MHA Bans Hiring of Tobacco Users

The Massachusetts Hospital Association unabashedly announced this month that it will no longer hire tobacco users, sending a very public get-tough message that it hopes will resonate with other employers looking to reduce healthcare costs.

MHA President/CEO Lynn Nicholas says the trade group for more than 100 hospitals in the Bay State decided to go public with the ban—which takes effect Jan. 1—to raise awareness about the No. 1 cause of preventable death in the United States.

"We could have just implemented this policy and never said a word," Nicholas says. "I thought that by putting the example out there it would start a dialog."

Nicholas unapologetically concedes that the ban on hiring smokers follows an "all stick" and no carrot mantra because she believes sticks are more effective when it comes to discouraging smoking.

"We have had the carrots out there for years. I was in a debate with someone from the business community and they said it's all about carrots. Au contraire!" she adds. "What has caused people to quit smoking is public awareness, but more so the cost of smoking has gone way, way up, and the prohibitions on smoking on public places make it really hard to find a place other than your car. That is what has driven it. Those are all sticks."

Nicholas says MHA and its 45 employees also have an obligation to provide a high-profile role model for healthy living and to find way to reduce soaring healthcare costs.
"We are so proud in Massachusetts that we have enacted virtually universal coverage but that is costly and the pressure is now on to bring the cost of healthcare down," she says.
"This seemed to be obvious. There is such a cause and effect here. I'm in a position because of my leadership role working with hospitals to lead by example."

Smokers are not a protected class of workers, Nicholas says, so there is not fear of violating federal law with the ban, which will not affect MHA employees already on the payroll. While Massachusetts state law permits the ban, the National Conference of State Legislatures said that 29 states ban discriminatory hiring policies aimed at smokers.

Nicholas says she's not too concerned with infringing upon prospective workers rights by telling them what they cannot do off the clock. There are no subtleties when it comes to tobacco use, Nicholas says, so an anti-smoking strategy shouldn't be subtle either.

"It's voluntary whether you apply for a position here or not and you can choose to smoke or not," she says. "It's a known public health hazard and the leading cause of preventable death in the U.S. Our hospitals are filled with patients who are there directly and indirectly because of tobacco use. We know that half of all smokers die from their addiction and that people who smoke cigarettes die 14 years earlier on average than people who don't."

Smoking costs an estimated $6 billion each year in Massachusetts, including $4.3 billion in direct healthcare costs, and $1.7 billion for lost productivity related to premature death.
Nicholas wants other businesses and organizations in Massachusetts to follow her lead. "I hope that by leading by example and talking about it and giving them the chance to think about it they may have the same discussions we had," she says.

Beyond health policy, Nicholas says she is personally motivated to push for a tobacco free Massachusetts.

"I lost my own father from lung cancer. He smoked from a teenager to age 40. He quit cold turkey and died of lung cancer anyway at age 65," she says. "I lost a good chunk of my family, aunts, uncles and younger cousins to direct smoking and second-hand smoke. I have seen and felt it personally in my own family; that and the fact that I really care about our workforce here. They are like my extended family and the fact that there are such strong health policy imperatives mean it's a no brainer for me to say this is worth doing."