Is It Okay to Fire People Who Smoke or Are Obese?

Two years ago, as part of their "wellness initiative," the Cleveland Clinic stopped hiring smokers. When the Clinic's CEO, Delos M. Cosgrove, was asked about the program for an article in last weekend's New York Times Magazine, he said that if it were up to him, he would also stop hiring obese people as well.

Clearly, lifestyle decisions lead to huge medical and financial costs to both the hospital and the country. The logic, according to Mr. Cosgrove and others who justify not hiring smokers and people who are obese, is that punitive sanctions will coerce smokers and overweight folks to live healthier lives. Not hiring them or charging them more money for insurance, according to their logic, would effectively persuade people to change harmful health practices.

These arguments and rationale were explored in the August 16th New York Times Magazine piece "Fat Tax." Since public health campaigns have been successful in reducing smoking, the article asks, shouldn't we use similar tactics to rein in obesity?

A few years ago, the Drug Policy Alliance anticipated that arguments used against smokers today could be used against overweight people tomorrow. We spoke out against a Michigan heath care company that fired four employees for refusing to take a test to determine whether they smoked cigarettes. The company, Weyco Inc., adopted a policy that allowed them to fire employees who smoke, even if the smoking happens after business hours or at home. The company justified the firings because smokers were costing their company more money for health insurance.

At the time, the Drug Policy Alliance created a flash animation that asked viewers to vote on whether the company should be allowed to fire employees who smoke. The flash animation laid out compelling arguments for both sides, explaining that smoking results in 400,000 premature deaths each year. But it also pointed out that smoking is not the only activity that increases health risks and costs. Smokers may be the target today, but who will be next? People who are overweight? People who ride motorcycles? Most importantly, the animation raised a powerful question: should people's private lives be subject to oversight by their employers?

Like most people, I support campaigns to reduce smoking and obesity. I believe in public education campaigns and policies that offer help to people who are trying to quit smoking or unhealthy eating. Positive incentives like gym membership reimbursements, or cessation aids like the smoking patch or Nicorette gum, can be valuable aids to those who struggle with addiction. But by firing workers for smoking or being overweight -- and penalizing them when it comes to their health care -- we will be demonizing and marginalizing those to whom we should be reaching out.

They fired the smokers first. Now they are talking about not hiring obese people. Your personal struggle or lifestyle choice may be next!