Emma Feeny is Director of Global Advocacy and Policy Engagement at The George Institute for Global Health

BMJ 2021374 doi: https://doi.org/10.1136/bmj.n1516 (Published 19 July 2021)Cite this as: BMJ 2021;374:n1516

Emma Feeny, advocacy director1,  Katie Dain, chief executive officer2Cherian Varghese, cross-cutting lead, NCDs and special initiatives3, George A Atiim, researcher4Dag Rekve, senior technical officer3Hebe N Gouda, project officer5

Women have traditionally consumed less tobacco and alcohol than men because social and cultural norms have stigmatised their use of these products, particularly in low and middle income countries. The combination of changing gender norms, aggressive industry marketing, and continuing population growth in low and middle income countries, however, means that without urgent action, the number of women and girls consuming tobacco and alcohol is likely to rise substantially in the coming years.

This change has important implications for the burden of chronic or non-communicable diseases and injuries, for public health, service delivery, and—given the strong, reciprocal links between non-communicable diseases and poverty1—sustainable development. Consumption of tobacco and alcohol has repercussions throughout life, particularly when it begins at a young age, making it harder to stop or reduce consumption later in life. Such consumption increases women’s risk of developing cardiovascular diseases, cancers, and a range of other conditions (table 1). Risks can also be transmitted to the next generation: tobacco and alcohol use during pregnancy can have lasting effects on the health of children, who are also more likely to use tobacco and alcohol themselves if exposed to parental consumption.45

link to https://www.bmj.com/content/374/bmj.n1516article

Key messages

  • Women and girls in low and middle income countries are exposed to aggressive marketing tactics by tobacco and alcohol industries, which exploit gender inequalities and associate their products with women’s empowerment

  • A rise in the consumption of alcohol and tobacco among women and girls will lead to an increase in non-communicable diseases globally, both in the short term and among generations to come

  • A rise in non-communicable dieases has important implications for public health and the achievement of global development goals

  • Governments and other stakeholders should tackle gender and other inequalities while improving health to protect women and girls in low and middle income countries from tobacco and alcohol promotion

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