HR Leader logo
Stay connected.   Subscribe  to our newsletter

Too many Australians are working while sick or injured

By Nick Wilson | |7 minute read

Paid sick leave, for most Australians, is so ubiquitous that it’s largely taken as a given. For the 4 million workers in insecure employment, however, it’s a pipe dream.

In 1922, paid sick leave was first implemented in an Australian industrial award. In the years following, these stipulations became more and more common in employment contracts and now, a century later, they’re ubiquitous.

It comes as some surprise then that as recently as 2023, over half of Australia’s insecure workers – comprising fixed-term and independent contractors, casuals, and gig platform workers – reported having worked while ill or injured because they couldn’t access paid leave. The disturbing trend was unearthed in the Australian Council of Trade Union’s (ACTU) recent Work Shouldn’t Hurt report.


“No one should have to go to work when injured or ill simply because their job lacks the most basic of protections,” said ACTU assistant secretary Liam O’Brien.

Falling through the gaps

In 2023, eighteen per cent of injured workers in secure jobs said they were unable to take time off due to limited paid leave entitlements. Among insecure workers, half were forced to work while injured or unwell – this is referred to as “presenteeism”. The problem is concerning, but the solution is simple: insecure workers need better access to paid leave.

Insecure workers have “little or no paid leave entitlements, [they receive] less pay for the same work as permanent employees, [and have] a lack of guaranteed continuity in their employment”, said Clare O’Brien of Australian Unions.

As many as one-third, or 4.1 million Australians, are employed on an insecure basis. It’s not just younger, inexperienced workers who take insecure work – it’s a major staple of our national workforce. Women are disproportionately likely to be employed as casual workers, while women from non-English speaking backgrounds are even more likely to take insecure work.

In some cases, full-time work is either unfeasible or undesirable. So much so that the federal government’s proposed industrial reforms designed to give casual workers easier access to permanent work have been criticised for presupposing that casual workers are only working on that basis for lack of full-time opportunities.

This is not the reality for those who see contract or casual work as optimal – it tends to attract a higher hourly rate through casual loading and allows for a more adaptable workload, among other benefits. However, many would take permanent work if it was available (some estimate that this camp comprises half a million workers in the country), and, regardless, this is no justification for restricting access to paid leave for insecure workers.

“Under the current law, if you’re a casual or gig worker and are injured or ill, you’re forced to make the difficult decision of either taking time off with zero pay or going to work and likely worsening your condition,” said Mr O’Brien.

Working under the weather

Presenteeism serves no one. Employees are compelled to work while unwell – often exacerbating existing symptoms and delaying our recovery.

Many workers report an ability to “delay” getting sick. There’s a belief that sickness can be held off through willpower and sustained hard work. According to Dr Luke Powles, clinical director at Bupa Health Clinics, this is a misconception. When we work through an illness, it might feel as though we are overcoming it, but in reality, we are just focusing on other things.

“The idea is the more distractions we have, the less we notice our symptoms or feel ill. The free time that comes with a break may lead you to notice that you’re not feeling your best,” said Dr Powles.

By using stress as a fuel, we’re pressuring our bodies to produce hormones like adrenaline and cortisol, which, after the frenetic burst of work is over, can leave us more vulnerable to immune system problems and mental health challenges, he explained.

Weeding out presenteeism is also in the best interests of employers as the productivity costs can be significant (not to mention the moral, reputational, cultural, and even legal cases to be made against overworking employees).

According to estimates by the Harvard Business Review, presenteeism costs upwards of $150 billion per year in lost productivity. Calculations differ, but the consensus is that presenteeism costs significantly more than absenteeism, with some claiming the costs of the former are 10 times greater than the latter.

It’s not difficult to imagine how presenteeism can compound the costs of absenteeism by delaying an employee’s recovers from illness or injury. Worse, presenteeism is far more difficult to identify than absenteeism, meaning it can often go under the radar and, like the illness or injury itself, fester and degenerate into a deeper issue.

“You know when someone doesn’t show up for work, but you often can’t tell when – or how much – illness or a medical condition hinders someone’s performance,” said the Harvard Business Review.

Presenteeism is not immediately obvious, but neither is it invisible. To manage presenteeism, Forbes recommends doing the following:

  1. Train managers to be aware.
  2. Provide generous benefits.
  3. Help employees manage workload.
  4. Lead by example.
  5. Focus on results, not inputs.

“[Presenteeism] takes a massive toll on your physical and mental health. Living with the uncertainty of not knowing where your next pay cheque is coming from can be crippling,” said Ms O’Brien.

“If you’re feeling sick, you’re left with the burden of deciding whether to soldier on or forfeit the income you need to survive. This is unacceptable.”



Benefits include any additional incentives that encourage working a little bit more to obtain outcomes, foster a feeling of teamwork, or increase satisfaction at work. Small incentives may have a big impact on motivation. The advantages build on financial rewards to promote your business as a desirable employer.

Nick Wilson

Nick Wilson

Nick Wilson is a journalist with HR Leader. With a background in environmental law and communications consultancy, Nick has a passion for language and fact-driven storytelling.