Sunday, February 12, 2006

FORCES Sees What's Going On With Employment Discrimination Policies; Why Can't Anti-Smoking Organizations?

In a February 10 column, FORCES suggests to its readers that it is a disdain for smokers that is motivating the call by groups like Action on Smoking and Health (ASH) for employers to fire smokers and for employers to refuse to consider applications from smokers:

"Michael Siegel, an advocate for tobacco control has seen the light. After pondering what on earth Action on Smoking and Health hopes to accomplish by lobbying private business, and now state and local governments, to refuse to employ smokers he realizes the only logical motive is ... a disdain for the stubborn people who refuse to obey the orders of better and wiser people. It's important that those who do not hate, such as Siegel, speak out against the ugliness that has no place in what purports to be a charitable organization set up to educate the public."

The Rest of the Story

As I argued in my posts of the past 2 weeks, I think FORCES is right. I simply have not seen, anywhere else in public health, the suggestion that an appropriate and effective way to improve the health of workers or to reduce business health costs is to fire people who don't behave in a certain healthful way.

You simply don't see public health groups calling on employers to fire fat people because they are at high risk of chronic disease and premature mortality and because businesses could save money by cleansing their workforce of obesity and because it's unfair to require thin and moderate-weight people to subsidize the health costs of fat people.

And you don't hear public health groups arguing that it's OK to fire fat people after giving them a chance to lose weight because most will decide to lose weight rather than risk being fired. Nor do you hear public health groups arguing that it's OK to refuse to hire fat people because it will serve as a fantastic incentive to get people to lose weight and most will do so if they really desire a particular job.

And, in fact, I'm not aware of any other legal health behavior (other than smoking) that doesn't directly affect job performance for which any public health group has ever called on employers to fire people with that health behavior or refuse to hire such people.

Can you imagine a public health group that is devoted to the obesity issue or to physical activity call on employers to fire anyone who is fat, or anyone who eats too much fat? Can you imagine a public health group devoted to preventing the complications of diabetes call on employers to fire workers who don't adequately control their blood sugars? Would any public health group that works on the issue of hypertension call on employers to fire workers who don't have adequately controlled blood pressure, or that such people not be hired in the first place?

It is simply beyond me that an anti-smoking group is acting in this inappropriate way, and I honestly cannot think of an adequate explanation other than that there is some disdain of smokers and some desire to punish them - in other words, that there is some hatred of smokers that is entering into the picture.

This is so contrary to my view of public health and tobacco control that it is difficult for me to reconcile. I came into medicine, public health, and tobacco control because I felt great compassion for my patients who were smokers and wanted to do something to help them and to prevent others from being in a similar situation.

So it is difficult for me to observe an anti-smoking group proceed with such a lack of compassion for smokers and with such a blatant disregard for basic public health standards of practice in order to pursue its narrow and overly zealous agenda.

My experience so far is that U.S. anti-smoking advocates and groups (unlike their British and Australian counterparts) have been defending and supporting ASH's actions, rather than condemning this aspect of ASH's agenda.

I wonder why it is that U.S. anti-smoking groups don't seem able to appreciate what FORCES and its members seem to understand - that at least part of the current anti-smoking agenda seems to be motivated not solely by pure public health concerns, but by an agenda that is at least in part separate from, and in conflict with, basic public health principles.

I'm glad that FORCES has been willing to consider and publicize my opinions on this issue, regardless of the difference of opinion that we have regarding many smoking bans, because at least the smokers out there who feel that policies such as those which discriminate against smokers in the workplace are not, in fact, supported by every anti-smoking advocate out here.

No comments: