From Tobacco Info No. 3 - November 2010
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American report recommends social housing go smoke-free
Canadian tobacco control experts on board
By Joe Strizzi
The demand for smoke-free housing in North America is on the rise as more people begin to understand that there is no safe exposure level to second-hand smoke, notably for those who cannot afford market rates and must rely on affordable social housing. However, ethical concerns prohibiting smoking in multi-unit dwellings have led to slow progress and some opposition. In an effort to protect children from tobacco exposure, health and medical professionals are pushing for a progressive ban on smoking in social housing, this according to a report in the New England Journal of Medicine (NEJM).
“Research shows that those living in multiple-unit housing are being exposed to toxins from tobacco smoke,” said Dr. Jonathan Winickoff, lead author and pediatrician at Massachusetts General Hospital for Children. “Even if you are not a smoker and don’t smoke inside of your own apartment, if you have a neighbour who is smoking inside of his, the entire building is contaminated.”
The NEJM report titled Regulation of Smoking in Public Housing argues that the use of federal regulatory or contractual mechanisms to ensure that public housing authorities implement non-smoking policies in public housing is justified in light of the harms resulting from exposure to tobacco smoke. The lack of other avenues of legal redress for non-smoking residents of public housing and the languid pace at which policy is being implemented are cited as the reasons why.
The report also outlines how a smoker in a single unit of a multi-unit dwelling (MUD) puts others at risk. Tobacco smoke can move along air ducts, through cracks in the walls and floors; off-gassing objects like furniture, carpets and drapes; open windows; outdoor patios and balconies; ceiling fixtures; elevator shafts and along plumbing and electrical lines to affect units on other floors.
Winickoff, along with co-authors Michelle Mello, of the Harvard School of Public Health and Mark Gottlieb, executive director of the Public Health Advocacy Institute at Northeastern University School of Law, contend that tobacco smoke exposure in public housing is particularly troubling because it afflicts disadvantaged and vulnerable populations. In 2008-2009, 32% of American households in public housing included elderly persons, 35% included disabled persons and 41% included children.
The report also suggests that in addition to providing a healthy living environment for children as they grow, smoke-free living spaces will encourage smoking cessation as well as help youth stay away from smoking in the first place.
“When children see smoking in and around their homes, it normalizes the behaviour for them,” said Mello to the Globe and Mail. “Research shows that no-smoking policies in the home lead to lower smoking initiation by teens.”
“As we move forward and further explore public housing policy, it is important to remember that the status quo is not acceptable for children,” added Winickoff. “Each child deserves a healthy start, and we can help provide this by encouraging smoke-free environments.”
The NEJM report goes on to say that exposure to second-hand tobacco smoke in MUDs can be avoided fully only through the implementation of a complete smoking ban. Mitigation measures such as fans, air filters, and separate smoking rooms are ineffective. However, the authors acknowledge that a complete ban could be problematic, as any addiction is difficult to overcome. Furthermore, a ban could put extra pressure on tenants addicted to nicotine and could raise concerns on how to deal with tenants who continue to smoke in their homes.
“Any no-smoking policies within [social housing] would need to be accompanied by clear instructions on how residents can access evidence-based smoking-cessation resources,” said Gottlieb to the Globe and Mail.
The NEJM report concludes that the same legal, practical and health issues that have driven other initiatives such as smoke-free workplaces, private vehicles, and private smoke-free housing militate in favour of extending similar protection to the vulnerable social-housing population.
In the Centre for Addiction & Mental Health monitoring survey, attitudes towards restricting smoking in MUDs are tracked and have increased substantially over the past few years. In 2009, 84% of Ontario adults thought that smoking should be restricted in MUDs; up from 72% in 2005. According to Statistics Canada’s 2006 census, this would affect a number of Ontarians as almost a third of the population live in MUDs.
However, opponents in Canada argue that a smoking ban for social housing would be an attack on the poor and vulnerable who are already at margins of society and that such measures are discriminatory.
According to a report released in the spring of this year by the Non-Smokers’ Rights Association (NSRA) titled Smoke-free Affordable Housing: Picking on Poor People or a Case for Social Justice?, the issue needs to be reframed within a social justice perspective. “Tobacco control with a social justice approach recognizes the social determinants of health and has the potential to remove barriers and equalize opportunities to enable marginalized people to enjoy better health, free of the consequences of tobacco addiction. Housing that imposes sickness and disease is not acceptable.”
The NSRA claim that another determining factor should be that tenants in affordable housing have the least amount of choice and mobility.
“The waiting lists for access to affordable housing are typically long. In Ontario, the average wait for a single person is five years, and in the Peel Region, the wait is up to 21 years for singles and families. Many people who wait for an extended period to get into affordable housing are not likely to simply move out if they experience unwanted second-hand smoke at home. Affordable housing tenants are effectively stuck and relying on affordable housing should not relegate tenants to involuntary exposure to second-hand smoke in their homes,” wrote the NSRA. It added that many affordable housing tenants are already marginalized by higher rates of chronic disease and disability, another reason that smoke-free policies should be implemented.
In a March 2007 study titled Canadian Case Law on Drifting Second-hand Smoke in Multi-Unit Dwellings, the NSRA compiled all the court precedence on smoking related proceedings in MUDs, and summed up the legality of going smoke-free after an examination of these rulings.
The NSRA wrote, “There is no right to smoke enshrined in Canadian law. Non-smokers have a right to breathe clean air and children have a right to be raised in a smoke-free environment. In a small handful of cases, Canadian courts have been sympathetic to the plight of non-smokers unwillingly exposed to drifting second-hand smoke in their own homes. Cases have been won on the premise of nuisance, as well as a breach of the covenant of quiet or peaceful enjoyment.”
Flory Doucas, codirector of the Quebec Coalition for Tobacco Control, said that tobacco control groups are not calling for legislation on smoke-free housing, but are encouraging administrators to progressively implement smoke-free policies by educating them on its legality and providing them with policy options to effectively protect tenants from exposure to secondhand smoke.
The next step
“Canada is the only country that does not have a national strategy. A country-wide policy is needed to help decrease huge waiting lists and improve upon old and crumbling structures,” said Pippa Beck, policy analyst with the Non-Smokers’ Rights Association, who added that people are starting to call health organizations to inquire about their rights to smoke-free housing, but don’t know where to go.
“Education is needed for all involved about the legality of making dwellings smoke-free,” wrote Jack Boomer, director of the Clean Air Coalition of BC (CACBC), in a email to Tobacco Info. “Ideally, we can work with other coalitions and groups across Canada to develop a national approach and learn lessons from each other. The NSRA, the CACBC and other groups across Canada are sharing resources through regular teleconference calls and also sharing resources such as those that are found on provincial websites like BC’s www.smokefreehousingbc.ca and Ontario’s www.smokefreehousingon.ca. As more unique resources are developed in each Canadian jurisdiction, they will be found on the www.smokefreehousing.ca website.”
Social housing in Canada: A summary
In Canada, social housing refers to housing where rent is kept at an affordable level for residents, specifically subsidies targeted to reduce rents to 25-30% of household income.
Public housing in Canada is complicated as all levels of government provide different measures or programs designed to provide subsidized assistance for low-income and poor people, despite housing falling under provincial jurisdiction. Increasingly provided in a variety of settings, public housing used to be one or more blocks of low-rise or high-rise housing operated by a government agency.
The Canadian Mortgage and Housing Corporation (CMHC) reports that the federal government estimates 440,000 households or 4% of Canadians received housing assistance under any level of government. However, they contend that their own estimates, as reported by the CMHC in 2000, show that some 639,000 households received housing assistance under existing federal agreements.
In September 2008, the Government of Canada dedicated $1.9 billion over five years for housing and homelessness programs for low-income Canadians. Canada’s Economic Action Plan includes a further, one-time investment of more than $2 billion over two years to build new and renovate existing social housing.
At the 2009 Smoke-free Housing Forum, it was recognized that a national approach to address the issue was needed, but that jurisdictions across Canada were at very different stages in terms of knowledge base, funding and capacity.
Regulatory vanguard in Waterloo
In Waterloo, Ontario, the municipal government owns and operates some 2,700 new, smoke-free units that house seniors, singles and families in need of social housing. As of April 1, the city banned smoking in dedicated social housing. This smoke-free policy will only apply to new tenants who move in on or after April 1. It does not apply to existing tenants unless they move to a new unit. The new policy also restricts outdoor smoking to five metres from a building. The policy provides three levels of smoking cessation programs: all new tenants as of April 1 will be offered six sessions of group or individual counselling and five weeks of free nicotine replacement therapy, such as nicotine patches; existing tenants will be offered group counselling and five weeks of free nicotine replacement therapy; and tenants who experience health conditions or other challenges, such as mobility issues which may limit their ability to go outside to smoke, will be offered individual counselling and free nicotine patches for a duration to be determined by a public health nurse. A regional survey in October 2008 found that 52% of residents living in regional facilities favoured a smoking ban.