Is anti-smoking employment policy smart health care or merely discrimination?

It’s nearly impossible to be a smoker today. In Philadelphia, the Clean Indoor Air Worker Protection Law prohibits smokers from lighting up in public spaces, including their place of work. The law also bans smoking in outdoor seating areas and within 20 feet of building entrances.

This week, Main Line Health decided to take its smoke-free workplace to the next level by announcing a new policy aimed at curbing the use of tobacco products among its workers.

From Main Line Health’s Career portal website:

Main Line Health is committed to the health and wellness of our employees. With that goal in mind, effective May 1, 2014, Main Line Health will implement a new “Tobacco Use Impact on Employment Policy” aimed at reducing the use of tobacco and nicotine products among Main Line Health employees.

To ensure that prospective employees are smoke-free, Main Line Health will require applicants to certify on their online application that they have not used tobacco products or nicotine in any way, shape or form for 90 days prior. Applicants will also be asked to abstain from smoking during their career with Main Line Health.

Insisting that employees embrace a healthy lifestyle is a commendable goal that should be shared by all health care providers. However, this new policy, a similar version of which is enforced by Thomas Jefferson University Hospital, is troubling on many fronts. It eliminates a significant number of job seekers from consideration for employment (which could also be viewed as employer-sanctioned discrimination), and it conflicts with Main Line Health’s commitment to a diverse workplace where employees and their experiences are valued.

Dr. Frank Leone, the director of the Comprehensive Smoking Treatment Program at the University of Pennsylvania, believes the new policy may have unintended consequences for Main Line Health and its employees.

“I think policies like this make it less likely that people are going to stop smoking,” said Dr. Leone.

Who does nicotine discrimination hurt most?

Legally, employers in the state of Pennsylvania have the right to determine how their workplaces are run, and there is no law on the books in Harrisburg that elevates smokers to a protected class in the same way that race, age, religion and disability status are protected. There are however laws in 29 states and Washington, D.C., that do shield individuals from discrimination on the basis of their smoking habits.

A tobacco-use ban by a large company like a health care provider here in Pennsylvania could be viewed as a legal form of discrimination. A study conducted by the Centers for Disease Control and Prevention (CDC) in 2012 revealed that whites account for 21.2 percent of Pennsylvania’s smoking population, while African-Americans make up 28.7 percent, Hispanics 27.1 percent, and Asians 6 percent. That’s 60 percent non-white for those keeping score.

Imagine if that number was applied to Philadelphia and its 1.5 million residents. If 74 percent of the population is over the age of 20 (according to a recent study by the Pew Charitable Trusts) and 22.4 percent is smoking (based on the CDC study), then the city of Philadelphia would be home to more than 149,184 non-white smokers who are now disqualified from applying for employment at Main Line Health as a result of its new policy.

If more companies choose to adopt the same non-smoking policy as Main Line Health and Thomas Jefferson University Hospital, a matter of employer discretion could severely limit the amount of job applications from minorities. Such a limitation could impact funding from state and private donors and deprive Main Line Health of a very valuable asset — a diverse workforce.

Driving the epidemic underground

What’s most ironic about Main Line Health’s decision to crack down on its employees’ smoking habits is the organization’s commitment to having a diverse, inclusive workforce.

On its career website, Main Line Health’s president and CEO Jack Lynch writes, “the men and women who make up Main Line Health are committed to creating a culture that welcomes and embraces the diverse backgrounds and traditions of our employees and the patients we serve.”

He goes on to explain that “[d]iversity means viewing each person as an individual and respecting the unique talents, experiences and contributions they bring to our organization. Main Line Health is dedicated to creating an environment of inclusiveness which is apparent to everyone who comes to us for care, to everyone who works or volunteers here, and to everyone with whom we do business.”

For some, smoking a cigarette, a pipe, or a cigar is part of their life experience, but it could also be an addiction upon which they are dependent. The reasons an individual continues to smoke are as diverse as Lynch’s employee base at Main Line Health, and for the ones who are addicted to nicotine, the process of defeating that addiction is not an easy one. Using a person’s job as leverage to quit could do more harm than good.

“Policies like this turn smoking into a secret,” said Dr. Leone. “I can’t think of another example of a public health crisis we’ve faced at anytime in history where the approach was to drive it farther underground and make it more of a secret. We try and actually engage people with the problem and deal with it head-on in a rational, scientifically based approach.”

Recognizing a missed opportunity

An employer’s focus should be on the applicant or employee’s talents and how they benefit the organization, not on what they do off the clock. Instead, Main Line Health and Thomas Jefferson University Hospital should focus on promoting an environment that allows an employee with a nicotine addiction to feel supported, so that when they decide to put an end to their tobacco dependency, they know what resources are available to them.

More importantly, Main Line Health is robbing itself of a major PR opportunity. If a health system can boast about its success rate with helping its employees kick the habit, that success will have smokers throughout the Greater Philadelphia area lining up to be a part of it. Dr. Leone likens the decision to quit with the thought process of a person learning to swim.

“Trying to push too hard is what keeps people out of the pool. Being calm, courteous, respectful, supportive, and being an advocate is what encourages people to come into the pool with you.”

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CORRECTION: A previous version of this article indicated that Pennsylvanians are protected from discrimination based on sexual orientation. Sexual orientation is not a basis of discrimination protected under current state or federal law. It is, however, included as a protected class under the city of Philadelphia’s non-discrimination ordinance.