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More hospitals won’t hire smokers. Is it discrimination?

Experts debate implications of tobacco-free hiring

Topics: Health and Wellness, Benefits, Labor Expense, Workforce, Staffing, Recruitment and Retention

January 09, 2012

More U.S. health systems—focused on creating a culture of wellness—are refusing to hire tobacco users, but some worker advocates argue that the policy is discriminatory.

Many organizations say the tobacco-free hiring policies reflect their health-focused missions, having already banned on-campus smoking . For example, Texas-based Baylor Health Care System's tobacco-free hiring policy requires scanning applicants' urine tests for signs of nicotine use. According to USA Today, such hiring policies seek to promote employee wellness and reduce insurance premiums.

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CDC statistics show that smoking or secondhand smoke exposure causes 443,000 premature deaths and results in $193 billion in health costs and lost productivity annually. According to the agency, about 19.3% of U.S. adults smoked in 2011, down from 42.4% in 1965.

Marcy Marshall of Geisinger Health System in Pennsylvania—which will launch a nicotine-free hiring policy next month—says, "We're trying to promote a complete culture of wellness," adding, "We're not denying smokers their right to tobacco products. We're just choosing not to hire them."

However, some members of the health care community say the policies amount to employment discrimination. Michael Siegel, a professor at Boston University's School of Public Health, says tobacco-free hiring practices do little to help smokers quit, noting that they "set a very dangerous precedent."

Although 29 states and the District of Columbia have passed smoker-protection laws, some of the measures exempt not-for-profit groups and health care associations. Chris Kuzynski of the U.S. Equal Employment Opportunity Commission says businesses can refuse to hire nicotine users under federal law because it does not recognize smokers as a protected class (Koch, USA Today, 1/6).

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What Your Peers Are Saying

Rating: | Lisa Baker | January 13, 2012

I think Kenneth may be onto something with an examination of insurance, but I disagree with making it premiums punitive-- that assumes a level playing field where all unhealthy people understand the details of wellness and want to do more than just take a pill for this or that. I'd rather see a bonus for wellness targeted objectives achieved, which would still have to cost less than the cost of claims should they choose not to try. Or what if employers ponied up subsidies so that employees (at all wage levels) could afford Y memberships and offered incentives to make use of it? I'm just brainstorming a little, but I think rewards get better results than punishment. My dogs agree.


Rating: | Pat Eaton | January 10, 2012

Mr. Siegel obviously has the mistaken view that a hospital's responsibility extends to "helping smokers quit", when in fact our responsibility is to keeping our patients safe. When employees are unavailable to assist because of a smoke break, or go in a room reeking of tobacco, the patient suffers. It is incumbent upon us to put our patients first. If this means not hiring smokers, that is the hospital's call. Freedom to choose whom to hire is not discrimination - we make those judgements every day.


Rating: | kenneth olshansky | January 10, 2012

This is a terrific discussion !! It opens up so many issues. The most important issue is how do we get control of skyrocketing healthcare costs and at the same time respect individual liberties. When talking about individual liberties and healthcare, the issue is that if individuals practice poor health habits, we all pay for it. We all know that the highest risk patients utilize the most healthcare dollars driving up costs for everyone. I'd like to throw out a proposal (I'm sure controversial) for discussion. Suppose any organization or insurance company offered the following type of program for it's employees and subscribers: There would be three sets of premiums A) Persons with no risk factors would have their premiums capped for 3 years as long as their annual risk assessment didn't change. 2) Patients with certain Risk Factors ,let's take for exampls an obese , type 2 diabetic with hypertension. They would be given let's say three penalty points worth $500 each. That would mean that their premium would be $1500 above (1). However,if they entered a weight loss program, diabetes program (endocrinologist,regular hemoglobin A1C's, etc.) and took all of their meds as prescribed and met the set goals,then they could wipe out the penalty points and receive the same premium plan as a healthy person. 3) The third group would be those high risk patients who decide not to participate. In that case they would have a significant deductible. This allows, in a fair way, that everyone has "skin in the game' and shares in the responsibilty of keeping healthcare costs down. Everything else has been tried with few successes. Unless we think out of the box and have real bold incentives,in my opinion the trajectory of healthcare costs won't change.


Rating: | Michael Murphy | January 09, 2012

But who decides and where do we draw the line at what's healthy/unhealthy behavior? My hospital already has a strict non-smoking policy, so breaks are not an issue and neither is second-hand smoke. That was one of the best moves our hospitals made. But we keep opening ourselves more and more to laws and restrictions so that we will soon have very few rights to brag about in this "free" country. And no, I'm not a smoker. But I think it's wrong to discriminate against LEGAL behavior. I agree with Lou, we should PROMOTE, not MANDATE or DICTATE!


Rating: | Michael Murphy | January 09, 2012

But who decides and where do we draw the line at what's healthy/unhealthy behavior? My hospital already has a strict non-smoking policy, so breaks are not an issue and neither is second-hand smoke. That was one of the best moves our hospitals made. But we keep opening ourselves more and more to laws and restrictions so that we will soon have very few rights to brag about in this "free" country. And no, I'm not a smoker. But I think it's wrong to discriminate against LEGAL behavior. I agree with Lou, we should PROMOTE, not MANDATE or DICTATE!


Rating: | Lou Ventura | January 09, 2012

While I understand the health and wellness aspect of this, I am afraid it opens up a door to escalating discrimination. We are essentially talking about behavior that increases insurance claims, so what about those who play sports and are repeatedly injured? What about potential employees who have kids? An employee who has his or her family covered by insurance surely will mean more claims--why don't we stop hiring people who have reproduced? Can we come up with a test that can tell the last time someone had a glass of wine? That must mean that they can't be hired by a hospital either. What about those who are overweight? I believe that if we continue along these lines, weight discrimination will be the next thing on the horizon: we won't hire you because you exceed the weight statistics for your age and height and are therefore more likely to use more health benefits. Let's remember that healthcare organizations are to PROMOTE health, not MANDATE it.


Rating: | Jill Noffsinger | January 09, 2012

Up until a little over 2 years ago, I smoked, so I think maybe I can see both sides now. First, I will tell you that rarely am sick, so I don't think my smoking caused my insurance much burden nor my employer. I will most likely lose many sick hours when I hopefully retire in the next couple years. And yes, I agree that hospitals should lead in wellness....but is that just smoking issues...there are so many things that can be unhealthy..not just smoking. By not hiring smokers, is that going to make us more of "a complete culture of wellness"? I agree with Kenneth, then we need to look at the big picture and only offer healthy foods on our menus and in our cafeterias then we will look more like we are promoting a complete culture of wellness.
But, are we going to not hire those "over weight" people, those people that don't exercise, those people that use artificle sweetners? Those people that have "behaviors" we feel are not healthy? The employeement application is getting longer and longer!!!
Where does it stop? I know that by just not hiring those that smoke, is not going to "promote a complete culture of wellness". The Cleveland Clinic is definitely on the right track!!!


Rating: | kenneth olshansky | January 09, 2012

Kudos to any healthcare organization which adopts a no smoker hiring policy. It's disingenuous to call ourselves healthcare organizations and not lead in wellness. The same is true with cafeteria food. How many hospitals have wellness programs but continue to serve fried chicken,french fries,sodas ,etc. in their cafeterias. It sends a mixed message! Cleveland Clinic, Bon Secours and Geisinger are showing leadership and shouldn't apologize for it. Not only that,but bold leadreship can improve the health of our employees and communities and also cut healthcare costs. I believe they are strong reasons to lead. Kenneth Olshansky,M.D. , Richmond ,VA.


Rating: | Alice Peterson | January 09, 2012

Discrimination against an attribute someone was born with or born into is wrong. That's why we have laws against discrimination by gender, sexual orientation, ethnicity, race, and religion. Discrimination against someone due to their behavior is and should be acceptable. If you engage in criminal activity, I have a right to distance myself from you for my own protection. Likewise, if you engage in unhealthful activities, I think I also have a right to protect myself from the irritations of your secondhand smoke, your smelly, offensive clothing, breath and hair, and the multiple breaks you insist upon taking that our more productive, non-smoking workforce do not take. (This is personal opinion and does not necessarily reflect the opinions or practices of my employer.)

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