WHO report highlights tobacco use and social inequity

The complex and ravaging interrelationship between tobacco use and social determinants of health is explored in “Equity, social determinants and public health programmes,” a 300-page report released by the World Health Organization in May 2010.

An entire chapter of the report explores tobacco use as a marker of social inequity and provides an in-depth examination of how the health consequences of smoking are borne by the most disadvantaged groups in society.

Key findings are summarized below, and the whole report can be downloaded at no charge.

World Health Survey data and results from numerous other studies point to unequivocal inequities in many areas, including:

• Income. Whether measured by country, household, or individual income, occupation, or level of education, tobacco use is linked to low socioeconomic status.
• Gender: Globally, smoking prevalence is much higher for males, and when countries are grouped by income group, gender differences are greater for low-income and lower middle-income groups.
• Members of lower socioeconomic groups, like single mothers, new immigrants, people who are long-term unemployed, mentally ill individuals, and members of ethnic minorities, are all more likely to smoke.
  

The consequences of tobacco use disproportionately burden poor households, where money that is spent on tobacco is not available for education, health care, or housing; and where the poor health that results from tobacco use also perpetuates poverty.

The WHO Framework Convention identifies interventions that address the inequities faced by socially disadvantaged groups. These interventions include:

• Reducing availability of tobacco products, by implementing tobacco taxes, eliminating illicit trade, and prohibiting sales to minors
• Shifting attitudes toward health as a core value by incorporating tobacco control into the global development agenda
• Increasing the prevalence of such as smoke-free workplaces, restaurants, and other public places.
• Banning tobacco advertising, promotion, and sponsorship; adding graphic picture warnings on tobacco products; and promoting tobacco-free role models.
• Supporting partnerships with community groups and organizations so tobacco control interventions are linked with community development and empowerment of lower socioeconomic groups
  

While the World Health Organization has a significant role to play in promoting these interventions, the health sector can also take action to address the health inequities that result from tobacco use among the world’s most disadvantaged groups.