Monday, March 09, 2009

RealAge Doctors Argue Against Houle and Siegel's Plea to End Employment Discrimination Against Smokers; Cite Decrease in Smoking Prevalence as Benefit

In a column published on the web site, RealAge doctors Michael Roizen and Mehmet Oz take issue with my article published in Tobacco Control last month which argues against employment discrimination against smokers.

Roizen and Oz write: "We think some editors may have been smoking something, based on what's being written about tobacco in their publications. Recently, the journal Tobacco Control published an article criticizing some companies for refusing to hire smokers. The article argued that refusing to hire smokers could make their health even worse. How so? The authors -- Brian Houle of the University of Washington and Michael Siegel, M.D., of Boston University -- think smokers might be forced out of their jobs if they can't kick the habit, leaving them without health insurance." ...

"The fact is, reducing smoking makes North America not only healthier but also more job-competitive. ... smoking DOES harm other people at work. And it makes North America less job-competitive and lowers our standard of living. How? Our greatest cost disadvantage with Europe and Asia for jobs is medical costs. Ours are twice as high as Europe's and three times as high as Asia's. Why? Simple: We have twice as much chronic disease as Europe and three times as much as Asia. Blame tobacco, physical inactivity, poor food choices and stress. ... So the next time you feel bad for a smoker who can't find a job, do like the Cleveland Clinic does: Offer to help him or her quit. It will help all of us."

The Rest of the Story

While I agree with the authors of this column that efforts to reduce smoking are a priority and will save health care costs and have innumerable benefits for society, I do not believe that discriminating against smokers in employment is an appropriate way to accomplish that shared goal.

If Roizen and Oz are serious about their argument, then workplaces should also take steps to make American more job-competitive by refusing to hire fat people, individuals who do not get enough exercise, those who eat poor diets, and those who suffer from frequent stress. All are responsible for driving up health care costs because of their increased rates of illness and disease. The same reasoning that would argue for improving the public's health by refusing employment to smokers holds for each of these other population subgroups.

The fact that Roizen and Oz are not calling for similar interventions to reduce the prevalence of obesity, hypertension, cancer, stroke, and heart disease by providing incentives for people to be physically active, improve their diets, and reduce their levels of stress is telling. Why single out smokers?

The answer is simple: discrimination against obese or overweight people, or those who don't exercise or eat well doesn't fly. Discrimination against smokers does.

Also, there tends to be a fair amount of hatred towards smokers, disapproval of their lifestyle choices, and a desire to punish them for their decisions. The same hatred and intolerance has not (yet) reached these other groups. But discriminating against smokers opens the door to discrimination against these other groups as well. The same argument that supports not hiring smokers also supports not hiring overweight people or those who make poor food choices.

The logical extension of Roizen and Oz' argument is a job application which screens out prospective employees with a host of unhealthy behaviors that put them at risk of chronic disease, and therefore of making America less competitive. Questions on tobacco use would certainly be a part of this screening questionnaire, but so would questions regarding food choices, fast food intake, salt intake, weight, body mass index, body fat content, and physical activity.

The other major flaw in Roizen and Oz' argument is that because of the addictive nature of cigarette smoking, many smokers will not quit and will suffer unemployment because of these policies. How does it help them and their families to severely reduce their family income? How does it help the children of these unemployed workers, who may suffer reduction in the nutritional content of their diets due to the inability of their parent to find a job? The decision to smoke is not simply a choice. It is an addiction and cannot be stopped easily by many individuals. In fact, for most people, controlling one's diet and level of physical exercise is a lot easier than quitting smoking.

I'm not compelled by the counter-arguments provided in this column. Instead, I'm struck by the inconsistency of the application of the authors' arguments and by the degree to which smokers are being singled out for intolerance and punishment of a decision which we in tobacco control have long argued is largely out of their control.

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