If a company eliminates applicants because of an unhealthy behavior, are they fostering workplace wellness, or cutting healthcare costs? Are they promoting a culture of healthy employees, or discriminating against potential candidates? Or is it somewhere in between?

With U-Haul’s new smoke-free policy, workplaces across the country have to ask themselves where the policy falls.

U-Haul’s New Policy

On December 30th, U-Haul International announced that beginning February 1, 2020, it would implement a nicotine-free policy in 21 states without protections for smokers’ rights. As of February 1, it will become one of the first major companies to decline applicants who are nicotine users.

The policies will be enacted in:

• Alabama
• Alaska
• Arizona
• Arkansas
• Delaware
• Florida
• Georgia
• Hawaii
• Idaho
• Iowa
• Kansas
• Maryland
• Massachusetts
• Michigan
• Nebraska
• Pennsylvania
• Texas
• Utah
• Vermont
• Virginia
• Washington

According to the company, applicants in these 21 states can expect to see the anti-nicotine policy on their job applications. They will be questioned about their nicotine use and may be required to undergo nicotine testing in certain states before they can be deemed hirable.

The policy also covers e-cigarettes and vaping products. Any current U-Haul employees who are nicotine users will be grandfathered into the policy, offering nicotine cessation programs to assist them.

The goal of the policy, nominally, is to further U-Haul’s goal of promoting one of the healthiest corporate cultures in the United States and Canada.

Policy Implications By the Numbers

In Arizona alone, where U-Haul is headquartered, the implications of the policy are significant.

U-Haul employs 30,000 workers in the United States and Canada. In Arizona, it is one of the state’s largest employers, with a workforce of more than 4,000. It is also legal in Arizona to discriminate against nicotine users in the hiring process.

That might be good news for people exposed to nicotine, but not for applicants who use nicotine.

As of 2017, 15.6% of adults in Arizona smoked cigarettes, while 5.3% of adults used e-cigarettes and 2.8% used smokeless tobacco. Out of a population of roughly 7.1 million, that’s over 1.1 million adults who smoke cigarettes, 376,300 who use e-cigarettes, and 198,800 who use smokeless tobacco.

All of whom would no longer be eligible for employment with U-Haul — which is, again, one of the largest employers in the entire state of Arizona.

The Public Health Implications of Smoking

Of course, the public health implications of smoking and nicotine use are nothing to sneeze at. Nicotine is known to be a dangerous and highly addictive chemical, and it is by no means the only chemical associated with smoking. Cigarettes contain more than 5,000 chemicals, hundreds of them harmful to human health, including:

• Arsenic
• Benzene
• Cadmium (a metal used to make batteries)
• Formaldehyde
• Tar

Smoking has been linked to 90% of lung cancer cases. Almost one-third of coronary heart disease deaths are the result of secondhand smoke. 

Nicotine itself is known to increase blood pressure, narrow the arteries, and contribute to hardening arterial walls, which in turn can lead to heart attacks.

It is, in short, one of the main preventable causes of death in the United States.

The risks are also high for anyone around secondhand smoke: people exposed to it are 25% to 30% more likely to develop heart disease.

Public Health, or Lower Healthcare?

U-Haul posits the policy as part of a shift toward corporate health and wellness, asserting that the shift toward a healthier workforce is an investment in the wellbeing of their team members. The policy, according to U-Haul, will help reinforce a wellness program that encourages workers to focus on four areas: health, fitness, nutrition, and mindset.

However, the company also noted that the policy was part of a continued effort to decrease healthcare costs.

Are There Cost Benefits? 

Workplace wellness is an industry with $8 billion in annual revenue in the United States. Almost half of all employers with at least 50 employees offer a workplace wellness program. Of those that don’t have a program, half have said they plan to introduce one.

The popular story among corporations and researchers is that these efforts reduce healthcare costs for employers. A 2010 review by a Harvard economist stated that wellness programs return $3 in healthcare savings and $3 in reduced healthcare costs for every $1 invested.

But is that actually the case?

Research by the RAND Corporation, including data from 600,000 employees from seven employers and 10 years of data from a Fortune 100 employer, found that wellness programs have little, if any, immediate impact on employer healthcare costs.

Generally, wellness programs have two components: lifestyle management (which focuses on employees with health risks such as obesity or smoking), and disease management (which focuses on employees who already have a chronic disease). Together, the two programs generate $30 in savings per member per month. But 87% of those savings came from disease management, even though only 13% of employees participate in disease management — compared to 87% participation in lifestyle management.

One might make the case that disease management can result from diseases caused by smoking, but U-Haul’s policy targets lifestyle issues and prevents nicotine users from being hired in the first place, thereby precluding their ability to participate in disease management programs.

In short, it’s hard to say whether U-Haul’s policy can save the company healthcare dollars in the long run.

Loopholes in the Policy That Penalize Workers

But what we can say is that the policy penalizes nicotine users, including those who are trying not to use nicotine.

The program as presented makes no exceptions for nicotine users who are trying to quit smoking. And while nicotine users can remain smoke-free, 30% of them do so with the aid of some kind of nicotine product.

What about quitting with nicotine-free products? That’s not as easy as it sounds. The FDA has only approved two nicotine cessation products that don’t contain nicotine: Chantix and Zyban.

And yes, nicotine replacement products and medicines do show up in nicotine screenings. Nor does the policy seem to differentiate between smokers and those with nicotine in their system due to secondhand smoke, or between cigarettes and nicotine products with a lower risk to bystanders, like smokeless tobacco.

Balancing Wellness and Fairness

Is the policy good for worker health? From the perspective of removing harmful substances from the workplace, yes.

Is the policy fair for workers? From the perspective of smokers and people with smokers around them, not so much.

That U-Haul’s policy lacks any differentiation implies that the company’s stance is a moral one more than a health one. Given that the healthcare cost benefits to the employer seem unclear, it begs the question: How much employers can force their own policy views to restrict the lives of their own employees?

It’s not a bad idea to discourage unhealthy habits per se. The issue is doing it in a productive and nondiscriminatory way. U-Haul’s broad policy is a bit unclear in that regard, so we’ll have to watch how this plays out.