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.

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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.