Anti-Smoking Interventions May Have Set the Stage for Discriminatory Employment Policies

In a post this weekend, I suggested that we as tobacco control practitioners have an obligation to speak out against employment policies that discriminate against smokers because although tobacco control groups are not necessarily supporting these policies, the social climate that we have fostered which tends to stigmatize smokers may be contributing to the advancement of these policies:

"Although tobacco control groups are not necessarily promoting these policies, I think it is encumbent upon us, as tobacco control professionals, to speak out unequivocally against these policies. It is, I think, the social climate of stigmatization of smokers that anti-smoking groups have helped to create that is contributing, at least in part, to the enactment of these policies, and therefore I think we have an obligation to condemn them in no uncertain terms."

However, I may have been too generous in suggesting that the advancement of these discriminatory policies is merely an unintended consequence of anti-smoking campaigns. In contrast, these policies are specifically considered as a strategy for reducing smoking in documents produced by tobacco control organizations.

For example, the National Cancer Institute's (NCI) ASSIST manual (Strategies to Control Tobacco Use In the United States: A Blueprint for Public Health Action in the 1990's) specifically suggests preferential hiring of nonsmokers as a viable policy option to decrease cigarette consumption:

"Economic incentives serve to reduce consumption of tobacco products by increasing, either directly or indirectly, the costs of using these products. In this section, three economic incentive policies are examined: (1) higher excise taxes on cigarettes, (2) preferential hiring and promotion of nonsmokers, and (3) insurance premium differentials for smokers and nonsmokers." ...

"A range of worksite policies and programs may potentially influence smoking behaviors. Rigotti (1989) outlines a continuum of worksite smoking policies that includes (1) no explicit policy, (2) environmental alterations, (3) designated smoking and nonsmoking areas, (4) total smoking bans, and (5) preferential or exclusive hiring of nonsmokers. This section considers only the fifth and most restrictive category." ...

"The reasons for preferential hiring and promotion of nonsmokers appear somewhat different and more situation-specific than those given for on-site restrictions. Protection of the health and rights of nonsmokers in the workplace is a key component of worksite restrictions (Rigotti, 1989). However, the extension of policies to personal behaviors away from the worksite may be motivated more by economic considerations (Walsh and McDougall, 1988). Employers defend the practice of preferentially hiring nonsmokers because smokers incur higher costs to both the business and society (Action on Smoking and Health, 1989)." ...

"Clearly, one potentially important contribution that such policies make is the message they convey about the changing social acceptability of smoking. Formal policies against hiring smokers are still relatively uncommon but may be highly visible and attract considerable media attention. The more direct impact of such policies is expected to occur through the economic incentive to quit smoking provided by the policy. If employment is contingent on quitting smoking, some potential applicants might be motivated to quit smoking rather than settle for some other job." ...

"The legal right of employers to preferentially or exclusively hire nonsmokers is generally recognized. Federal and state statutes prohibit discrimination on the basis of race, religion, national origin, and, in most circumstances, age and sex. In some situations, it is also unlawful to discriminate on the basis of sexual orientation, political affiliation, marital status, citizenship, and physical or mental handicap (Myers, 1990). Aside from these attributes, employers in most situations have the right to make hiring decisions on whatever basis they choose, including smoking status." ...

"Many other elements have been introduced into the debate over the fairness of economic incentives. Among these are ethical concerns about paternalism, victim blaming, and fair distribution of costs. The current racial and socioeconomic disparities between smokers and nonsmokers has elicited charges the economic incentive policies are racist and elitist. ... Potential consequences include a lack of employment opportunities and affordable insurance for those who are unwilling or unable to stop smoking." ...

"Despite the numerous arguments raised in opposition to economic incentive policies, there is broad support for these approaches."

The Rest of the Story

First of all, it is important to point out that what the NCI is doing here is reviewing potential strategies to reduce tobacco use, and not necessarily endorsing any particular strategy. However, my reading of this chapter is that the NCI is essentially including preferential hiring of nonsmokers as a viable strategy for reducing tobacco use. Even though the chapter points out some limitations of this approach, it concludes that despite the arguments in opposition, there is broad support for these approaches. The conclusion seems to suggest to me that NCI is intimating that this policy remains a viable alternative strategy for tobacco control practitioners.

This changes the impression that I may have left in my earlier post. It suggests that discriminatory hiring practices are not just an unintended consequence of anti-smoking campaigns, but that these policies have been considered as a legitimate and viable aspect of the overall tobacco control movement's strategy for reducing smoking.

As such, I think it is even more encumbent upon us as tobacco control groups and individual advocates to speak out unequivocally against these policies. It looks like we are at least partially responsible for getting smokers into the mess they are now in - I think we have at least some responsibility for helping get them out of this mess.

We certainly owe it to the smokers who are our primary clients, patients, and target population who we serve.