Calling in sick is all too often a luxury families cannot afford. Monica Bryant faced that dilemma after spending all night in the emergency room with her young son, and then reporting to work for her 7:00 a.m. shift at a Seattle, Washington, Safeway store. She was far too tired and worried about her son’s recent seizure to focus on her job in the meat department where she works with sharp slicers. But the rent was due and she knew she could not pay if she didn’t report to work.

Millions of other families face that same no-win situation every day. Income insecurity directly affects their health, the health of their families and that of others with whom they come in contact. In fact, studies show that lower paid, hourly wage earning families suffer greater health risks due to workplace hazards, stress, lack of access to healthy food and more severe cases of contagious diseases like colds and the flu.

Yet, approximately half the workers in America do not have paid time off for illness or medical treatment. Lower paid workers are far less likely to have paid sick leave than their higher paid counterparts. So they come to work, because they cannot afford not to. And they send their children to school sick – more than twice as often as those who have paid sick leave – because they cannot leave them home alone and like, Monica, they cannot take a day off to care for them without risking longer term financial stress.

You don’t have to be a medical expert to know that keeping kids home from school when they are sick makes it easier for them to recover – and lessens the chance that they will infect other children at school. On the flip side, whole communities suffer when germs are constantly passed around schools, resulting in poor attendance and ultimately, poor educational outcomes. In fact, paid sick leave policies can significantly reduce the havoc the flu and other contagious diseases can wreak on any community.

The same holds true for workplaces. Low-wage workers are at greater risk of being infected by their co-workers – unintentionally – as they all share the risk of coming to work with infectious illnesses. The severity of those illnesses may also be higher because low-wage workers cannot take time off to rest.

Flu is just one example of how lack of paid sick leave can have severe health consequences. One study looked at more than 30,000 working adults and found that those without paid sick leave were three times more likely to delay medical care or skip it altogether, making it more difficult to effectively control chronic conditions such as diabetes.

Those without paid sick leave are also more likely to skip preventative care such as mammograms and other cancer screenings that might allow for conditions to be detected in less advanced stages and therefore improve medical outcomes. A mother’s inability to take time off after the birth of an infant is likely a contributor to lower rates of breastfeeding among African American women, according to one study, which may in turn be why black infants had more than twice the deaths of whites attributable to lack of optimal breastfeeding. Compared with white infants, ear infections due to suboptimal breastfeeding were 1.7 times more common in black infants and 1.4 times as common in Hispanics; gastrointestinal infections due to suboptimal breastfeeding were about 1.3-to-1.4 times as common among both black and Hispanic infants, the study found.

Paid sick leave is not, of course, the only reason for disparate health outcomes among lower-income people and people of color. Many lack health insurance and could not afford to pay for care even if they could afford to take time off for a doctor’s appointment. Living in conditions that are not conducive to good health – communities where it is impossible to get affordable, healthy food or housing that exacerbates illnesses like allergies also increase the likelihood of poor health. Together, all these economic factors – factors that are the direct result of policy decisions made by state and federal governments. When lawmakers refuse to mandate a living wage, or invest in safe, decent affordable housing, or require a humane paid sick leave policy, they are laying the groundwork for economic hardships that directly affects the health of Americans like Monica and her son.