Should Smokers Be Banned from Hospital Jobs?

Texas' Baylor Health Care joined the Cleveland Clinic and other hospitals in banning smokers from hospital jobs, Fierce Healthcare reported today. As Alice Wolke of My FOX Houston explained in an article about Baylor Health Care's decision, "on the company's Careers page, the rules are laid out:

• Applicants who admit to nicotine use will not have their applications processed
• Anyone who is hired will be tested for nicotine
• If you test positive, your job offer will be withdrawn
• After a positive result, you can reapply for the job after 90 days"

By enforcing this policy, Baylor might be setting a healthy example for patients at its hospitals. To be ruthlessly practical, barring smokers from employment also saves the hospital system a lot of money in employee health care costs. The CDC's Vital Signs public heath site is featuring adult smoking statistics this month, and the numbers are statistics they quote are disturbing: the 19.3% of American adults who smoke (as of 2010) create $96 billion yearly in medical costs.

Barring employment to people with certain medical risks or conditions, however, sets a disturbing precedent. Some people argue that these methods are intrusive of medical privacy, especially considering the high levels of chronic disease and other health problems in America. Others point out a certain hypocrisy in targeting employees who smoke while ignoring those who drink heavily or make other risky health choices when they are not at work.

This month, the Department of Health and Human Services is taking a less punitive approach to better health, launching the "Million Hearts" Initiative to prevent one million strokes and heart attacks between now and 2016. Focusing on "proven, effective, inexpensive interventions" that can prevent heart disease and stroke, the initiative includes many stop-smoking measures, such as:

• Providing Medicare funding for stop-smoking medications
• Funding mass media anti-smoking campaigns
• Creating smoke-free (not smoker-free) workplaces
• Possibly reimbursing health care providers better for preventative care such as stop-smoking counseling.

Yes, it's time to reduce the shockingly high number of Americans who smoke. But I think it's more effective to use a carrot than a stick.

New Cigarette Warnings Don't Solve the Problem

The new, graphic anti-smoking warnings proposed by the FDA should be chosen by the middle of next year, and run on cigarette packets by the end of 2012. The warning images do give you pause, such as the picture of the very ill woman in  "Warning: Cigarettes Causer Cancer" and the man smoking through his tracheotomy in  "Warning: Cigarettes Are Addictive."

The new warnings might indeed further drive down smoking rates in the United States. Tobacco companies, though, have already shifted their strategies to sell cigarettes to promising markets abroad, such as China (where over half of the men smoke, according to 2010 World Health Organization statistics) and India.  

"Cigarette companies are aggressively recruiting new customers in developing nations... to replace those who are quitting or dying in the United States and Europe, where smoking rates have fallen precipitously," wrote Duff Wilson in a New York Times article on international cigarette sales and legislation ("Cigarette Giants in a Global Fight on Tighter Rules"). "Worldwide cigarette sales are rising 2 percent a year," Wilson wrote.

To protect their markets, some cigarette manufacturers work to suppress what they consider excessive anti-smoking legislation abroad. Wilson wrote that when Uruguay tried to limit cigarette use by covering 80% of cigarette packages with health warnings, cigarette manufacturer Philip Morris International, whose sales exceed Uruguay's gross income, sued the country.

Driving cigarettes out of the U.S. market, as the FDA is doing, is really just pushing tobacco into other countries that have fewer resources to resist it. In response, the World Health Organization is fighting global tobacco use with its Tobacco Free Initiative, but it's clearly a tough battle.