Tobacco smoking (SDG target 3.a.1), alcohol consumption (SDG target 3.5.2) and obesity

Risk factors for NCDs are strongly influenced by gender and links with other social determinants to health

Dec 2019

Tobacco smoking (SDG target 3.a.1), alcohol consumption (SDG target 3.5.2) and obesity

Men are known to have higher rates of smoking and risk behaviors linked to gender, social and cultural norms about masculinity and what it is to be a man (56).  Table 2 shows the differences between men and women in selected countries in the Region for (i) prevalence of smoking any tobacco product, (ii) alcohol consumption and (iii) prevalence of obesity. Apart from obesity it illustrates that men consistently have higher prevalence of risk and or risk behaviors linked to NCDs. However, this and the other NCD data reported for the profiles only show sex-differences between males and females in the Region and within countries. The following subsections and Box 6 bring a gender and equity lens to illustrate how analysis of these indicators with additional information can accelerate efforts to prevent and tackle NCDs in the Region more effectively and equitably.

  • Risk factors for NCDs are strongly influenced by gender and links with other social determinants to health

As indicated, important gender-based differences exist in tobacco smoking with a higher prevalence of tobacco smoking for men compared to women in nearly countries reporting data in the Region (Table 2) (113). The only exception is Nauru, where 49.2% of women report smoking any tobacco product compared to 39.5% of men (see Table 2).[1] Data on current tobacco use among adolescents 13-15 years however suggests a higher prevalence for adolescent females (Figure 10) compared to adults 15+ years in the same countries (113). However, this may reflect the age of the data e.g. some

 Risk factors for NCDs (tobacco smoking, alcohol consumption and obesity), males and females, selected countries, Western Pacific Region, 2016 and 2020

  SDG target 3.a.1 SDG target 3.5.2  



Prevalence (%) of smoking any tobacco product among persons aged 15+ years, 2020 (113) Alcohol, total per capita consumption (in litres of pure alcohol) among persons 15+ years, 2016 (115) Prevalence (%) of obesity among adults 18+ years, 2016 (116)
Male Female Male Female Male Female
Australia 14.3 11.0 16.7 4.7 29.6 28.4
Brunei Darussalam 29.8 2.7 0.6 0.2 12.5 15.7
Cambodia 42.5 2.0 11.9 2 2.7 4.8
China 45.7 1.4 11.7 2.5 5.9 6.5
Cook Islands 17.5 3.7 52.6 59.2
Fiji 35.8 11.9 5.2 0.7 25.1 35.3
Japan 29.2 9.6 13.5 2.9 4.8 3.7
Kiribati 59.1 38.8 0.8 0.1 41.6 50.4
Lao People’s Democratic Republic 51.9 7.0 17.6 3.3 3.7 6.7
Malaysia 40.2 1.1 1.6 0.3 13 17.9
Marshall Islands 48.4 57.3
Micronesia (Federated States of) 4.2 0.6 40.1 51.5
Mongolia 45.4 4.5 12.8 2.1 17.5 23.2
Nauru 39.5 49.2 10.5 1.6 58.7 63.3
New Zealand 17.2 4.6 30.1 31.4
Niue 18.2 10.3 12 2.1 44.8 55.1
Papua New Guinea 2.1 0.3 51.8 58.8
Philippines 39.0 7.4 11.3 1.9 16.6 25.8
Republic of Korea 46.9 3.8 16.7 3.9 5.2 7.5
Samoa 35.9 17.3 4.3 0.6 4.4 4.8
Singapore 28.3 4.9 3.3 0.8 39.9 55
Solomon Islands 2.5 0.3 5.8 6.3
Tonga 45.6 12.4 2.7 0.4 17.9 27.1
Tuvalu 3.1 0.4 41.4 54.5
Vanuatu 1.8 0.2 47 56.2
Viet Nam 46.2 1.1 14.5 2.5 20.2 30.1

of which is from 2003. Furthermore, tobacco companies are increasingly targeting young women in marketing cigarettes, linking smoking with western-style independence/female empowerment, stress relief and weight control (114).

 Attention to gender aspects in tobacco control can help to strengthen policy, programs and research, while countering harmful messaging from the tobacco industry and perceptions of masculinity among males (114). This includes looking at whether women bear a disproportionate burden of exposure to second-hand tobacco smoke linked to power inequities in the home and or workplace (114).

Patterns of smoking tobacco are influenced by and intersect with other determinants of health. Analysis on tobacco use in 54 low and middle-income countries (LMICs) showed that socioeconomic inequalities in tobacco use exist in LMICs, varied widely between the countries and were much wider in the lowest income countries (117). However, among women,  women in higher income quintiles were more likely to smoke.

A 2017 population survey in Palau, found that smoking tobacco was most prevalent among men, young

Prevalence of current tobacco use among adolescents aged 13-15 years, males and females, selected countries, 2003-2013 (latest year)

adults, and less educated individuals, with no differences among Palauans and non-Palauans. E-cigarette use while low followed a similar pattern (118). Betel nut use is more prevalent among women, young Palauans and individuals with a lower education, and 87% of respondents using betel nut add tobacco.  In the Philippines, the 2017 DHS found that overall 5% of women aged 15-49 years smoke a tobacco product, decreasing from 7% in 2003 and remaining low overall (17). Smoking a tobacco product is slightly higher among women living in urban compared to rural areas and there are regional differences, but there is little variation based on wealth (17).  In Vanuatu the patterns of smoking tobacco for men and women are similar to the rural/urban patterns in the Philippines. However, the percentage of women who smoke tobacco increases slightly with educational attainment and household wealth (22).

The 2017 DHS for Lao People’s Democratic Republic provides data on both women’s and men’s smoking of tobacco disaggregated by age and cross-linked with education, ethnicity and wealth index quintile (32). Among women use of any tobacco product increases with age, decreases with higher education and wealth quintile, and varies by ethno-linguistic group.  Among men while the pattern is largely similar, there is minimal difference in use based on wealth quintile (64.5% in richest quintile versus 68.9% in poorest quintile (32).

Alcohol consumption, using the indicator from the UHC and SDG profiles of total per capita consumption of pure alcohol (litres) (see Table 2), men have higher rates in than women in all 25 countries reporting on this indicator. In all countries the difference between men and women is quite significant. As with smoking tobacco, women are not encouraged to drink alcohol in many cultures in the Region. This means that the differences between men and women in a country can be quite significant even where men have low alcohol consumption levels e.g. Brunei Darussalam and Malaysia. Women in countries such as Australia, New Zealand and the Cook Islands have relatively high levels of alcohol consumption relative to women in other countries reporting on the total per capita consumption of pure alcohol (litres) (115). [link to Box Page]

However, the indicator used makes a difference to the patterns observed among men and women across the Region.  For example, when measuring harmful alcohol use over 12 months, men in Mongolia and Korea have a far higher prevalence of harmful use than all other men in the Region (119). Whereas Table 2 shows very high levels of alcohol consumption among men in New Zealand and the Cook Islands using the agreed SDG indicator of total per capita consumption (in litres of pure alcohol) among persons 15+ years. In 20 of the 24 countries providing data (2016), more than 50% of men reported heavy episodic drinking in the past 30 days (%) with highest percentages in Cook Islands (89.8%), Niue (82.7%) and the Federated States of Micronesia (71.8%) (120) . For this indicator, women in the Cook Islands (65.9%), Niue (51.4%) and Nauru (44.4%) had the highest reported percentage of heavy episodic drinking (120).

As with patterns of smoking tobacco, alcohol consumption shows differences among men and among women based on age, place of residence, level of education, ethnicity and or wealth quintile in the Philippines, Vanuatu and Lao People’s Democratic Republic.  For example, in the Philippines use of alcohol by women was greater in urban compared to rural areas however the percentage of women who drink alcohol rose with increasing household wealth, from 19% in the lowest wealth quintile to 30% among those in the fourth and highest wealth quintiles (17). In Vanuatu more men than women reported sex while drunk and drunkenness during sex was higher in urban areas than rural areas for both males and females (22).  In Lao People’s Democratic Republic, among women increasing education and wealthmake a difference, with 14.2% of women in the poorest quintile consuming alcohol in the past month compared to 48% in the wealthiest quintile. For men, alcohol consumption increases with age, education and wealth. There are differences in consumption of alcohol based on ethnic groups with a smaller percentage of women (10%) and men (48.7%) of Hmong-Mien ethnicity consuming alcohol compared to other ethnic groups (32).

Obesity is a significant risk factor for NCDs. In the Region, the prevalence of obesity among adults is 6.4%, 6% for males and 6.7% for females – second lowest among the WHO Regions, with the lowest prevalence in the WHO South East Asian Region at 4.7% (116).  Women are more likely to be obese than men in the Region (see Table 2). This is especially the case in many Pacific Island countries, which have an overall higher levels of national obesity compared with the rest of the Region, but where the prevalence for men is still less than that of women (116). Obesity among males is slightly higher in Australia and Japan compared to women  (116).

As with smoking tobacco and alcohol use, there are differences in the prevalence of obesity among women and among men within countries, based on characteristics and determinants such as level of education, place of residence (urban rural) and socioeconomic status or wealth quintile. In low- and middle-income countries in the Region, the gap by place of residence is less when stratified by level of education or income (45).


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