High rates of smoking not always confined to the poorest groups
It is conventional belief that smoking levels are highest in the poorest groups of the population. However, it is not always the case, as shown in the recent study conducted from the World Health Survey in 2002-2004. This study focuses on 48 low- and middle-income countries surveyed for data on current smoking and demographic and socioeconomic factors. 11 countries from the WHO European Region are represented in this study: Bosnia and Herzegovina, Croatia, Czech Republic, Estonia, Georgia, Hungary, Kazakhstan, Latvia, Russian Federation, Slovakia and Ukraine.
Gender and socioeconomic differences show varying patterns
Among all 48 countries focused on for this study, the highest overall smoking prevalence for men was found in Latvia, where nearly 65% of men smoked. Among women, the highest rates of smoking were seen in Hungary, where nearly 40% of women smoked.
The study shows that high rates of smoking were not always confined to the poorest groups. For example, in Bosnia and Herzegovina, Georgia, Latvia, Philippines, Russian Federation and Ukraine, even in the richest population group smoking in men was more than 50%. In Georgia, there was significant pro-poor inequality for males; that is, men in more affluent groups smoked more than the poorest groups.
Socioeconomic inequality in women was much more mixed, showing types of both pro-rich and pro-poor inequalities. Pro-rich socioeconomic inequality was most extreme in Congo, Kenya and Lao People’s Democratic Republic where the poorest women had more than 10 times more risk of smoking compared to the richest women. Conversely, in Ecuador, Georgia, Kazakhstan and Mexico, women in the richest women in the population had over three and a half times the risk of smoking compared to the poorest groups. In fact, this type of pro-poor inequality in women was observed in 16 of the countries studied, and was statistically significant among 9 countries.
The study shows that the magnitude and direction of socioeconomic inequality varies substantially between countries. Particularly in women and in middle income countries, a significant pattern of pro-poor inequality was observed – risk of smoking was higher in the wealthiest populations groups.
Implementing interventions with an equity lens
There is a major equity challenge in the development of tobacco control and it is suggested that interventions to reduce the burden of tobacco related ill health should also be directed at poverty itself. In addition to strong country commitment to implementing the measures of the WHO Framework Convention on Tobacco Control (WHO FCTC), monitoring the implementation of the Convention should include an equity lens that pays special attention to the possibility that some population groups may be more susceptible to tobacco use and some population groups may be better positioned to access, utilize and derive the health benefits from tobacco control interventions.
