Thursday, April 20, 2006

Tobacco Control Practitioner Supports WHO's Decision Not to Hire Smokers; Bigotry Alive and Well in Anti-Smoking Movement

In an editorial appearing in next month's issue of The International Journal of Tuberculosis and Lung Disease, the director of the tobacco control and prevention division of the International Union Against Tuberculosis and Lung Disease supports the World Health Organization's (WHO) decision not to hire smokers and suggests that this policy of refusing employment to smokers is the logical next step in the campaign to prevent smoking-related disease.

In the editorial, she argues that: "Health professionals have for years been enjoined not to smoke as part of their professional responsibilities. And now, many health organisations see the need for coherence in their staffing requirements. In my view, the WHO has taken a decision that is a timely next step in our changing perception of tobacco use."

In trying to explain why there is what she calls a "schism" in the tobacco control movement on this issue, she suggests that the reason why some in tobacco control have denounced these policies is that they are afraid of being accused of "telling other people how to run their lives" and of being cast in the dark cloud of "moralizing," and therefore are reluctant to support the WHO's policy. She seems to be suggesting that those in tobacco control who oppose this policy are doing so only because they are afraid of what others might think if they expressed support for it, but that deep down, they actually do support the idea.

In her words: "such comments [that we in tobacco control are moralizing] make us a bit edgy, and we leap to deny any accusation that we are telling people how to live their lives. The blatant deception, chicanery and exploitation the tobacco companies have been shown to extend to their customers have had the secondary effect of taking away some of the '‘moralising'’ cloud over tobacco control, but many are nevertheless working in this shadow. Hence the reticence to support the WHO'’s new hiring requirement."

The Rest of the Story

Bigotry is defined as utter intolerance of any creed, belief, or opinion other than one's own. The author of this editorial apparently feels that smokers have no place in the workplace, or at least in workplaces that involve the practice of public health. She is certainly entitled to her opinion, and should she wish to implement such a policy in her own workplace, that is her prerogative as an employer, as long as she is not breaking any anti-discrimination laws in her country (and I have no knowledge of employment discrimination law in France).

But to suggest that her opinion on the inappropriateness of smokers in the public health workforce should be institutionalized in the form of policy, at the expense of an entire segment of the population who are largely addicted to a product which they are unable to easily stop using due to the addiction, is intolerance on a grand scale.

It is intolerance of the lawful behavior choices of an entire population of people, choices which do not directly affect their ability to perform the duties of a public health job and which do not conflict in any way with the practice of public health.

The argument that this tobacco control practitioner is making is, I think, an extremely dangerous one. Because she seems to be suggesting that hiring smokers represents incoherence with the appropriate staffing policies of a public health organization.

Well let's go with that for a while. Let's accept her contention that smoking is incoherent with the job of being a public health professional. Let's give her the complete benefit of the doubt here.

What I would then ask us to consider is whether being fat is also incoherent with the job of being a public health practitioner. Clearly, according to the same reasoning, it is. Obesity is arguably the number two public health problem, right behind smoking. So if it is inappropriate for someone who chooses to smoke to practice public health, then it is also inappropriate for someone who chooses to not exercise and not control their food intake to be a public health practitioner.

And then we can go right down the line. It would also be an incoherent staffing policy for a public health organization to hire someone who does not adequately control their blood pressure. The same goes for inadequate control of their cholesterol level, blood sugar level (especially in diabetics), and excessive fat intake (as these are three of the most important factors in the development of heart disease, the #1 cause of preventable death).

So according to this reasoning, the only people who should be employed by public health organizations are thin, physically active, normotensive, normocholesterolemic, non-diabetic (or diabetic with good blood sugar control) people who don't smoke and don't eat too much fat. The "coherent staffing policies' that are being called for here are really a call for an "Aryan race" of public health practitioners who meet all of these lifestyle and behavioral requirements.

This kind of thinking is bigoted. It is completely intolerant of behavior that differs from one's own. And for no reason that has anything reasonably to do with the requirements to perform a job.

I'll tell you one thing I can say for sure. If we disallowed smokers to enter the nursing field, patient care in this country would suffer significantly. Many of the absolute best nurses I have had the good fortune to work with happened to be smokers. It would have been not only ludicrous, but also would have diminished the quality of patient care to deny these talented and well-qualified individuals employment in the health care profession because they happened to smoke when they were off-the-job on their own time.

I certainly think that programs to try to encourage health care professionals to quit smoking are reasonable, but I think worksite wellness programs and incentives are the appropriate way to deal with this issue - not banning smokers from the public health workforce.

Now to the insulting part of the editorial.

The author of this piece suggests that the reason why some of us in tobacco control who oppose the WHO's policy do so is that we are afraid of being accused of moralizing and telling people how to live their lives. Somehow, our concerns are not legitimate ones - we are just cowards, too "edgy," or are just protecting our movement from criticism.

I can't speak for anyone else, but I can assure the author of this piece that I oppose the WHO's discriminatory and bigoted hiring policy not because I'm afraid that supporting the policy would open the door to criticism of our movement, but because I think it's a discriminatory and bigoted policy.

I don't oppose the WHO's policy because I'm afraid of being accused of moralizing and telling people how to live their lives. I oppose it because I don't believe that we should moralize or tell people how to live their lives. We certainly shouldn't cast judgment on people who engage in unhealthy, lawful behaviors. And we most certainly shouldn't preclude them from the workforce, our own (the public health workforce) or anybody else's.

It seems to me that this editorial is just another example of how the tobacco control movement allows no room for dissent with its established dogma. Anyone within the movement who criticizes this policy is being cast not as having any legitimate opinion, but of simply acting insincerely out of fear or purely strategic concerns. Our opinions critical of the direction the movement is going cannot possibly be heartfelt, legitimate, well-reasoned concerns. It can't be how we "really" feel. After all, we're tobacco control practitioners. There must be some other motivation driving us to this dissent.

I agree with the author of this editorial on only one thing. The World Health Organization's decision is a "timely next step." It is a timely next step towards taking the tobacco control movement completely out of the realm of public health and turning it into little more than a fanatical, overzealous, and bigoted crusade against a good 20% of the population.

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