Nov. 18 marks the 35th Great American Smokeout. The anniversary provides an excellent opportunity to take stock of how far we've come to reduce the costly blight of tobacco, how far we've yet to travel, and what we can do to help others kick the deadly habit.
The battle against tobacco use—particularly smoking in public places—has been so steady and incremental over the decades that it's possible to forget how widespread smoking was in this country only a generation ago.
The American Cancer Society—sponsor of the Great American Smokeout—provides a nice timeline of success. Unfortunately, the battle is far from over. The Campaign for Tobacco-Free Kids reports that 450,000 deaths each year are attributed to smoking or second-hand smoke. And although tobacco use continues to decline, one in five Americans—roughly 61 million people— still smoke.
Oddly, until the last decade or so, hospitals were notable laggards in the antismoking effort, with smoking policies that were less restrictive than those of steel mills.
In fairness to hospitals, they had to consider the stress associated with hospital visits for patients and their families—anxieties that could be at least temporarily relieved with a cigarette break.
Hospitals have moved from having designated indoor smoking areas to designated smoking areas outside the hospital doors, to butt-littered smokers' huts on the far reaches of the campus. Now, many hospitals are phasing out those enclaves—even banning smoking inside cars—and declaring their campuses tobacco-free zones.
Some healthcare organizations are taking the antismoking crusade one big step further. The Massachusetts Hospital Association declared this month that—effective Jan. 1—it would no longer hire tobacco users. MHA President/CEO Lynn Nicholas says the trade group for more than 100 hospitals in the Bay State decided to go public with the new ban—which takes effect Jan. 1—to raise awareness about the No. 1 cause of preventable death in the United States.
Nicholas unapologetically concedes that the ban on hiring smokers is "all stick" and no carrot because sticks—in the form of bans, fines, and high taxes on cigarettes—more effectively discourage smoking. "I love carrots but when carrots are shown not to work on an important health issue like this I'm not above using a stick," she says.
Nicholas' argument is understandable. However, where do we draw the line between workplace and personal life? Is this nanny state overreach?
Most smokers want to quit. They know they are in the clutches of an expensive, disgusting addiction that's sucking the life out of them one puff at a time. These are good people who don’t need to be browbeaten or threatened, especially because nicotine addiction is particularly tenacious.
In marked contrast to the MHA, Gundersen Lutheran Health System is more carrot than stick. Jeffrey E. Thompson, MD, CEO at the La Crosse, WI-based health system, says smokers are still hired there, but they're encouraged and incentivized early on to kick the habit. "We believe it is the employees' responsibility to say they want to get better, and it is our responsibility to try to help them get better, and between the two of us it works pretty well," Thompson says.
Employers have legitimate concerns about the costly effects of tobacco use, Thompson says, "but the question is whether it’s a justifiable action to tell people they can't do something when they are not working."
"There are precedents for employers to reach beyond the doors of the workplace, but my hope would be to go the other way; to educate and show how smoking affects productivity and long-term health and your family," he says. "My direction would be to expand the incentives for people not to smoke, to be clear in the hiring that there is an expectation down the road that no quarter is given for people who smoke."
Smokers at Gundersen are encouraged to join support groups, and they can get cash incentives for passing risk assessment tests that measure smoking.
"There are no penalties, but we have made it pretty clear that the organization is not responsible to support your habit by giving you any special breaks or times compared with coworkers," he says. "You have to carry your own load."
About 21% of Wisconsin adults smoke. At Gundersen, 12% of employees smoke. The health system boasts that it has seen a 40% decrease in the number of employees who continue to smoke once they've been in the organization at least five years.
As healthcare costs continue to soar well above the Consumer Price Index, Thompson—like Nicholas—believes more employers may take the hard-line stance against hiring smokers.
"Employers are going to get more and more anxious about how expensive the delivery of healthcare is and they will do things that they can control that they believe can help reduce costs," he says.
Perhaps even hard-pressed employees may soon call for a ban on hiring new coworkers who smoke, if it's determined that the policy provides some relief from crippling annual healthcare premium hikes. After all, 80% of Americans don't smoke, and that number is growing every day.
John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.