Memorial Hospital's decision to stop hiring workers who smoke beginning February 1 can be broadly justified as a symbolic standard for a health-care provider. Yet its challenge to traditional standards of fair treatment for employees and job applicants is a bit more tricky. Ultimately it leads to question of whether employers should attempt to regulate the private, legal, off-premises, life-style behaviors of their employees, and, if so, where to draw the line.
Memorial Hospital's decision was not based -- as many might suppose -- on potential savings in health-insurance costs, said Brad Pope, vice president of human resources. Rather, it was intended to reflect the hospital's commitment to health. (Tobacco use is already forbidden on the entire Memorial campus, and current employees who smoke will not come under the ban.)
"Like it or not, what's proven is that tobacco is the most preventable cause of death and disability in the United States," he said. "I think the Chattanooga and surrounding communities should expect this from Memorial."
Use of tobacco is, indeed, the most readily apparent example of an external, deliberately selected behavior that is devastating to an individual's health. It also is seen as a risk that individuals should be able to control or quit, however strong the addiction.
People who choose to smoke risk not only their own health; their second-hand smoke also poses a health risks for those around them. Smokers willingly, if negligently, run a high risk of several types of cancer and pulmonary disease, and their higher, tobacco-related, health care costs often falls heavily on insurance costs to the government (through Medicare and Medicaid) or a user's employer and colleagues, whose insurance premiums bear the cost-sharing burden.
Thus it has become easy for non-smoking colleagues and their employers to justify a demand for higher insurance premiums from their tobacco-using colleagues, or, more obliquely, to provide discounted premiums for those who do not smoke.
Tennessee's businesses and government agencies, moreover, have more reason than some other states to actively discourage tobacco use. Tennessee's smoking rates are higher than in many states. Tennessee's rate was 23.1 percent in 2008; that's significantly higher, for example, than the 19.5 percent rate in Georgia. Tennessee's youth smoking rates also are going up, rather than down.
Still, tobacco is hardly the only risky behavior that individuals, in many cases, could consciously avoid to safeguard their health and to lower potential health-care costs to themselves, their employers and to the general economy. Soaring rates of obesity, a precursor to type-2 diabetes, is perhaps the next best example.
With an adult obesity rate of 30.2 percent, Tennessee is the fourth-most obese state in the nation, according the most recent annual report by the Trust for America's Health. Worse, the obesity rate for children in this state is a shocking 36.5 percent. In fact, health care officials now predict that one of every three children born after 2000 will be obese and at risk of type-2 diabetes.
At stake in the near future is both the health-care costs of obesity, which ranges widely from diabetes to heart and vascular disease and a range of other ailments, and the resulting sickness, disability and loss of economic productivity. In fact, obesity rates now portend significantly higher economic and health care costs, and a substantial drag on our general prosperity. Coupled with our lamentably low education rates, the downward trend of our health indices is yet another crippling blow to the state's future.
Yet other risky behaviors abound. Many people, for example, drink too much alcohol. Others ride motorcycles, which produce a high incidence of catastrophic brain injuries and exorbitant medical costs that is often shifted to the public. One could argue that rock-climbing, hang-gliding, sky-diving, and bicycle, ATV and horse-back riding are needlessly risky.
It is imminently fair to ban smoking and other tobacco use at work, and to charge differentiated health insurance premiums. But if it is fair to discriminate against smokers by barring them from jobs on the grounds of a commitment to health, why stop there. Or better yet, why begin down that slippery slope.