According to an article in last week's Editor & Publisher, Gannett Company - a media conglomerate consisting of newspapers, television stations, and other media outlets - is instituting a new policy in January for its 40,000 U.S. employees which will require any of its employees who smoke or use smokeless tobacco products to either attend a stop smoking program or to pay a $600 surcharge for their health insurance coverage.
According to the article: "During the insurance enrollment period, employees will be asked if they use tobacco products even occasionally. Those who say they smoke or chew tobacco will be given the choice of enrolling in a stop-smoking program at the company's expense, or paying the surcharge."
According to a company spokesperson: "This is part of a health and wellness initiative the company started a few years ago." The policy reportedly applies to all smokers and smokeless tobacco users, even if they use the products only occasionally.
This policy appears to be part of an increasing trend of employer policies related to off-the-job smoking. These policies range from health insurance surcharges to refusal to hire smokers, and in the case of Okemos, Michigan-based Weyco, Inc., even to firing existing employees who smoke.
The Rest of the Story
Interestingly, although I have been dedicated to tobacco control for more than 21 years, I oppose the Gannett policy and do not believe it to be justified.
First, let me discuss why I oppose the policy as it is and with the reasons given for its institution.
For one thing, the policy is clearly not crafted in order to address the problem of Gannett's health care costs and the desire to recover health care expenditures related to smoking. If it were, then one would expect that the company would simply issue a surcharge for smoking employees.
But that's not the policy. The policy is that smoking employees must either pay a surcharge or attend a smoking cessation program. Not successfully attend a smoking cessation program - just attend such a program.
That's troubling to me, because it suggests that the primary purpose of the policy is not to recover increased health care expenses paid by the company for medical care for smokers, but instead, to punish smokers who don't seem to want to quit smoking. If you smoke and you aren't motivated enough to quit to join a smoking cessation program, then you are punished by having to pay $600 per year. If you join that smoking cessation program but aren't able to quit, then you don't have to pay anything, even though your health care costs will be no lower than the smokers who failed to attend the program.
If the purpose were to simply recover increased health care costs from smokers, then it shouldn't matter whether someone attends a stop smoking class or not. The only thing that matters is whether they smoke or not. Attending stop smoking classes does not, in and of itself, lower health care costs.
In addition, if the primary purpose of the policy was to offset increased health care costs for smokers, then it seems illogical to institute the financial penalty for anyone who smokes, regardless of how little they smoke. The Gannett policy appears to treat someone who smokes 2 packs per day the same way as someone who lights up a cigarette or two every two weeks. That hardly seems fair. Nor does it make any sense if the purpose is to offset the increased risk of expensive health care for smokers.
If there is any doubt about my inference that the policy is one to punish smokers rather than recover health costs, the company has removed it by explicitly stating that the policy is a health and wellness initiative, rather than based on a purely financial or actuarial consideration.
Now before some anti-smoking advocates become outraged, I am not against employee programs to encourage smoking cessation. However, in public health we generally try to provide positive incentives to encourage people to change their behavior. The idea of punishing people for not taking the actions we desire of them is quite distasteful to me, and I don't believe that it belongs in the public health repertoire.
(Note that at least one major company - Dow Chemical - offers financial incentives in the form of salary bonuses to encourage changes in health behaviors of its employees.)
So while a health insurance surcharge based on a purely financial or actuarial concern may be somewhat reasonable, a financial punishment for smokers (disguised as a health insurance surcharge) is not.
The punishment approach to public health is also unjustified, I would add, based on the addictive nature of cigarette smoking. If smoking is truly as addictive as anti-smoking advocates have been claiming (and the addictive nature of smoking is one of the principal tenets of the DOJ lawsuit against the tobacco companies), then you simply can't start to punish people for failing to be able to (or to want to) quit smoking.
Now I will comment on the policy of instituting increased health insurance payments for employees who smoke.
While this policy, if based solely on financial (actuarial) concerns, seems somewhat reasonable, I am still opposed to the idea. And here's why:
First, and most importantly, I think this type of policy puts us on a slippery slope that we just don't want to go down. After all, if smokers should be required to pay a health surcharge, then certainly those who are overweight should also pay a surcharge, since obesity is responsible for a higher level of increased health care expenses.
And employees with higher fat intake and lower intake of fiber, vegetables, and other sources of anti-oxidants should also be required to pay a health surcharge, since these nutritional factors play a substantial role in the incidence of chronic disease.
Alcohol is a well-recognized risk factor for certain gastrointestinal cancers as well as for liver disease, so employees should certainly be questioned about their alcohol intake, with surcharges applying for excessive alcohol consumption.
Workers with lower levels of physical activity should also have to pay a significant surcharge, since physical activity is well-recognized as being a substantial factor in determining the risk of heart disease and in overall health status.
For younger employees, unsafe sexual practices should certainly be charged extra. The risk for a variety of diseases, including very costly ones such as HIV/AIDS, is obviously related directly to these health behaviors.
Moreover, there is a relatively linear dose-response relationship between smoking and lung cancer, so a graded system of health surcharges should be implemented such that the surcharge increases with the level of smoking. If you are trying to recover increased health care costs, then there is simply no justification for forcing someone who smokes only two or three cigarettes per day to pay as much as someone who smokes two to three packs of cigarettes per day.
A second reason why I oppose the idea of health surcharges for employees who smoke is that I think it truly undermines the entire public health movement and its emphasis on the addictive nature of smoking, as well as undermines the recognition, among public health practitioners, of the extreme difficult of people changing certain health behaviors.
As I mentioned above, if smoking is truly as addictive as anti-smoking advocates have been claiming, then you just can't start punishing smokers for being addicted to tobacco products. And if the role of the tobacco industry in recruiting smokers is also as strong as anti-smoking advocates have been saying, then who are we to start casting blame on smokers by punishing them financially for an action that we are arguing, in the courtroom, is not entirely under their control?
I therefore think that the policy of charging smoking employees for their smoking completely undermines what many public health advocates have been working for in terms of trying to address the tobacco industry's role in the smoking problem. These types of policies simply help reinforce the notion that smokers are to blame and they help take the focus off of corporate responsibility, enhancing the "blame the victim" approach that I think is contrary to our public health objectives.
Third, I think that these policies represent an unwanted invasion of privacy of employees. I think that employers have a legitimate interest in the lawful, off-the-job, personal behavior of their employees with respect to only two things: (1) job performance; and (2) consistency with the mission of the company.
Outside of that, I think that employers do have a legitimate interest in trying to help employees improve their health by, among other things, encouraging them to change unhealthy behaviors, but I think such efforts should remain separate from any official employment-related aspects of the job, such as hiring and firing policies, salary, etc. (with the exception of financial incentives, which I think are acceptable to encourage health behaviors).
Health and wellness promotion programs are an important aspect of employment that employers should offer, but they should remain separate from other aspects of the employer-employee relationship. I don't mind being told that I should be concerned about my health behaviors and offered help, but it should in no way be a condition of my employment nor a factor in determining my salary (which is effectively reduced if a health surcharge is imposed).
While promotion of health and wellness in the workplace is invaluable, I don't think we need to invade employees' privacy in order to accomplish it.