Gender in tobacco control – a missed opportunity for sustainable action

World No Tobacco Day (WNTD) 2019 comes at a time when global public health is progressing from the Third United Nations High-Level Meeting (UN HLM) on Noncommunicable Diseases (NCDs) in 2018 to the upcoming UN HLM on Universal Health Coverage (UHC) in 2019. A common denominator between the NCD response and achieving UHC is that neither can be accomplished without synergistic efforts for ensuring that all people get good quality services for NCDs, with equity of access and financial risk protection.

An important pillar of the fight against NCDs and their risk factors is the vast body of work on tobacco control which has guided countries and public health entities across the world towards an exemplary reduction and de-normalisation of tobacco use. Emphasis has been laid on identifying areas for tobacco control interventions in research, policy and practice, while concurrently resisting the tobacco industry lobbying. However, a component often overlooked in this pursuit is tobacco use among women and girls. This is manifested in policies and programmes which are gender-blind, compounded by the unhindered efforts of the tobacco industry to specifically target women and girls through curated marketing, advertisements and sponsorship.

The absence of a distinct gender-integration in tobacco control should be addressed before it stymies the decades of public health response as developmental agencies worldwide have acknowledged the cross-cutting nature of gender as a pervasive social determinant of health. Moreover, especially for low-income countries, the economic cost of tobacco for a family has a crowding-out effect on necessities such as food, health and education which takes a disproportionate toll on women and girls, as they are placed at the bottom of the social ladder. Therefore, there is a need for tobacco control action to formulate and implement gender-sensitive approaches, which are aligned with the Sustainable Development Goals (SDGs) as Goal 5 strives to “achieve gender equality and empower all women and girls.”

As a young public health professional, I believe there is a pressing need for youth-oriented and youth-led NCD prevention and control. My motivation for engaging youth in strengthening tobacco control in India was furthered by a recent opportunity to attend the Global NCD Forum on Children and Youth organised by NCD Child and Friends of Cancer Patients (FoCP) in Sharjah, UAE in March 2019. The two-day gathering was filled with lectures, debates, working group sessions, and multiple occasions to interact with people and learn from their experiences. Most of all, it was replete with inspiration as there are few things as encouraging as being amidst patients, survivors and practitioners, and hearing their stories of change.

In a particular working group session at the Forum, I had the chance to brainstorm with a group of experienced professionals from various countries to identify an NCD research priority for youth and develop a campaign. We decided to work on the targeting of women and girls by the tobacco industry in India and articulated a campaign for addressing the same. We devised a holistic approach which would address midstream and downstream factors through a grass-roots online and offline campaign. This would familiarise young school-going girls with the health effects of tobacco use and where to find help for reducing and abstaining from the same. The upstream factors would be covered by an analysis of the strategies used by the tobacco industry through a desk review and using tools such as the SEATCA Index. A combination of the campaign results would then be used for policy advocacy for gender-integrated tobacco control strategies in India.

Although hypothetical, there is no reason why such a campaign should not take the form of reality. On the contrary, especially for youth, gender-sensitive tobacco control strategies at an early age can be helpful in inculcating other healthy behaviours, such as those pertaining to sexual and reproductive health. Therefore, as we move towards the goals of UHC, NCD prevention and control, and particularly the response to tobacco use should be cognizant of a greater focus on integrating gender to ensure a sustainable behaviour change that can translate into healthy people.

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