Conflicts and compromises in not hiring smokers.

1371 that “there but for the grace of God go they.” Given nonsmokers’ resistance, it would be helpful if employers providing smoking-cessation support engaged in early outreach emphasizing that helping smokers to quit adheres to the principle of risk pooling underlying health insurance. Successful cessation programs could lead to higher productivity and lower insurance contributions for nonsmokers, thereby benefiting all employees. The goal of reducing smoking rates is important. Although smoking rates among U.S. adults have decreased from 42% in 1965 to 19% today,5 more remains to be done, particularly for low-income and unemployed populations. Promoting public health is a shared responsibility, and employers have a social obligation to contribute to the public health mission outlined by the Institute of Medicine: “fulfill[ing] society’s interest in assuring conditions in which people can be healthy.” By cherrypicking “low-risk” employees and denying employment to smokers, employers neglect this obligation, risk hurting vulnerable groups, and behave unethically. The same goes for imposing high penalties on smokers under the guise of providing wellness incentives. We believe that employers should consider more constructive approaches than punishing smokers. In hiring decisions, they should focus on whether candidates meet the job requirements; then they should provide genuine support to employees who wish to quit smoking. And health care organizations in particular should show compassion for their workers. This approach may even be a win–win economic solution, since employees who feel supported will probably be more productive than will those who live in fear of penalties.