More individuals may undergo cancer screenings when employers are mandated to provide paid sick leave, according to a new study published by Callison et al in The New England Journal of Medicine. Researchers found that breast cancer screening rates increased up to 4% and colorectal cancer screenings increased between 6% and 8% during a 7-year period in areas included in policy-driven paid sick leave mandates.
Background
For most individuals in the United States, the two major obstacles to proper medical care are time and money. While insurance can sometimes reduce health-care costs, having time to visit a physician is just as important.
“These nonmonetary barriers to health-care access matter,” emphasized lead study author Kevin Callison, PhD, Assistant Professor of Health Policy and Management at the School of Public Health and Tropical Medicine and Professor of Economics at the Murphy Institute for Political Economy at Tulane University. “Improving or reducing these barriers can have meaningful impacts on people’s health,” he added.
According to the Center for Economic Policy and Research, the United States remains the only wealthy nation in the world without federally mandated paid sick leave; about one in four workers are unable to take a single paid sick day.
Study Methods and Results
In the new study, researchers examined changes in breast cancer and colorectal cancer screening rates among 2 million private sector employees from 2012 to 2019—a time in which several states and cities adopted policies mandating paid sick leave. The workers were spread among 300 metropolitan statistical areas, 61 of which were included in a paid sick leave mandate during that time frame.
The researchers noted that although the increases in screening rates seem small, the results of the study included workers who already had paid sick leave and were unlikely to decrease or increase their cancer screening habits. When the results were scaled to focus only on workers gaining sick leave for the first time via mandates, they estimated that breast cancer screening rates increased by 9% to 12% and colorectal screening rates increased by 21% to 29%.
“Our effects become much larger if we're willing to assume that only the workers who are gaining paid sick leave coverage are the ones who are changing their screening behaviors,” stressed Dr. Callison.
Past studies have examined the relationship between sick days and cancer screening habits by comparing rates among those with paid sick leave to those without it. However, some workers may be more health-conscious than others and may exclusively seek jobs that offer paid sick leave. By focusing on the change in screening rates brought by policy-driven mandates, this study removed some of the potential behavior-based biases.
“Because we focused on these policies that drive changes in coverage rather than people self-selecting into coverage, our argument is that we have a more accurate estimate of the relationship between paid sick leave and cancer screenings,” Dr. Callison explained.
Conclusions
The new findings underscore the value of paid sick days and may represent one potential way of increasing health-care equity in the United States. “[It’s] reasonable to assume that more cancer screenings lead to earlier detection and better outcomes,” Dr. Callison suggested, stating that more research would be needed to determine if paid sick leave directly correlated with earlier cancer detection and a decline in mortality rates.
The majority of those without paid sick leave are individuals of color, those with less wealth, and those with less education. Although 17 states and 18 cities have adopted paid sick leave, 18 states have passed laws prohibiting cities from passing similar mandates.
“We know that racial and ethnic minorities tend to have higher mortality rates for certain cancers. So are things like this going to improve those gaps? That’s really the next step where we want to go,” Dr. Callison concluded.
Disclosure: For full disclosures of the study authors, visit nejm.org.
