The article reviews recent literature on the relationship between sickness absence and the conditions of the economy (i.e., recession or expansion). Two notions, notably the "employer selection" and the "worker disciplinary effect", can be useful in speculating on the relationship. The general idea is that recessions are linked with higher unemployment, which is in turn linked with heightened employment insecurity among the workforce. Such feelings of insecurity would then make employees reluctant to declare sickness absence for fear of losing their jobs. Indeed, this is what available empirical evidence generally suggests. However, it appears that there are a number of ramifications that make the relationship more complex. For example, it appears that the anxiety and stress caused by recessions per se harms physical and psychological health, hence, making it more likely for people to fall genuinely ill in the first place. This then leads to the grim "paradox" that at times of recession workers are more likely to be genuinely sick but simultaneously less likely to declare illness. This in essence means that at periods of recession many more people attend work when they are not in proper physical or psychological condition, which results in lower performance and heightened probability of accidents.