Yesterday, I criticized Action on Smoking and Health (ASH) for its public declaration in support of policies by which employers fire all their smoking employees in order to save health care costs. Here, I will consider a more basic question:
Why is it that an anti-smoking group should even be interested in the issue of the health care costs borne by employers in the first place?
The mission of anti-smoking organizations, I would think, is to try to decrease the morbidity and mortality caused by smoking. I don't see their mission as trying to find ways for employers to save money on their health care bills. Of what interest is it, then, for a group like ASH to issue a press release encouraging employers to fire smokers as a possible solution to their financial woes?
The only legitimate interest that I can see would be if this action is viewed by ASH as an appropriate public health intervention -- not a financial, economic, or actuarial intervention, but a public health intervention.
And the only way that firing smokers could possibly be viewed as a public health intervention would be if the purpose of the intervention was to reduce smoking rates. After all, that is arguably the only potential health benefit of firing smokers.
So what this basically comes down to is an anti-smoking organization promoting firing smokers as an intervention to improve the public's health. By forcing smokers out of jobs and making it much more difficult for smokers to obtain jobs, these anti-smoking groups apparently believe they will convince many smokers to quit smoking and therefore to benefit from these discriminatory and invasive policies.
The Rest of the Story
As a public health practitioner, all I can say about this type of public health intervention is that I find it hateful.
Yes - it is full of hatred.
And I don't think hatred should have any place in our tobacco control movement.
There is not another health behavior in the world that I can think of for which we as public health practitioners intervene by firing people who engage in a legal, off-the-job, harmful activity because they will benefit from the incentivization to alter their behavior.
Would we ever see ASH, or any other public health group, stating that firing fat people is "an appropriate and very effective way to stop burdening the great majority of employees who wisely chose to control their weight with the enormous unnecessary costs of obesity on the part of their fellow employees?"
Would we ever see ASH, or any other public health group, stating that firing people who consume excessive amounts of fat is "an appropriate and very effective way to stop burdening the great majority of employees who wisely chose to control their fat intake with the enormous unnecessary costs of atherosclerotic disease on the part of their fellow employees?"
Would we ever see ASH, or any other public health group, stating that firing diabetics who do not adequately control their blood sugar fat people is "an appropriate and very effective way to stop burdening the great majority of employees who wisely chose to control their blood sugar with the enormous unnecessary costs of uncontrolled diabetes on the part of their fellow employees?"
And would we even ever see ASH, or any other public health group, stating that firing people who engage in unsafe sex is "an appropriate and very effective way to stop burdening the great majority of employees who wisely chose to engage in safe sex with the enormous unnecessary costs of AIDS on the part of their fellow employees?"
We don't and we won't, because in public health, we simply don't view this type of intervention as being an appropriate one.
Unless, of course, you are an anti-smoking organization talking about smoking. I can tell you that in my years in medicine and public health practice, I have never heard a single group or practitioner even consider the potential intervention of firing people as a method of changing their health behavior. The only time I have heard of such a proposed intervention is with regard to smokers, and the only practitioners who I have heard support such an intervention are anti-smoking groups and advocates.
And to be truly honest, the reason why I think this intervention even comes to mind among anti-smoking groups is that there is a lot of hatred for smokers here in tobacco control. I simply don't see any other explanation for this peculiar phenomenon of public health practitioners supporting a policy for which there is no other precedent in public health and which blatantly flies against everything that we stand for in public health.
It would take a lot to overcome the overwhelming accumulated experience and wisdom of public health practice to actually promote or support such policies, and the only thing I can think of that would enable groups to overcome this huge barrier would be some rather serious hatred of smokers and a feeling that they need to punished for their "unwise" personal choices.
So when I see ASH taking the initiative to issue a press release and to go to the extent of obviously trying to influence major media coverage of the topic of employers who fire smokers, I do not for one minute buy the argument that ASH is simply pointing out that firing smokers would indeed result in a health care savings. No - what ASH is clearly doing is encouraging these policies, and as a public health group, they are going to great lengths to do this since saving money for companies is not part of their legitimate primary interests as an organization.
No - there is no room for hate in the tobacco control movement. And I'm not going to sit silently and watch it dictate our actions so long as I'm a part of this movement.