Tuesday, June 30, 2009

Humana of Ohio Announces that It Will Start Practicing Lifestyle Control for Its Employees

Humana of Ohio - a health care insurance company - announced earlier this month that all new employees who smoke will be required to enter a smoking cessation program within 30 days or else be fired from the company. Similar requirements will not hold for Humana's employees who work in neighboring areas in Kentucky because that state has a law which prohibits employment discrimination against smokers. According to the company, the purpose of the program is to improve employee wellness in order to reduce health care costs and improve productivity.

According to an article in the Louisville Courier-Journal: "The Louisville-based insurer, which employs more than 1,200 people at its new operations in Cincinnati's Walnut Hills neighborhood and hundreds more at a distribution center in West Chester, said Monday, June 15, that it would give all new employees a questionnaire. If the workers use tobacco, they will have 31 days to enroll in a company program called Breathe. The company said the new requirements are part of a continuing commitment to employee wellness programs to shave costs and improve productivity. According to a Humana press release, its Breathe program is offered to all of its employees as part of the health initiatives. It is only mandatory for new Humana of Ohio employees. The company’s new regional headquarters and customer service center, located near downtown Cincinnati, was designed to foster employee health and wellness, Humana says. Features include walking tracks on three floors, an on-site fitness center, healthy food service, and well-lit stairwells to encourage exercise. Humana said in its release that it 'puts a strong emphasis on personal responsibility for health and wellness, which lead to improved quality of life and greater workplace productivity.'"

The Rest of the Story

Unfortunately, this new Humana policy isn't about saving health care costs and improving productivity at all: it's about controlling its employees' lifestyles and picking on smoking as one particular behavioral decision that cannot be tolerated.

If the true concern were saving health care costs, then Humana would be requiring smokers to actually quit smoking, or else be fired. Instead, the requirement is simply that employees agree to enter a smoking cessation program. It apparently doesn't matter if the program works or not. The important point is that the company has been able to express its disapproval of the smoking decision and to coerce the employee into entering such a program, whether the smoker actually quits or not.

In fact, the effectiveness of these types of smoking cessation programs is dismal and the majority of smoking employees who enter them will not quit. Thus, for most employees, the policy will not save any health care costs at all. It will not result in any change in the individual's health status; it will simply scold the employee for that health decision.

In contrast to the way the company is handling the decision to smoke, Humana is apparently not requiring obese or overweight employees to enroll in a weight loss program. It is apparently not requiring employees who are not physically active to log a certain number of hours each week on the treadmill. It is not mandating that workers who eat a crappy diet enroll in a nutrition education program.

All of these other employee wellness initiatives are voluntary. The only mandatory aspect of the company's wellness program is smoking cessation -- or to be more accurate, participation in a smoking cessation program which is, in the majority of cases, not going to be successful.

What's most interesting to me is why Humana would choose to handle smoking in a very different way than all other health behaviors. The company clearly is concerned about a range of behaviors. It has walking tracks, a fitness center, and well-lit stairwells to encourage exercise and a healthy food program to encourage improved nutrition.

However, all of these aspects of its wellness program are optional. Employees are not monitored to see if they do indeed go up and down the stairs. Their use of the fitness center is not mandatory. They can choose to use or not use the walking tracks. But the smoking cessation program: mandatory.

This raises the question of what else is going on here besides just a concern about employee health and wellness. The inconsistent treatment of smoking compared to other health-related behaviors suggests to me that smokers are being discriminated against for a reason other than a pure concern for health. I believe that a disapproval of smoking underlies this policy. But why a disapproval of smoking, but not of eating excessively or not exercising?

I think it's because it has become acceptable to scorn, punish, and discriminate against smokers. But to treat any of the other health-related behaviors in the same way would be immediately and strongly condemned because it is socially unacceptable.

In other words, intolerance of smokers has become socially acceptable in a way that intolerance of other health-related behavior decisions has not.

Humana of Ohio certainly has the right to implement this policy, but they should at least call it what it is: it's not a health and wellness program, it's an attempt to control the lifestyle of its employees.

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