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Pragati B Hebbar and Vishal Rao: Tobacco or a job?

31 Jan, 14 | by BMJ

The department of personnel in Rajasthan, a state in India, has taken a bold step by making it mandatory for candidates who want a government job to commit to not smoking or chewing gutka (smokeless tobacco product) when in government service. [1] What could be the reason for such a move? Do such rulings help people quit? What are the advantages of such a ruling?

To attempt to answer these questions, first let us take a look at the government’s healthcare expenditure because of  tobacco use by their employees. Absenteeism and reduction in work productivity among smokers compared with non-smokers has been studied time and again, and is being used even by insurance companies. Smokers are made to pay an additional premium as they are more prone to various diseases compared with non-smokers. In a similar way, why would the government invest in people who are ultimately a liability? When the government is spending huge amounts of money ensuring the wellbeing of its employees and their families through various health schemes, it has the right to enforce policies which ensure healthy lifestyles among their employees. The government could expect to spend more on smokers because of the increased likelihood that they will have a major illness such as cancer, heart, and lung diseases, and so will their family members who have been exposed to secondhand smoke. The Rajasthan ruling paves the way for a healthier work environment for all employees. This can already be seen in the hospitality industry where the major benefit of having smoke free hotels is protecting the health of employees who are constantly exposed to second hand smoke, as well as increasing business by encouraging a more family based crowd.

The International Classification of Diseases has now classified “tobacco dependence” as not just a habit, but a disease. With studies on quit rates indicating figures not even reaching double digits, the nature of strong addiction can be gauged. Such rulings can prompt young new users to quit the habit for want of a job. This will also help long term users to quit if they wish to continue in their jobs. An example of a successful attempt to make workplaces free of tobacco is of Bajaj Electricals [2] which found 157 of its 1400 employees using tobacco two years ago. It decided to make the entire workplace tobacco free, and two years down the line the number of users is zero. Such workplace policies can be an effective tool to increase quit rates if dealt with sensitively by providing the required help to people who want to quit. This is an issue not only related to government jobs. Even private companies can take up the matter of tobacco use proactively, and successfully develop a healthier workplace.

The other side of this issue is whether public health policy is infringing on private and personal choice. The example of polio vaccination by the Indian government is an excellent example of public policy benefiting the population at large over personal choice. The vaccination of children below 5 years was initiated in 1978 by the Indian government. This campaign was intensified in 1995-96, and in 2012 the World Health Organization declared India free of polio. The polio programme was a success not only by improving the health of children, but also by improving the health of many others who would have been infected by transmission from an unimmunised child.

Similarly tobacco free work place policies could go a long way in safeguarding the health of employees, employers, their families, and the public at large. The benefits would definitely outweigh the initial struggle in setting up such work policies.

In India, with roughly 60-70% of healthcare expenditure being out of pocket, the financial brunt, as well as the physical and emotional burdens, are borne by families. Recently it has been shown that owing to tobacco use, 15 million people in India are being pushed into poverty. [3] An estimate of the amount of direct and indirect costs due to tobacco use was around 1.7 billion in India as calculated in 2004. This is a huge loss to the nation in terms of economic growth and loss of productivity considering the lakhs of premature deaths. Hence it is a win-win situation where the government’s expenditure on healthcare is reduced, work productivity of employees is increased, and their overall wellbeing is also improved.

The Rajasthan ruling can set the stage for tougher tobacco free policies at work places and is a welcome decision. Can and will other Indian states pass a similar rule? That is something that only time can tell.

Competing interests: All authors declare that that we have read and understood the BMJ Group policy on declaration of interests and we have no relevant interests to declare.

Pragati B Hebbar is a dentist. She did a Masters in oral medicine and radiology and is currently working as an advocacy officer at the Institute of Public Health, Bangalore.

Vishal Rao US, is a senior consultant oncologist at the department of head and neck surgical oncology, at the BGS Global Oncology Institute. He is a consultant at the Institute of Public Health, Bangalore.

References:
1. http://articles.timesofindia.indiatimes.com/2013-11-08/india/43821497_1_tobacco-control-tobacco-users-tobacco-consumption
2. http://bajajelectricals.com/download/news/smoke-free-zone.pdf (accessed on 25/1/2014)
3. John RM, Sung HY, Max WB, Ross H. Counting 15 million more poor in India, thanks to tobacco. Tob Control. 2011 Sep;20(5):349-52.

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  • Upendra

    Happy to see this blog by colleagues and good friends. While I have seen authors’ efforts to reduce tobacco use in society from close quarters and am appreciative of their work and views in general, I cant agree on this stand. I feel in a broader view of moving towards well being of population, tobacco free workplace is okay but I find it too much to pit employment opportunity against an individual habit, which is too addictive and often sustained despite knowledge about its harms in a society where nearly half of men and a quarter of women folks use tobacco.

  • Greg Burrows

    What next alcohol eating the wrong food, being slightly over weight, on what grounds are a Totalitarian society justified, none, you make up weak excuses such as this passage, “which found 157 of its 1400 employees using tobacco two years ago. It
    decided to make the entire workplace tobacco free, and two years down
    the line the number of users is zero”. How many of these people who smoke, left the company in this time and what was the cost in their skills, people smoke for various reasons, and without them our society would be far poorer, most of the great statesmen and inventors, were heavy smokers, creating an apartheid between smokers and non smokers, and even denying them the right to work, because of a health or political agenda, instituting that they must do your will, this is dictatorship, of the worst kind.

  • http://www.daktre.com/ NS Prashanth

    Tobacco-use in and around workplaces has undergone a lot of change in India. I remember as a kid, when I used to accompany my grandfather to banks, ashtrays were the norm at most desks where people were writing challans. In fact, many would be smoking as they wrote and others would inhale without choice. Even before the legislation came in to ban smoking in public areas, there was already a cultural taboo building towards people who would exhale smoke in public areas such as parks, bus-stands and government offices.

    That said, is it not a bit much to expect people joining government jobs to commit to not smoking while in government SERVICE? I hope what is meant is that they would not smoke while in their workplaces/premises. There is also a strong case to be made of individual choice here. I understand the polio example of course, but “choices” people make to smoke or not is often not about exercising a moment’s free will. And when they do exercise this within the confines of their homes, should s/he be held in violation of such commitments?

  • Praveen Aivalli

    Very nice blog, a good move by Govt. of Rajasthan. I think such rules should come in corporate sector as well specially in IT companies of Bangalore. My friend who works in reputed IT company in Bangalore who smokes 5 to 6 cigarettes per day, he is completely addicted to cigarettes, before joining the company he wasn’t a smoker, IT companies “smoker zone” and work stress made him a smoker, I am wondering why these companies should create a “smoker zones” in their buildings ? is smoking is the only way to tackle work stress ?

  • Praveen Aivalli

    Very nice blog, a good move by Govt. of Rajasthan. I think such rules should come in corporate sector as well specially in IT companies of Bangalore. My friend who works in reputed IT company in Bangalore who smokes 5 to 6 cigarettes per day, he is completely addicted to cigarettes, before joining the company he wasn’t a smoker, IT companies “smoker zone” and work stress made him a smoker, I am wondering why these companies should create a “smoker zones” in their buildings ? is smoking is the only way to tackle work stress ?

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