Wednesday, July 06, 2005

Montgomery County Considering Hiring Only Nonsmokers

According to an article in yesterday's Bucks County Courier Times, Montgomery County (Pennsylvania) is considering hiring only nonsmokers in an effort to reduce its health care costs for its employees. The chair of the County Commission, who proposed the idea, stated that the county could save an estimated $25 to $50 million over the next 25 years on health insurance expenses.

The Rest of the Story

While I could understand a policy of not hiring smokers if the smoking was directly related to job performance or to the mission of the employer, neither is the case here. The proposed policy is simply designed to save money on health care costs. I find this extremely problematic and troubling.

Policies such as this one threaten to create a second class of citizens - smokers - who have highly limited access to employment opportunities. Is this really what we want to be doing? Smokers already tend to enjoy lower levels of income and if these policies were widely implemented, their incomes and opportunities would sink lower and eventually they would become second class citizens.

Not only is this policy in conflict with the most basic goal of public health - social justice - but it also represents a very dangerous slippery slope. After all, there are a number of other effective ways Montgomery County could save money from health care expenses:
  • it could refuse to hire obese persons, who we know have far greater morbidity and therefore require much higher health care expenditures;
  • it could refuse to hire people whose cholesterol levels are greater than 200, which is a well-documented risk factor for heart disease, the nation's leading cause of morbidity;
  • it could refuse to hire people who eat more than 6 grams of salt a day; this is a major cause of high blood pressure and is associated with heart disease and strokes.
Just as making employment decisions based on body mass index, cholesterol levels, or diet is not justifiable, neither is making non-performance related hiring decisions based on smoking behavior. It represents an unreasonable intrusion into privacy, an intrusion so severe that no public health or economic concern can or should override it.

Tobacco control practitioners should be particularly alarmed at this emerging trend, because I view it as being in direct conflict with the principles of the public health practice of tobacco control. Smokers should be viewed as the primary population that we are trying to serve, not as the villains who need to be relegated to second class status so that the rest of society can enjoy economic benefits.


Mrs. Non-Gorilla said...

interesting. although i've been surrounded by public health practitioners my whole life (and am one myself), i have never considered social justice to be the most basic goal of public health. rather, i see it more as a consequence of a country's enlightened self-interest, keeping the privileged healthy by affording a certain baseline level of health to the underprivileged. social justice is a lofty ideal, but it doesn't build infrastructure -- the threat of a cholera outbreak does (see the case of peru).

what i find especially interesting, though, is that you do not offer any alternatives to the county commission's proposal, while expending quite a bit of bandwidth criticizing and ridiculing it. what is the core problem here? it isn't that the county has anything against smokers, it's that the health insurers charge higher premiums to cover those who smoke. this violates the most basic purpose of insurance: pooled risk. by carving the population up by disease risk factors, health insurers are stacking the cards in their favor. perhaps that is what should be criticized, and not the fact that a county is looking for ways to stretch its budget dollars.

Michael Siegel said...

Thanks for your thoughtful comment. You make a great point about the insurance industry, and I share the feeling that it is to blame in large part for the ridiculous health care costs that employers face. I don't know that I have any solutions for Montgomery County's problems, but the alternative to not hiring smokers that I see is hiring smokers. In other words, I don't see that an invasion of privacy is justified just because the County has no other way to address its fiscal problems. But I agree that an important underlying problem is how to address the insurance industry and the escalating health care costs in the first place.

grandma blue said...

Right on.

Bill Godshall said...

Freely negotiated contracts between employers and employees are far more desirable than unwarranted laws that unfairly restrict the ability to freely negotiate employment contracts.

Just as employers aren't forced to hire on continue to employ cocaine or heroin addicts (who refuse to quit their addiction), employers shouldn't be forced to hire cigarette addicts (who refuse to quit their addiction).

Forcing employers to subsidize the many different costs imposed by employee cigarette smoking is a terrible public health and social justice policy, as it elevates cigarette smoking to a civil right and discourages smokers from quitting.

Ron Davis said...

A summary of reasons why some employers have policies not to hire smokers appears in a comment I wrote at:

The essence of my argument is that the public health community shouldn't condone or condemn hiring policies that favor nonsmokers. But we should vigorously oppose laws that would prohibit discrimination based on smoking status, for reasons explained at the URL cited above.

Anonymous said...

Maybe Bill may see a few parallels in this hypothetical.

A condom manufacturer funds a national right to life group at the encouragement of the white house, and persuades them into taking a slightly different approach.

Instead of pushing for the criminalization of abortions, they are persuaded to use the tax the behavior approach.

Instead of taxing the patient, the abortionist is taxed instead. A portion of the taxes collected go to promote safe sex practices, all in the name of good public heath mind you. With the coffers filling, money abounds, and study after study are funded attempting to show the links between cervical, and breast cancers with abortions. Other studies show that unsafe sexual behavior leads to higher health care costs, and turmoil in the work place.

Other funds then are earmarked to educate employers and they are encouraged them to screen applicants for prior abortions, and employment contracts are freely negotiated with employer and employee aimed at weeding out those that failed to maintain safe sexual practices and promiscuous behavior.

Pro-lifers successfully fight all attempts to establish a legally protected status for abortion recipients. After all forcing employers to subsidize the many different costs imposed by the sexually indiscriminate is a terrible public health and social justice policy, as it elevates promiscuous sexual activity to a civil right and fails to discourage unsafe sexual practice.

Condom use rises, STD's decline, as well as the number of abortions which more than doubled the number of smoking related fatalities for many years. Seeing the opportunity to promote good health, and J&J products, the RWJF is quick to jump on the band wagon, with it's lobby experience push to establish a national registry for those that have had an abortion. The RWJF is also quick to resurrect an enemies list to assail the character of those who had spoken in the name of Pro Choice, as they all must be associated with the pornography industry somehow.

We are one step closer to a healthier nation, and everybody is happy, this is Bill's world, and welcome to it.

Nah, he'll never see it, maybe we should just stick to big mac's for the time being. Besides, the above example didn't include any lawyers. Speaking of which, how's Banzaff and his big mac attack going?

Seymour Bloom said...

I agree that it is unethical to have a policy of not hiring smokers, obese persons and others with health problems. But it is not clear that it is wrong to charge them more to participate in a health plan offered by the employer. In fact, such a policy would be of benefit to people with current or potential health problems. Employers would not be reluctant to hire them because of the financial costs of their current or possibly future medical condition.