COVID-19 & Public Health: Fairness in Economic Structures

Michael Crawford outlines how the COVID-19 epidemic reveals why fair, universal, and prorated access to paid sick leave and other benefits are necessary to address health and productivity challenges experienced by the precariously employed.


Globally, commentary on the pandemic has been raising alarms concerning growing economic disparities and disproportionate health effects upon vulnerable communities, particularly among the aged. Canadian policy-makers have tended to focus economic interventions upon mitigation of job loss, business losses, the uneven distribution of economic injury, and the ways in which childcare burdens have damaged the security and advancement of women. Curiously, and with only a few exceptions, there has been little discussion about how economic structures affect public health efficacy.

Generally, discussions during the pandemic about the intersection of economics and health policy have focused upon the historical deterioration of public health spending and structures, and upon access to vaccination and healthcare. Some exceptions revolve around consideration of incentives to supplement pay for higher risk essential workers, and the provision of paid sick leave. The latter is critical. Low wage earners cannot afford to lose salary in order to safely isolate. They face a perplexing dilemma: either work and risk contracting and spreading COVID-19 or stay at home, face daunting bills, and risk losing their job.

Photo Credit: Image

Photo Credit: pixabay. Image Description: A stethoscope, two bundles of US dollar, some pills, and a not that reads “Paid Sick Leave”.

The lowest and most vulnerable socioeconomic strata play a key role in servicing health and elder care settings (especially in privatized settings). So economic realities are important to consider. Often, for-profit care settings use casual part-time labour. Casual part time labour is cheap because it permits employers to avoid paying benefits like sick leave. In the context of a pandemic, frontline workers (including, for example, those working at grocery stores, providing elder- or childcare, working in factories or warehouses) are left with only unpalatable options. They are denied agency, freedom and security of the person, and solidarity: they are prevented from making decisions that are best for themselves, they risk their health and finances, and they understand that they are bearing an unfair burden relative to permanent workers (who have benefits), or their employers. Moreover, if they hold multiple part time jobs in order to make ends meet, they are disproportionately exposed, are much more likely to suffer infection, and they are more likely to act as vectors of COVID-19 into their communities, workplaces, and homes.

A blatant example of economic structures failing health delivery can be found in the excruciating performance of Canadian elder and long-term care facilities. Waves of premature deaths swept these facilities, exacerbated by the fact that some part time workers, in order to eke out a living, occupied several jobs at multiple facilities. Some unknowingly carried infection from one facility to another, to their communities, and home. In addition, when they fell ill themselves, or decided that minimum wage was not worth the risk, their absence from work left a vacuum not easily filled. Finally, personal protective gear, standards of care, and training were deficient at multiple institutions, and especially at those that operated on a contractual basis for profit (Ontario, B.C., Quebec). Facilities that shared employees were a concern in Quebec. In B.C. and Ontario, casual laborers were eventually prohibited from working at more than one facility. In some jurisdictions, the risk was acknowledged and compensation was raised accordingly. 

When B.C. restricted inter-facility mobility, workers tended to preferentially work for facilities run by the Health Authority rather than for the for-profit contractors. The pay and benefits were better, and for-profit facilities were left challenged to re-fill positions, and this is a pattern seen system-wide.

Consider the larger context – care facilities are canaries in the coal mine. They reflect problems that are also common throughout factories and warehouses that employ part time labor. Toronto’s Medical Officer of Health recently stated that only 42% of Canadians have access to paid sick leave, but that among the low-wage workers deemed essential during the pandemic, only 10% enjoyed the benefit.

Two themes figure prominently in the dilemma faced by part time workers even in the best of times: the precarity of their employment, and the lack of benefits. Recent federal-provincial jockeying has seen Ontario grudgingly propose a temporary three days’ sick leave program for unfunded workers, although the program has been denounced as inadequate by Opposition members. But why should governments have an obligation to provide paid sick leave for workers when employers use casual labour to maximize profit by denying benefits? There is a simple solution: pass legislation that requires employers to fund benefits for part-time staff on a pro-rated basis. This would create a disincentive to profit from exploitive hiring practices and require fair pay and benefits (including sick leave) for the lowest-paid members of the workforce. The advantages that might accrue include:

  1. disincentivizing part-time in favour of full-time positions;
  2. alleviating some of the psychological and financial stress attending precarious employment;
  3. reducing staff turn-over thereby improving continuity and training;
  4. allowing sick employees to protect themselves, their co-workers, their families, and not incidentally, the continuity of the businesses that employ them.

Ultimately, fair, universal, and prorated access to paid sick leave and other benefits are necessary to address health, economic, and productivity challenges experienced by the precariously employed.


Michael Crawford is a Professor of Biomedical Sciences at the University of Windsor.

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