Thursday, February 02, 2006

On Firing Smokers: POST #3 - Inconsistency with Public Health Practice

This is the third of a three-part series devoted to this important issue. My first post presented my own plan to save employers money spent on health care and to prevent employees from having to subsidize health care costs of their fellow workers. My second post suggested that to save employers money on health care and prevent employees from having to subsidize health care costs of their fellow workers who made unwise choices, ex-smokers should also be fired.

The background for this commentary is as follows:

According to a press release issued by Action on Smoking and Health (ASH), a Washington, D.C.-based anti-smoking organization: "firing smokers is an appropriate and very effective way to stop burdening the great majority of employees who wisely chose not to smoke with the enormous unnecessary costs of smoking by their fellow employees."

The Rest of the Story

Worksite health promotion is a well-established aspect of public health. In the words of the National Institutes of Health (NIH), it provides "employees opportunities to learn and practice healthful behaviors and to integrate health promotion and disease prevention activities into all aspects of work life."

A large number of employers have worksite health promotion programs. These programs are quite diverse and they cover innumerable health behaviors and health issues, including smoking, fitness, physical activity and exercise, nutrition, mental health, ergonomics, cancer screening, blood pressure control, cholesterol control, breastfeeding, substance abuse, and a lot more.

Among the programs that I have seen included in such worksite health promotion initiatives are education, health fairs, provision of exercise facilities and walking and jogging paths, incentives for improving health behaviors and health indicators, subsidized or free smoking cessation programs and other classes, free blood pressure, cholesterol and cancer screening, nutrition programs, and a lot more.

But the one worksite health promotion program I have never seen in any other area of public health is the firing of people who exhibit the unhealthy characteristic or behavior of concern.

It is only in the anti-smoking movement that I have ever even heard of the suggestion that one appropriate and effective worksite health promotion intervention may be to simply fire employees who engage in the unhealthy behavior.

Clearly, ASH's support for firing smokers (and the failure of other anti-smoking groups to condemn this approach) indicates that the anti-smoking movement has long since left the realm of public health. It seems to be becoming a fanatical, unreasonable, extreme, draconian movement that has lost its bearing in basic public health practice.

The first class I ever took in tobacco control was called "The Public Health Practice of Tobacco Control." The title of the course emphasized that tobacco control is part of the larger practice of public health.

I'm afraid that we are in many ways no longer in the realm of public health. We are no longer part of the larger practice of public health. We're starting to go out on a quite fanatical and unreasonable and in my view, crazy limb of our own, not backed or supported by appropriate public health thinking, values, or principles.

And I don't think that limb can long survive without getting re-connected to its public health roots.

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