How a smoking ban is regressive policy

Imagine a smoking ban in the privacy of your own home? For over 2.3 million residents of public housing, this will be their reality. On November 12, 2015, former Secretary of Housing and Urban Development (HUD), Julian Castro, announced HUD’s policy for “smoke-free” federally funded public housing. The policy requires that residents refrain from “using tobacco products in their units, common areas, and within 25 feet of public housing and administrative office buildings.”

I do not think anyone can reasonably argue that the goal of smoke-free housing in itself is a bad thing.  During medical school, I remember seeing numerous children diagnosed with asthma and other allergic disorders, whose parents were chronic household smokers.  Regardless, the means by which HUD has suggested achieving this goal is not good public policy, and should not be embraced by the public health community.

First, let’s talk about enforcement. HUD suggests that housing officials treat smoking like other “nuisance violations.” However, how can smoking be treated like other violations people sign in lease agreements? If someone breaks equipment in the housing unit, of course, they should pay for it. If someone plays music too loudly, of course, they should be warned to “turn it down in there!” But smoking is inherently different. Smoking tobacco is not like other violations because it is addictive. According to the American Cancer Society, it can take up to 8 to 10 quit attempts before someone is successful. Therefore, the science predicts someone will relapse several times. And when they do, they are likely to be in the privacy of their own home — where they feel safe, secure, and secretly shameful. What if each time they light a cigarette they are marked with another code violation; with the threat of eviction around the corner?

On the contrary, one can argue that eviction is unlikely. In a HUD survey of 11 public housing agencies (PHAs) which implemented smoke-free policies, up to 6 percent of residents were evicted due to smoking in restricted areas. However, as of July 3, 2014, less than 10 percent of PHAs have adopted smoke-free policies. Therefore, there is the possibility that eviction rates will rise as more PHAs enforce the new policy. HUD is delegating enforcement to PHAs, advising them to follow “graduated enforcement.” Nonetheless, variation in enforcement practices should be expected, with some agencies adopting more liberal practices than others.

Secondly, the policy is markedly regressive. Federally funded public housing was created with the intent to provide homes first — not to be the experiment for a public health policy agenda. HUD’s job is to combat homelessness; to ensure the safety and security of our most vulnerable populations. Data from the CDC indicate that 26.3 percent of smokers today live below the poverty level. Additionally, according to 2015-2016 data, 64 percent of residents in HUD-funded housing make “extremely low income” (below 30 percent of the median household income in the U.S.). With this in mind, why should a policy to eliminate secondhand smoke (SHS) only apply to some of our country’s least well-off populations? That does not seem like sound judgement by our policymakers.

Proponents of the rule harp on the notion that it focuses on “smoke, not the smoker.”  No one can deny SHS exposure is detrimental to our society. It is responsible for about 9 percent of all smoking-related deaths in the United States. It increases the likelihood that children get ear infections, asthma, acute respiratory tract infections, and other chronic respiratory conditions. However, the effects of SHS do not only apply to residents of HUD-funded housing units — they also apply to private homes. In the latter case, individuals fortunate enough to purchase their home can smoke as they please, even when they may be exposing their children and family members.

No one denies smoking and the externalities it produces are bad for us. But we are treating public housing residents differently than the rest of our nation’s private citizens. This is something HUD either did unintentionally or chose to ignore. Either way, it’s not right.

Saagar Pandit is a medical student.

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