After nearly a decade of hoping state legislators would pass an earned paid sick time law, advocates in Massachusetts decided it was time to put the question to voters. Now, in November, voters will have the chance to help improve the lives of nearly 1 million workers who can’t earn one, single hour of sick leave and are often left to choose between caring for themselves or a loved one, paying the bills or losing a job.

“This is about fundamental fairness in the workplace,” said Elizabeth Toulan, a senior attorney at Greater Boston Legal Services and former coordinator of the Massachusetts Paid Leave Coalition. “There’s something that seems fundamentally unfair about looking at a worker and acting as if they don’t have these needs. This is so basic. It arises for all of us at some point.”

The ballot proposal, known as Question 4, would allow all workers to earn one hour of sick time for every 30 hours worked, up to 40 hours per year. Workers could use the earned leave to care for themselves or a family member, and employers would be prohibited from firing workers for using earned sick time. Question 4 would apply to companies with 11 or more employees, while workers at companies with 10 or fewer employees could earn up to 40 hours of unpaid sick time. Toulan and her colleagues working on the Yes On 4 campaign seem optimistic about their chances, noting that the issue is attracting an outpouring of support. Toulan tells me that more than 7,000 volunteers statewide collected about 365,000 signatures to get Question 4 on the ballot — and those are record-breaking numbers.

“This much I know — we’ve had vigorously strong support among likely voters in this election,” Toulan said. “It’s support that you hold onto even after opposition arguments have been advanced. This is something that people will actually leave their houses to vote for in a midterm election.”

The campaign to bring earned paid sick leave to Massachusetts workers began 10 years ago when the first version of an earned sick leave bill was filed in the state legislature. Since then, a bill has been filed during every legislative cycle, but to no avail. Then about two years, Toulan was discussing the issue with her client Deb Fastino, who’s the executive director of the state’s Coalition for Social Justice, and they decided it was pointless to file another legislative bill without an accompanying ballot strategy. To do that, earned sick leave advocates had to expand the breadth and depth of their coalition, eventually joining up with the minimum wage movement and forming Raise Up Massachusetts. The statewide coalition, which launched last year, has three main pillars: community-based groups, faith-based groups and unions. (The coalition celebrated an early victory in June, when Massachusetts Gov. Deval Patrick signed a bill raising the state’s minimum wage to $11 an hour by 2017 — that’s the highest state-based rate in the nation.)

Even though it’s mostly low-wage workers who struggle with a lack of paid sick leave, the story of workers having to choose between sick children and a paycheck seems to resonate across the demographic spectrum. Fastino said it’s the values message that really appeals to voters.

“People believe it’s a fundamental right, not a privilege, to be able to care for yourself or for someone in your family,” Fastino told me. “It’s that values piece that hard-working people shouldn’t have to choose between jobs they need and the people they love.”

Paid sick leave & public health

The research is on the side of earned sick leave as well, especially when it comes to containing health costs and curbing the spread of disease.

For example, a 2012 research brief from the Institute for Women’s Policy Research found that in Massachusetts alone, the “benefits to workers and their families as a result of improved ability to care for sick relatives and reduced flu contagion are estimated at $24 million annually.” Another research paper found that providing paid sick leave to Massachusetts workers who currently don’t have the benefit would prevent about 27,450 emergency department visits each year and reduce health care costs by about $23.4 million, as workers will be less likely to delay needed medical care.

Nationwide, the National Partnership for Women & Families reports that adults without paid sick leave are 1.5 times more likely than workers with paid sick leave to go to work with a contagious disease. Plus, paid sick leave means children have access to their most important caregivers — their parents. In a perspective in support of family leave policies published in the New England Journal of Medicine earlier this month, physicians Mark Schuster and Paul Chung write:

But it’s not only preventable hospitalizations and contagion that are at issue: when children are sick enough to require medical attention, we need parents to be with them. Outpatient facilities and hospitals depend on parents to supervise their children, transport them to and from appointments, fill out forms, monitor symptoms, communicate with clinicians, collect laboratory samples, administer therapies, and provide comfort during tests and procedures.When children become patients, parents become health care providers, and without them, the pediatric health care system would grind to a halt.

Earned sick leave is an issue of public health, said Rebekah Gewirtz, executive director of the Massachusetts Public Health Association, which is an organizational supporter of Yes On 4. Not only does earned sick leave limit the spread of disease, it also impacts the social and economic determinants that shape people’s health, Gewirtz noted.

“You have people who live in low-income communities and communities of color who suffer much higher rates of mortality and disease and work in jobs with no flexibility to care for themselves or their families,” she told me. “So the question is what are we doing about that? We need to alleviate that reality for families. We need public policies that lift people up and keep families healthy.”

Gewirtz said that public policies such as earned paid sick leave are critically important to protecting the public’s health and supporting families. She noted that historically, Massachusetts has been a leader on issues of social and economic justice — such as minimum wage and health reform — and it’s paying off. According to this year’s Kids Count Data Book, Massachusetts ranks No. 1 in the country for child well-being. And many of the child health indicators that contributed to that top ranking were the result of supportive public policies, Gewirtz said.

“We hear about workers who are fired (for taking sick leave) and it just doesn’t make sense,” she said. “It doesn’t make sense in the interest of public health and it doesn’t make sense in the interest of justice. …Ultimately, (earned sick leave) is something that is long overdue and will even further benefit the families of Massachusetts and hopefully serve as a model for the rest of the country.”

While Question 4 has a lot of public support, advocates predict the opposition will begin to get louder as the vote gets closer. They’ll likely make the usual claims — like earned sick leave will run employers out of business or that workers will abuse the system. But the evidence doesn’t support such arguments. For example, in Connecticut, which passed the first statewide earned paid sick leave law in 2011, researchers found that the law had “modest effects or none at all on the state’s businesses.” Also, few Connecticut employers reported any abuses of sick leave and many said the new policy improved workplace morale and reduced illness at work. In San Francisco, which was the first locality to pass a paid sick leave policy, researchers found no evidence that paid sick leave affected job growth and, in fact, only found positive benefits.

Toulan said that the Massachusetts coalition made a point to reach out to and work with business owners in drafting the ballot proposal, and so Question 4 does have support within the business community as well. Still, Massachusetts workers really do have the power. As Toulan said: “If everybody who doesn’t have sick time gets out to vote, we’ll win.”

“People should be able to have their work valued and their dignity respected,” Toulan told me. “There’s no legitimate explanation for not treating workers with dignity and not valuing what they bring to the job.”

Nationwide, 40 million workers have no access to paid sick leave, including more than four in 10 private-sector workers and more than 80 percent of low-wage workers.

To learn more about the Massachusetts effort, visit Yes On 4. For more on paid sick leave, visit the National Partnership for Women & Families. And for a lot more coverage of why paid sick leave is a public health priority, read some of the Pump Handle’s previous coverage.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.