Introduction
Imagine a house where your child has asthma attacks due to secondhand smoke leaking through the windows. This is the reality for a large number of people living in social housing in the United Kingdom. Social housing communities face rates four times higher than in privately owned homes (Person, 2018). This isn’t just a health crisis—it’s a story of inequality. Smoking-related health issues would worsen the NHS’s load and prolong generational health inequities without intervention (Marmot, 2020).
Our Rationale
The following major problems are identified in the literature as having a detrimental effect on the implementation of smoke-free housing policies: Tenant privacy is given precedence above public health regulations by the law, resulting in unresolved legal problems; In the UK, shared ventilation systems are used in social housing, and residents are exposed to secondhand smoke at disproportionately high levels. In underprivileged communities, smoking is a coping mechanism for poverty (Graham, 2011).
However, the majority of the data that is now available on smoke-free housing regulations is from North America, where empirical studies have shown how effective comprehensive smoking bans are at lowering secondhand smoke exposure and encouraging quitting within housing that is subsidised. These conclusions, however, are predicated on institutional and cultural circumstances that differ significantly from the social housing environment in the United Kingdom. This reduces the literature’s direct relevance to the formulation of UK policy.
With this in mind, our research seeks to address a key question: what are the difficulties in implementing smoke-free policies in social housing in the UK, and what policies can be implemented effectively whilst avoiding placing an undue burden on residents?
Our Study
Through structured focus group discussions involving six social housing tenants and three housing policy professionals, participants collaboratively mapped barriers to smokefree policy implementation while proposing context-specific solutions. Employing inductive thematic analysis, we have identified three major themes, each with two sub-themes, as shown below. Let’s take a look at each theme in turn.
Systemic Failures
Frustration with Current Enforcement
Both housing officers and tenants expressed discontent with the unenforceable policies. Housing experts highlighted legal constraints: “We cannot evict smokers under existing laws, even when neighbours suffer” (P1). Tenants complained of unsolved smoke intrusion issues, one stating, “The Council knows about the problem but does nothing” (T1).
Legal and Practical Limitations
Housing experts found legal limitations: “There is no law about this” (P2). Defects in buildings like old ventilation and joined chimneys provide opportunities for smoke to move from one flat to another. Councils lack means to compel compliance, and thus it is patchy. Tenants criticized a lack of assistance: “Rules exist without help” (T3).
Social and Operational Dilemmas
Cultural and Demographic Barriers
Smoking is a habitual practice for particular groups. For instance, smoking was a social occasion for Turkish residents. Non-smokers described smoking exposure as a violation of communal rights, while there were individual liberty vs. common welfare conflicts.
Gaps in Support Resources
Free cessation aids (i.e. nicotine patches and smoking cessation counselling sessions) were under-advertised, with households reporting that they had not seen any publicity about them. Meanwhile, short-term treatments were criticised for failing to provide long-term advantages and ignoring systemic causes such as poverty. “Six counselling sessions are not enough as they tend to start to work on the fifth” (T5). Tenants also rejected surveillance-based control as “offending evidence” (T6).
Resilience Governance Strategy
Collaborative Solutions
All of the housing professionals concurred that collaboration between sectors is key for policy implementation of equity. It was among their recommendations that “public health and housing sectors must work together” (P2). This coordination is designed to tackle structural along with behavioural barriers. Policy implementation of smoke-free policies is also believed by the tenants to need to be coordinated with management.
Prioritise Risk Management
Stakeholders prefer pragmatic measures over bans:
- Compulsory fitting of air cleaners to smoking homes to reduce harm initially “without confrontation” (P3).
- Unbiased audits in terms of fire safety that react equitably to smoking hazards and “focus on safety, rather than blame” (P1).
- Prioritize “smoking families with children” (P2) with increased education and publicity campaigns.
Take Home Message
Implementing smoke-free policies in reality presents obstacles that defy easy fixes. Since they are founded on structural violence brought on by systemic underinvestment, poor housing, and cultural marginalisation, they call for methodical and equitable action. Policymakers can move beyond the limitations of anti-smoking legislation by focusing on renters, supporting cross-sectoral co-operation and reframing smoking from a risk management perspective. Adaptive government—that is, an awareness of the interplay between institutions, cultures, and personal decision-making—is the way forward, not compulsion. This study shows that rather than rigorous enforcement, resilience stems from the ability of all people to recognise health equity in the face of long-standing disparities.
However, there are limitations to our study:
First, limited sample diversity—focus groups with 6 tenants and 3 Haringey Council professionals predominantly engaged middle-aged, long-term residents (average age: 54.5), excluding younger or transient tenants. This single-borough focus further overlooks regional disparities, such as rural housing estates or ethnically distinct communities (e.g., Birmingham’s South Asian populations). Second, reliance on cross-sectional data captures only momentary perspectives; longitudinal tracking of health outcomes or tenant mobility would clarify causal pathways. Finally, the absence of frontline expertise (NHS clinicians, addiction specialists) obscures systemic collaboration gaps between housing and healthcare sectors.
Reference
Graham, H. (2011). Smoking, stigma and social class. Journal of Social Policy, 41(1), 83–99. https://doi.org/10.1017/s004727941100033x
Marmot, M. (2020). Health equity in England: The Marmot Review 10 Years on. BMJ, m693. https://doi.org/10.1136/bmj.m693
Person. (2018, March 14). Likelihood of smoking four times higher in England’s most deprived areas than least deprived. Likelihood of smoking four times higher in England’s most deprived areas than least deprived – Office for National Statistics. https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/drugusealcoholandsmoking/articles/likelihoodofsmokingfourtimeshigherinenglandsmostdeprivedareasthanleastdeprived/2018-03-14