The Ethics of Not Hiring Smokers.

14 Dec

Dr. Michael F. Roizen

Co-Author of 4 #1 NY Times Bestsellers including: YOU Staying Young.

The Owner’s Manual For Extending Your Warranty (Free Press)

Our basic premise is that your body is amazing.  You get a do over. It doesn’t take that long, and it isn’t that hard if you know what to do.  In these notes, we give you a short course in what to do so it becomes easy for you, and for you to teach others. We want you to know how much control you have over both the  quality and length of your life.

This month, I want to talk about something you might advocate for your business that was featured in two recent New England Journal of Medicine op-eds that highlighted what we had done at the Cleveland Clinic (so forgive me if I use us and Ohio as a parochial example).

Those two recent New England Journal of Medicine op-eds asked a question: “Was it ethical for employers not to hire smokers?” That’s the wrong question.  It should be: Is it ethical for employers to hire those who smoke, a practice that fosters ill health, and therefore makes America less competitive in an international marketplace?

The expense of healthcare in the United States represents over 18 percent of GDP, more than any other country, threatening our sustainability as a nation, and now squeezing out social programs, education, and defense.  Therefore, we must do everything we can to bring down costs while improving quality.  At Cleveland Clinic, we have been able to do that by creating a culture of wellness, which promotes personal healthcare accountability and reduces the burden of chronic disease.  A significant component of chronic disease is tobacco use– accounting for one in every five deaths each year in the USA and in North America.

With a mission to heal the sick and cultivate a healthier community, Cleveland Clinic felt it had to encourage wellbeing to combat disease.  To us, supporting a habit that ultimately leads to death would be unethical.  In 2006, we began offering free smoking cessation to our employees; the following year we offered the same to Northeast Ohio (free, absolutely free).  In 2008, we stopped hiring smokers – a natural progression towards building a healthier community.

Self-reported tobacco use by employees showed that the rate of smoking declined from 15.4 to 6 percent, resulting in a savings of $2,000 per year for each smoker who quit – or $7.4 million less in medical expenses from 3,800 fewer smokers.  Savings are passed on to employees through lower health insurances costs.  By ridding our campuses of second-hand smoke, savings for non-smokers equally translate.

Cuyahoga County’s smoking rate decreased by 11.2 percent by 2009, generating a savings of about $260 million every year for our taxpayers and corporations.  Cost-savings such as this allow our community to remain competitive in the marketplace, create jobs, and fund social programs.

In contrast, the largest cost increase in our state (Ohio) that’s  causing the largest need for increased taxes is the removal by the prior Governor of the $40 million for tobacco prevention programs.  Ohio now spends less for tobacco prevention than any other state. As a result, we have gone from 20.2 % smoking rate for adults in our state (similar to the national average) to 25.4% while the rest of the USA has fallen to 19.2%  (CDC data from bi-annual surveys).  That will soon (there is a delay in costs of about 5 years though we have some increased costs now) result in a extra $1.1 billion in health care costs per year for the state of Ohio and our businesses, and taxes required from our citizens.  Yes, smoking is an addiction, but the fact that over 60 million smokers have quit and have stayed tobacco free means we have the ability to help most, if not all, to breath free, and even more possible to motivate many to never smoke.

What can be the incentive for the individual… if better health or more disposable income aren’t enough? The Gallup organization says the greatest feeling of self-worth and the greatest incentive is to have a job.  If the states and federal governments quit hiring smokers, and offered free smoking cessation to everyone they cover for health care, then that would be a strong incentive for the individual to quit or not start. We could take off over $100 billion a year from our health care bill (and maybe much more if you include things like our disability bills) to allow medical care for those who need it most, and to pay for those things we need like education and defense.

As a health system whose inherent mission is to heal the sick and cultivate wellbeing, does it make sense to support a habit that causes chronic disease and ultimately, higher healthcare costs for all?  At Cleveland Clinic, we don’t believe so.

Thanks for reading,

Young Dr. Mike Roizen (aka, The Enforcer)

NOTE: You should NOT take this as medical advice. 

This article is of the opinion of its author.

Before you do anything, please consult with your doctor.

You can follow Dr Roizen  (and get updates on the latest and most important medical stories  of the week) on twitter @YoungDrMike. 

Feel free to continue to send questions to You can follow Dr Roizen on twitter @YoungDrMike (and get updates on the latest and most important medical stories of the week).  The YOU docs have a new web site:  and its companion the only site we know of where you can find skin products proven to meet the claims (opened for business on June 1st, 2012), and a new book: YOU: The Owner’s Manual for Teens.

Michael F. Roizen, M.D., is chief wellness officer and chair of the Wellness Institute at the Cleveland Clinic. His radio show streams live on  Saturdays from 5-7 p.m . E-mail him questions at   He is the co-author of 4 #1 NY Times Best Sellers including : YOU Staying Young and YOU: The Owner’s Manual. He is Chief Medical Consultant to the two year running Emmy award winning Dr Oz show– The Dr Oz show is #2 nationally in daytime TV.  See what all the fun is about, and what he, The Enforcer, is up to. Check local listings or log onto for channel and time. And for more health info, log onto anytime.

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