — see, for instance, John F. Kennedy plowing ahead despite crippling back pain and Addison’s disease, which he wanted to conceal from the public; and George H.W. Bush ignoring a doctor’s advice in 1992 to stay in bed rather than attend a state dinner in Japan, with the result being that he vomited on the Japanese prime minister. “The president is human,” Bush’s physician told reporters at the time. “He gets sick.”

In a letter, Hillary Clinton’s doctor describes the candidate’s “mild” pneumonia.

Going to work sick is not just a function of political work, however, or even of merely being human — it is a profoundly American behavior.

In 2014, the public health and safety nonprofit NSF International found that 26 percent of American workers regularly go to work when under the weather, or about 39 million people in today’s labor market. Twenty-five percent of those who do so told NSF that their bosses expected it of them; 37 percent said they couldn’t afford to take the time off. A second 2014 study, conducted by Brian Gifford and Kimberly Jinnett of the Integrated Benefits Institute, arrived at similar findings: Twenty-one percent of people who went to work sick couldn’t afford to miss hours; 23 percent said their workload was too heavy to allow it; 9 percent said they “fear[ed] negative consequences.”

More than a third of workers have no sick leave.

Caitlyn Collins, assistant professor of sociology at Washington University in St. Louis, says these figures reflect a widespread American bias that “valorizes work and the ideal worker image” at the expense of personal health and well-being.

“Our culture is reflected and reinforced by public policy,” Collins says. “We are the only industrialized country with no federally mandated paid sick days. When the federal government tells you that you have no right to sick days, they’re telling you that you have no right to self-care or to care for loved ones.”

With sick leave decisions left to the marketplace, many employers simply don’t provide it or don’t provide it for all employees. The Bureau for Labor Statistics reports that 32 percent of civilian workers have no access to paid sick leave of any kind, and among part-time civilian workers, that number leaps to 69 percent. If you’re working part-time at minimum wage, even one missed day can mean an unpaid bill, or worse, being fired.

The American notion of pulling ourselves up by our bootstraps explains part of our willingness to work through illness, but it doesn’t necessarily explain why we’re comfortable with allowing some people a chance to stay home and recover while denying others.

Alison Green, who runs the Ask a Manager blog, writes in an email: “There’s a correlation between how skilled a position is, and thus how hard it is to fill, and the compensation and perks that a job offers. Employers often think of lower-skill, lower-wage workers are more easily replaceable, and they don’t have the market pressures to offer them paid sick leave that exist in other places in the labor market.

“This set-up is short-sighted. … When you treat people better than the market says you have to, you tend to get better workers and longer commitment.”

It’s well-established that fast-food workers, those exemplars of part-time employment and swift workplace turnover, are particularly likely to have to report to work despite illness. Aside from causing problems for the workers themselves, their presence in the workplace while sick poses serious public health risks. The Institute for Women’s Policy Research reports that in the course of the 2009 H1N1 pandemic, some 8 million infected American workers took no time off; it’s estimated that they, in turn, infected another 7 million people.

When workers come to work sick, everyone gets ill.

Recent years have seen some legal advances, with more than two dozen cities, five states and the District of Columbia passing sick leave laws, but, “what we need to do is pass the Healthy Family Act, that’s the bottom line,” says Debra Ness, president of the National Partnership for Women and Families.

The Healthy Family Act would require businesses with 15 or more employees to let them earn an hour of paid sick leave for every 30 hours worked (up to 56 hours annually); businesses with fewer employees could opt out, but would then be required to provide at least 56 hours of annual unpaid sick leave.

And that would be an enormous improvement — but even if passed, sick leave laws mean little if our culture discourages us from taking advantage of them.

Ness refers to a “fierce, independent work ethic” that characterizes the American approach to our jobs, adding, “we see it all the time, people powering through illness — we just saw a presidential candidate doing it. [Clinton] was doing what many of us do, powering through with pneumonia. … Sometimes that kind of independent work ethic works against us.” She adds: “A lot of times those people have a choice [to take sick days or not] — but they’re the same people who don’t realize that so many people don’t have a choice.”