should companies not hire tobacco users? i’ve been wrestling with this question as news continues to spotlight this particular “stick” companies yield in their efforts to improve employees’ health.
if you’re unfamiliar with the no-hire tobacco policy, let me get you caught up. companies like cleveland clinic, humana, geisinger and others have stated they won’t hire tobacco users. some, like geisinger and cleveland, allow job candidates to reapply for a job once they can prove they’ve quit tobacco. geisinger and cleveland clinic won’t hold the job, but if the position’s still open, candidates can put their hat in the ring again. this no-hire tobacco policy is a more aggressive tactic than tobacco surcharges, which 64% of companies apply or plan to apply, according to a 2010 AON hewitt report. there are no stats, that i’m aware of, for what percentage of companies are currently or planning to institute this no-hire policy.
on the one hand, a no-hire tobacco policy stands on solid financial and cultural ground. tobacco users are more expensive. full stop. they run up more health care bills. they lag in productivity. their habit leads to other devastating, expensive illnesses and negatively affects the health of those around them, whether through second-hand or third-hand smoke. they even make cleaning maintenance bills go up. and culturally, public sentiment does not favor tobacco use. nor does tobacco use align with a company’s healthy workplace vision—particularly for health organizations. after all, how can an insurer or hospital system preaching healthy living reconcile unhealthy behaviors within its own workforce? how can a health team advise a patient to quit tobacco when that patient sniffs tobacco residue lingering on a nurse’s uniform?
on the other hand, this policy has some serious shortcomings:
- tobacco users don’t come by their tobacco use by chance. marketing, education level and a host of other factors affect someone’s “choice” to use tobacco. many were ensnared before they were the wiser, thanks to cigarette manufacturers manipulating the nicotine yield, making cigarettes increasingly addictive.
- the majority of tobacco users want to quit and have tried to do so. the average tobacco user attempts to quit between 8 and 11 times before he’s successful. that number increases for people with mental or other substance abuse problems—problems that are exacerbated by economic distress, such as being jobless and reviled.
- tobacco users don’t get the counseling they need when they’re adrift. employees outside of a tobacco-free workplace may continue using tobacco simply because they’re not coming into contact with those who’d provide, or even advise, quitting support and resources. according to the CDC, only 50% to 60% of smokers receive advice about quitting smoking from a health care provider, and only 39% of smokers are offered over-the-counter or prescription medication or counseling to support the quitting process.
- tobacco users are left outside of a supportive environment. one of the steps in most advocated quitting approaches includes creating a supportive environment, with new habits, cleansed-of-tobacco spaces, and got-your-back co-workers. listening to cleveland clinic talk about their no-hire tobacco policy, i was struck by the fact that they’ve been successful in cutting by half the percentage of their employee population who smoke. wouldn’t it be far more effective to wrap tobacco users in an environment that motivates their quitting rather than spurns it?
there are additional challenges. employees may question their company’s messaging about creating a culture of health. they’d be justified in asking why tobacco users are singled out and not those who threaten their health or others’ via drunk driving, domestic abuse or even too many twinkies. many have raised the point that obesity is a much more expensive and pervasive problem today than tobacco use.
employees might not be the only ones to buck at the no-hire approach. according to the edelman 2011 health barometer, we consumers want to work for, buy from and recommend those companies that make public health a priority. do consumers see a no-hire policy as a company standing up for good health? or do they view it as a quick way to save a buck? chances are if you sell tobacco but won’t hire tobacco users or charge them more for health insurance, your company’s open to derision.
we’ve made great progress helping people quit, thanks to changes in public policy and public perception. but now we may be a little stuck. a 2010 gallup poll found that 22% report smoking cigarettes, a figure unchanged from five years ago. employers can use their exposure to tobacco users and their hefty influence to move the needle—if they choose to offer tobacco cessation resources for free to eliminate financial barriers, ban tobacco use in buildings and other office property, and implement a comprehensive tobacco-prevention communication strategy. or they can sew a scarlet “T” on people’s chest and show them the door.
for assistance with your approach to tobacco at work, review this document from the CDC.