2021-06-14-世界卫生组织-The_case_for_paid_sick_leave_30页_1mb

Background and Importance

Paid sick leave is a critical component of social health protection, especially during economic crises. It protects workers from financial hardship and prevents ill health from leading to job loss or decreased productivity. Gaps in paid sick leave, as seen during events like the H1N1 pandemic, can worsen public health outcomes and economic costs, such as increased healthcare expenses and productivity losses due to presenteeism (working while sick).

Definition and Components

Paid sick leave consists of two main elements:

• Leave from work due to illness or injury.
• Cash benefits that replace lost income. It is defined as compensated days lost to sickness and is a key part of social security frameworks, such as ILO Convention 102, ensuring financial protection during health-related absences.

Organization and Financing

Paid sick leave is integrated into broader social health protection systems and can be funded through:

• Government taxes or public social expenditure.
• Employer and employee contributions via mandatory schemes like social insurance.
• Private insurance (often optional and affordable only for higher-income groups).
  In many countries, it is linked with other schemes like disability or unemployment benefits to ensure seamless transitions.

Benefits and Coverage

• Wage Replacement Rates: Vary widely, from 50% to 100% of wages, with about 51 nations replacing wages at 50-75%.
• Duration: Ranges from less than 7 days to over two years in some cases.
• Coverage: Includes salaried workers in formal employment; informal workers, self-employed, and some informal sectors are often excluded. Countries like 145 provide paid sick leave, but effective coverage depends on social protection schemes and national regulations.

Global Incidence and Patterns

Globally, paid sick leave incidence varies greatly:

• High incidence in countries like Slovakia and Sweden, possibly linked to their benefit designs.
• Influenced by factors like age (older workers often take more sick days), gender (women consistently have higher leave rates), income (lower-income groups have more days off), and economic conditions (recessions reduce incidence).
• Data shows patterns tied to labor market structures and working conditions, with significant variance across and within regions.

Expenditure and Affordability

Expenditure varies by country, with per capita costs in Europe ranging from 70 EUR (Portugal) to 940 EUR (Norway). It is generally affordable as part of social protection, constituting a small percentage of social spending but linked to health outcomes and economic productivity. High expenditure in some countries correlates with higher labor productivity, outweighing costs.

Policy Lessons and Recommendations

Paid sick leave should be embedded in national social protection floors to address health and economic inequalities. Policy should:

• Ensure affordable and universal access, particularly for vulnerable groups.
• Shift funding and regulations to reduce exploitation and include comprehensive protections.
• Prioritize during crises to stabilize economies, promote decent work, and balance social and economic issues, based on frameworks like the ILO/WHO Social Protection Floor initiative.