Population Health Research Brief Series

Paid sick leave is good for health, yet there is no federal paid sick leave mandate, and U.S. states are increasingly preempting their city and county governments from mandating employer paid sick leave. This brief describes how working-age (ages 25-64) mortality rates from several external causes of premature death (suicide, homicide, drug overdose, alcohol poisoning, and transport accidents) from 1999 to 2019 may have been lower if states had not preempted cities and counties from mandating paid sick leave. The authors find that working-age mortality rates could have been over 7.5% lower in 2019 in cities and counties that were constrained by preemption laws if they had been able to mandate a 40-hour annual paid sick leave. The consequences of preemption laws are profound. They stymie local government innovation, constrain opportunities to take time off from work for medical care without financial repercussions, elevate risks of death among working-age adults, and contribute to geographic disparities in mortality.