For the past two years, the Cleveland Clinic has refused to hire smokers. This non-profit American research and treatment health centre (consistently rated as the #1 heart institute in North America) introduced this groundbreaking no-smoking hiring initiative as a way to walk the talk about the health and wellness of not only the 50,000 patients admitted each year, but of its 1,800 employees.
But now the head of the Cleveland Clinic says he wants to take this bold hiring policy one step further – and some are saying this would be going too far. Dr. Delos (Toby) Cosgrove, the heart surgeon who is the Clinic’s CEO, told the New York Times that if it were up to him, he would not only stop hiring smokers. He would also stop hiring obese people.
Dr. Cosgrove maintains that health professionals should be as proactive in addressing people’s weight issues as they are in pushing them to quit smoking. He claims:
“Our anti-obesity efforts have none of the urgency of our anti-smoking efforts. We should declare obesity a disease, and say we’re going to help you get over it.”
His theory: obesity can lead to early deaths and skyrocketing health dangers.
The Clinic chief was also quoted in the Wall Street Journal challenging U.S. federal government employment protections for obese people under the Americans with Disabilities Act, saying it could hinder efforts to address the problem.
But he’s willing to walk the talk. The Cleveland Clinic is among only about 10% of American employers that help cover bariatric surgery costs for employees. The hospital reimburses employees their co-payment (about $3,000) over five years providing they participate in follow-up care. The Clinic has spent $10 million since 2003 on the employee benefit, one of several health and wellness initiatives offered to its 40,000 employees. For example, they have eliminated fried foods, removed soda and candy from vending machines, and subsidized Weight Watchers and fitness programs for its employees. Dr. Cosgrove adds:
“In the past nine months, we’ve lost 110,000 pounds across the organization, which I think is an amazing tribute to the program.”
Dr. J. Michael McGinnis, senior scholar at the Institute of Medicine, sums up the overall causes of all early deaths in North America in this way:
- 10% of early deaths are the result of medical treatments
- 20% stem from social and physical environments
- 30% from genetics
- 40% of all early deaths are linked to patients’ personal behaviour choices
It’s taking responsibility for one’s personal behaviour choices that Dr. Cosgrove is pushing. And no wonder. He’s a cardiac surgeon who has spent a lifetime trying to save the lives of patients for whom heart disease seemed the logical endpoint after decades of poor lifestyle decisions. He maintains that we expect others will somehow magically provide a pill or a procedure to fix whatever ails us. We prefer to to outsource taking care of our own bodies to something called the health care system.
Consider that people in their 50s today are about 20 pounds heavier on average than 50-somethings were just 30 years ago. Dr. Cosgrove and other cardiologists now believe that this extra weight has caused a sharp increase in chronic diseases like diabetes and heart disease.
Dr. Cosgrove’s would-be hiring approach certainly poses some problems. Is it too severe? Is its focus too narrow? He acknowledges that any effort to attack obesity will inevitably involve making value judgments and even limiting people’s choices – just as Western society has already done to smokers.
And he’s not alone.
In the U.K, patients who refuse to stop drinking are now being removed from liver transplant waiting lists, as physicians start demanding that their patients take equal responsibility for their part in expensive, resource-draining procedures – procedures that have a high failure rate among those who are still drinking.
Demanding individual responsibility for poor behaviour choices can have dramatic and far-reaching implications for all health care decisions. And if influential people like Dr. Cosgrove get their way, our unhealthy choices may even affect our chances of landing a job someday.
But it’s tricky. Our culture has changed dramatically over the past few decades:
- We’re taking in more calories than we’re burning off.
- Gym classes and even recess have been cut in schools.
- We live sedentary lives all day at work and later at home in front of the computer or TV screen.
- We drive cars everywhere instead of walking or biking.
- We eat appalling amounts of pervasively advertised high-fat, high-salt, low-fibre, highly processed food-style products.
- We work such long hours that we’re too exhausted to even think about exercising.
- We’ve got multi-tasking down to such a fine art that our stress level doesn’t even seem abnormal anymore.
Economics journalist David Leonheart, writing in the New York Times, argues that the solutions to obesity problems are beyond the control of any one overweight individual.
“They involve a different sort of responsibility: civic — even political — responsibility. They depend on the kind of collective action that helped cut our smoking rates nearly in half. Anyone who smokes in an elementary school hallway today would be thrown out of the building. And taxes on tobacco have skyrocketed. But if you serve an obesity-inducing, taxpayer-funded school meal to a kindergartner, you would fit right in.”
What do you think of Dr. Cosgrove’s hiring ban idea?