Monday, November 27, 2006

To Reduce Health Care Costs, Employers Should Refuse to Hire Anyone Exposed to Tobacco Smoke: Both Active Smokers and Passive Smokers

Several anti-smoking groups (example 1; example 2) and many tobacco control advocates have expressed their support for policies by which employers deny jobs to anyone who smokes in an effort to try to curtail rising health care costs and to improve health by discouraging smoking. Among the employers who have followed this advice are Weyco Inc., Scotts Miracle-Gro, Crown Laboratories, Truman Medical Centers in Kansas City, the World Health Organization, and most recently, Medical Mutual.

These employers have instituted policies in which they refuse to hire anyone who smokes. Some enforce the policy by requiring a urine sample from prospective employees. If the urine cotinine level exceeds the threshold that indicates active smoking, then the applicant is automatically rejected for the position, regardless of his or her qualifications for employment. Several of these employers go so far as to fire existing smokers if they are unable to or uninterested in quitting within a given time period.

The Rest of the Story

These policies make no sense. If employers really want to reduce their health care costs, then it seems the appropriate step would be to deny employment not only to smokers, but to anyone who is exposed to secondhand smoke. After all, according to the United States Surgeon General and a large number of anti-smoking groups, there is no safe level of exposure to secondhand smoke and even brief exposure puts individuals at significantly increased risk of heart attacks.

In fact, according to Americans for Nonsmokers' Rights, "Even a half hour of secondhand smoke exposure causes heart damage similar to that of habitual smokers. Nonsmokers' heart arteries showed a reduced ability to dilate, diminishing the ability of the heart to get life-giving blood." If even a half hour of secondhand smoke exposure diminishes the ability of the heart to get life-giving blood, then certainly no employer would want to take on the risk of hiring someone who is exposed to this extreme hazard. Health care costs are simply too high already and employers need to protect themselves by refusing to hire passive smokers, no matter how brief the exposure.

Furthermore, according to the Association for Nonsmokers - Minnesota, "Research studies have shown that even just thirty seconds of exposure to secondhand smoke can make coronary artery function of non-smokers indistinguishable from smokers." If just 30 seconds of secondhand smoke exposure equalizes coronary artery function between smokers and nonsmokers, then clearly passive smokers should be considered in the same risk category as active smokers when it comes to employment decisions.

According to SmokeFreeOhio, "After twenty minutes of exposure to secondhand smoke, a nonsmoker's blood platelets become as sticky as a smoker's, reducing the ability of the heart to pump and putting a nonsmoker at an elevated risk of heart attack." Thus, any individual exposed to secondhand smoke for as little as 20 minutes raises health care costs for an employer because of the increased frequency of heart attacks among these individuals. To avoid incurring these costs, employers should refuse to hire anyone with detectable levels of cotinine in their urine. They should even consider firing existing employees who do not eliminate their exposure to secondhand smoke.

According to ClearWay Minnesota, "Blood flow in the coronary arteries is decreased in healthy young adults exposed to secondhand smoke." Certainly, reduced blood flow in the coronary arteries puts one at risk of a heart attack. And the medical care costs associated with heart attacks are extremely high. No employer wants to face such costs. The solution is quite simple: don't hire anyone, even a healthy young adult, who is exposed to secondhand smoke.

The reasons for refusing to hire individuals, even healthy young ones, who are exposed to secondhand smoke are not limited to the risk of heart attacks. According to SmokeFreeOhio, secondhand smoke exposure also causes the debilitating and costly lung disease - pulmonary emphysema: "Secondhand smoke can cause the debilitating disease pulmonary emphysema, causing severe damage to the walls of the air sacs, with the lungs eventually losing their capacity to expand and contract."

Obviously, the health care costs associated with hiring individuals exposed to secondhand smoke who go on to develop disabling pulmonary emphysema are immense. There is no reason why an employer should want to take this risk. Employers who are truly concerned about rising health care costs should not only deny employment to anyone with detectable levels of cotinine in their urine, but should fire workers who do not produce urines devoid of cotinine within a reasonable period of time: say one year.

Treating both active and passive smokers in a similar category is scientifically justified. According to Action on Smoking and Health, the heart attack risk associated with 30 minutes of secondhand smoke exposure is identical among passive smokers and chronic active smokers: "breathing drifting tobacco smoke for as little as 30 minutes (less than the time one might be exposed outdoors on a beach, sitting on a park bench, listening to a concert in a park, etc.) can raise a nonsmoker'’s risk of suffering a fatal heart attack to that of a smoker."

Employers should therefore start screening prospective employees to make sure that they do not spend time walking along beaches, sitting on park benches, or listening to concerts in areas where a smoker may be present. Doing so will cause the employer to incur the same health care cost risk profile as employing a smoker, according to ASH.

Beyond the risks of heart attacks and pulmonary emphysema faced by individuals exposed even briefly to secondhand smoke, lung cancer is another serious risk. According to the U.S. Surgeon General, "Even brief exposure to secondhand smoke ... increases risk for ... lung cancer." Moreover, the Surgeon General stated that "Breathing secondhand smoke for even a short time can damage cells and set the cancer process in motion."

Due to the enormous medical costs associated with the treatment for lung cancer, employers concerned about health care costs should deny employment to prospective employees exposed even briefly to secondhand smoke who, according to the Surgeon General, are at increased risk for lung cancer, and in whom the cancer process has in fact already been set in motion.

I urge all anti-smoking groups and advocates to support my call for employers to screen all potential employees for cotinine. Doing so will not only save millions of dollars in health care costs for businesses, it will also serve as a strong deterrent that will encourage smokers to quit and will encourage passive smokers to avoid exposure to secondhand smoke.

This initiative, which I am calling "Smokefree Workplaces 2010," aims to clear all the smoke, both active and passive, out of our workforce by the year 2010 to save money and save lives. It is a win, win, win proposal for our nation's employers, our workers, and the entire public's health.

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