• Part Two: Are nonsmoking hiring policies ethical?

    Elsa Pearson is a senior policy analyst at Boston University School of Public Health (@epearsonbusph).

    U-Haul just announced that, effective this month, it will no longer hire individuals who use nicotine products. Part one looked at whether these policies are legal (they are in some states) and effective at reducing smoking prevalence (they might be). Part two, below, will review the ethics — even if these policies are legal and effective, should we implement them?

    Are these policies ethical?

    The ethics of nonsmoking hiring policies are complicated. One can argue such policies are discriminatory while another argues it’s within an organization’s rights to decide whom it hires. Is there a general consensus?

    Similar ethical debates have occurred over smoking bans in outside spaces and in public housing. New York City banned smoking in outdoor spaces such as parks and beaches in 2011. Supporters argued it protected the rights and health of nonsmokers, allowing them to enjoy the outdoors without exposure to secondhand smoke or littered cigarette butts. But opponents saw the ban as an infringement on personal liberty.

    Michael Siegel from Boston University’s School of Public Health warned that the ban was unnecessary given the minimal health risks to others and that it could even erode the progress public health officials have made promoting indoor smoking bans, where the effects of secondhand smoke are greater.

    The US Department of Housing and Urban Development (HUD) banned smoking in public housing in 2016. Proponents of the regulation welcomed it as a step towards mitigating secondhand smoke exposure, which has a dangerous impact on children. Then HUD Secretary, Julián Castro, argued the subsequent public health benefits would be “tremendous” and public support was strong. (A recent study in Boston public housing found over 80 percent of residents were supportive of a nonsmoking policy.)

    Opponents, however, argued such a policy would lead to a significant number of evictions. One woman wrote a letter to the New York Times claiming the policy unfairly targeted the poor. She argued that a ban targeting those receiving a government subsidy should then include those receiving mortgage deductions.

    When considering nonsmoking hiring policies, the general consensus is that they are unethical, or dicey at best. Almost 90 percent of Americans don’t think employers should be able to refuse to hire smokers. Only 25 percent support a total smoking ban nationwide. These opinions are in strong contrast to those on other smoking restrictions; the majority of Americans support smoking bans in public places, raising the tobacco purchasing age, stricter regulations on e-cigarettes, and even higher health insurance rates for smokers.

    Clearly, nonsmoking hiring policies are viewed differently; regulating smoking through location bans and increased taxes is different than regulating an individual by refusing employment.

    Experts also argue these policies are unethical. In a 2013 Health Affairs article, Harald Schmidt et al. argue not hiring smokers is hypocritical for health care organizations who are dedicated to improving the health and wellbeing of their clients. They also claim the touted cost savings are not justified. If not hiring smokers saves employers money, why not also refuse to hire obese individuals or pregnant women or those who participate in risky sports? (Ethics asides, the increased costs associated with smoking are nothing to ignore. One 2013 estimate suggests a smoker costs his employer thousands more a year than a nonsmoker in lost productivity and increased medical costs.)

    Perhaps the most compelling argument to suggest nonsmoking hiring policies are discriminatory has to do with the physicality of smoking. First, smoking is addictive and quitting is hard. Almost 70 percent of smokers want to quit and more than half have tried to in the past year. But very few are successful; less than 8 percent who tried were able to kick the habit.

    Second, most smokers today started smoking before they turned 18 years old. Schmidt et al. argue that since we don’t hold children fully responsible for their actions, we shouldn’t hold smokers responsible for a habit picked up in adolescence in the face of targeted tobacco advertising and in the context of other social, cultural, and economic factors. Fundamentally, the choice to use an addictive substance, while a personal one, is not made in a vacuum.

    Conclusions

    There is clear consensus that smoking is harmful to both the smoker and those around her and that restricting where individuals can smoke is a good thing. But there is also agreement that refusing to hire someone based on their tobacco use crosses a line.

    Public buy-in is critical for new public health initiatives to work. While smoking restrictions seem to improve population health outcomes, there may not be support for implementing nonsmoking hiring policies next.

     
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