Developing and evaluating recommendations involves determining the best course for translating knowledge into action at a given time and place as well as for a specific population and issue. Recommendations that take the core concepts of sex, gender, diversity and equity into account are more likely to result in actions that are appropriate and effective for those at risk or in need.
For instance, advertising bans and negative labelling have helped to reduce tobacco use, but a growing body of research suggests that different strategies may be needed for women and men as a result of differences in gender roles and norms. Exposure to second-hand smoke is a case in point. Many countries have enacted smoke-free legislation for workplaces, which has helped to reduce exposure to second-hand smoke. But men stand to benefit more from this strategy because in most countries they are more likely than women to be in the paid labour force. At the same time, women and children are especially vulnerable to second-hand exposure in the home, particularly in countries with high rates of male tobacco use. Legislation doesn’t reach into households where women and children may have limited ability to negotiate smoke-free homes and cars.
Diverse groups of women and men may also need different strategies and supports to reduce tobacco use. We know, for instance, that increasing the cost of tobacco products through taxation encourages people to quit smoking, particularly young people and those with a low income. But as women are more likely than men to live in poverty, this measure may be more effective for women than for men. Other strategies would also be needed to encourage those who are more affluent to quit smoking.
Equity should always be the aim of policies and programs and this can only happen when recommendations are inclusive and comprehensive. For example, recommendations about reducing smoking among pregnant women recognize the effects that smoking has on the developing child. Cigarette smoking in pregnancy has been shown to increase the risk of complications in pregnancy, including low birth weight, still births, and premature births, as well as long-term health problems for women and girls, including infertility, early menopause, and respiratory and cardiovascular disease. Yet much of the research around smoking and pregnancy focuses on the baby’s health, ignoring the health and well-being of the mother both during pregnancy and afterwards. Since “most women are not pregnant most of the time”, particularly in developed countries, this means that smoking cessation campaigns ignore most women most of the time. (Jacobsen, 1986, p.125)
Equitable outcomes are less likely when some people or some aspects of peoples’ lives are ignored in the process of creating and implementing recommendations.
Sources: WHO (n.d.) Tobacco Facts. http://www.who.int/features/factfiles/gender_tobacco/facts/en/index2.html; WHO. (2007). Gender and Tobacco Control: A policy brief. http://www.who.int/gender/documents/tobacco/9789241595407.pdf; Jacobsen, B. (1986). Beating the Ladykillers: Women and smoking. London: Pluto Press