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

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.

2. (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.