Should Asian companies hold employees who smoke accountable?

It’s a big question and requires a careful and nuanced answer. Because although attitudes towards smoking have changed over the years, with many countries introducing strict anti-smoking laws and seeing smoking rates fall, there are still pockets of the world where smoking continues to be quite prevalent, and Asia is one of these regions.

And to hit hard with the numbers, tobacco use still kills around six million people each year.

That’s according to the latest figures from the World Health Organisation (WHO), which states that five million people die each year as a result of direct use, with over 600,000 dying due to secondhand smoke.

And all of this before even mentioning the health insurance costs relating to treating smoking illnesses.

So is it time for corporations to get involved through accountability programmes? Let’s explore.

Counting the cost of smoking in Asia: The human and the financial

Let’s look at the current situation before we get into solutions.

Right now, one third of the world’s smokers live in the Asia-Pacific region. In terms of individual countries, China sees over one million tobacco-related deaths per year and is home to over 300 million smokers, with more than 50% of the male population smoking regularly.

This figure is even higher in Indonesia, where according to the Campaign for Tobacco-Free Kids charity, nearly 70% of Indonesian males smoke and the habit causes 21% of adult male deaths and 8% of female deaths.

The trend continues over in Thailand, which had a male smoking population of 46.6% back in 2011, with reports of the rates rising substantially since.

Across the rest of Asia, Singapore is seeing a smoking prevalence of up to 16% of working adults in 2012, according to its Ministry of Health, while Malaysia has had a slight fall in smoker numbers over the last decade but is still home to a male smoking population of 43%.

In almost all cases, the number of female smokers is dramatically lower.

Nearly 70% of Indonesian males smoke, and
the habit causes 21% of adult male deaths
and 8% of female deaths.

So these are the human costs. And they are severe.

But then there is the huge financial burden that smoking places on these countries and their health services and insurers. Several studies, including one by Ohio State University, have looked into the hidden price of smoking and found that the excess cost to the business that employs a smoker is in the region of USD 6,000 per year in lost productivity. This comes not only from sickness but also the extra breaks that smokers take – not an insignificant loss for any company if you have a workforce with a high number of smokers.

Countrywide, that would soon add up. Take Thailand for example: A recent study from the University of Tokyo in conjunction with the Thai Ministry of Public Health put the total costs of smoking on the Thai economy in 2009 at USD 2.18bn due to productivity loss and medical costs. And these figures are very much echoed throughout much of the rest of Asia.

So the question is, to what extent should employees be held accountable for their choice to smoke? 

The accountability question

There is plenty of help and assistance that corporations can offer in terms of access to health professionals and smoking cessation classes, as well as very effective medication options to counter nicotine dependence – and these should absolutely be made available as part of a comprehensive wellness package. However, if we are really going to tackle this huge problem, it must be approached head on, by, quite frankly, putting accountability with those who smoke.

It’s common for employers to actively work to reduce the prevalence of smoking among their employees, from quitting classes to limiting on-site smoking areas. But now we’re seeing many companies take a harder line in the US. A paper published in the American Journal of Health Promotion argued that more needs to be done in terms of economic incentives to quit. Hit people where it hurts, in the pocket.

Because some American companies are no longer using quiet incentives to change the behaviour of their employees. According to Bloomberg, the department store Macy’s is adding a surcharge to health coverage for those employees who smoke, while a similar scheme is now in place at PepsiCo. Reported in MarketWatch, employees at Direct General are now required to do a nicotine screening test, since the ‘honour system’ of informing employers that you smoke was not always being … honoured. A controversial move, but companies in Asia-Pacific can certainly take something away from this strong anti-smoking stance to increase employee health and decrease healthcare spend.

According to Bloomberg, the department
store Macy’s is adding a surcharge to health

coverage for those employees who smoke.

Ultimately, it’s a case of putting the onus back on smokers to take responsibility not only for their health but the extra costs that result from their lifestyle choices. 

Smoking: Time for Asian governments to step up

When tackling a problem as big as smoking in Asia, a single-pronged attack is never going to be enough. Pressure must come from all angles to get the message across that if you smoke there are consequences – for your health and beyond.

Many countries around the world have seen huge success in bringing down smoking rates through blanket bans in public places. Along with the US and the UK, many others including Ireland, Spain, Italy and Canada have all seen smoking rates decrease since imposing anti-smoking laws over the past decade or so.

Often these public bans have been launched in conjunction with hard-hitting advertising campaigns and the implementation of graphic images of the effects of smoking on cigarette packaging. And, according to the World Health Organisation (WHO), such campaigns are hugely effective – noting that from Brazil to Thailand, pictorial warnings ‘…significantly increase people’s awareness of the harms of tobacco use.’


Unfortunately, only 42 countries (19% of the world’s population) meet the best-practice guidelines for such warnings on packaging, highlighting just how much more work needs to be done. The same goes for smoking bans – particularly throughout Asia. There are few anti-smoking regulations in place throughout many countries in the region, including China, the Philippines, Japan and Indonesia. Though it must be said, things are moving in the right direction: Both China and the Philippines have laid out plans for nationwide public bans in the near future.

Societal change, instigated by the government, may have the most power to reverse this costly trend and bring smoking rates down throughout Asia. It has been shown to be hugely effective in many other countries, including much of Western Europe and North America. As smoking becomes less of a social norm, fewer people are inclined to do it.

Societal change, instigated by the
government, may have the most power to
reverse this costly trend and bring smoking
rates down throughout Asia.

It’s time for that to start happening across Asia. The message from employers, governments, health bodies and insurers must be simple and united: If you smoke, you pay for it. 

What’s next for corporations concerned with healthcare costs?

The financial impact that smoking has on corporations in enormous. And while implementing cessation classes, limiting smoking spaces, and fresh governmental initiatives all help, the time has come for the employer to push back and ensure the employee takes responsibility for their choice to smoke.

This is a controversial position to take, and there has been much blow-back against US companies that have already taken up such measures. But this might just be a case where getting tough does ultimately benefit individuals, companies and insurers. Not an easy decision, to be sure, but one that will need to be addressed sooner or later.


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Inova care is an industry leading consulting and health care administration company specializing in managed care, clinical pathways and cost containment solutions for corporations and insurance companies.


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