Editorial: Public health gains leave women behind

Smoking rates are down, and that’s good news. But dig into the fine print and you’ll find a worrying trend: only men are driving the improvement. Women are smoking at the same rate as they did two decades ago, drinking more than before and using prescription drugs and medical cannabis at much greater rates. It’s gender equality but not the kind we were hoping for.

Let’s start with tobacco. Smoking rates are down significantly since 2001, with around one in five smoking cigarettes regularly versus the roughly one-third rate we registered 20 years ago. The catch is that while the male smoking rate has almost halved, the female rate has remained unchanged.

It’s a similar story when it comes to alcohol. Lifetime drinking rates have risen, with the increase attributable to women.

Trying alcohol is not in itself a sign of crisis, though data showing that women are catching up with men when it comes to past-month drinking is less encouraging.

Then we have pharmaceuticals. Women are twice as likely to use antidepressants and anti-anxiety medication as men, and current users of such medications tend to use them on a daily basis.

And, finally, medical cannabis. About 7,000 people have used it at least once and most of them are women.

Taken in isolation, none of these data points should spark panic. Together, though, they paint a picture that we would do well not to ignore. Instead of managing distress, are we medicating it away?

Experts have warned about adolescents struggling in similar ways. And, even here, research suggests girls are outpacing boys on several risky behaviours, including smoking and binge drinking.

This is not just a Maltese quirk. Male-to-female ratios in alcohol use and related harms have tightened everywhere. And Europe as a whole is doing worse than the rest of the world in getting women off cigarettes.

So what should Malta do, beyond putting up generic public health billboards?

We now have two decades of evidence – see the decline in men’s smoking rates – that gender-neutral campaigns will mostly reach the people already inclined to change their habits.

Women will be better served once we understand that their smoking and drinking are possibly shaped by different pressures to men’s: social expectations, workplace norms and (for many) a heavier intersection with anxiety and insomnia.

Women also stand to benefit from more focused strategies aimed at providing non-pharmacological anxiety treatments and sleep support. If prescription drug use is high and often daily, brief interventions cannot be limited to alcohol and cigarettes.

We must also acknowledge that alcohol marketing is a public health issue.

Our journey with tobacco taught us that advertising played a real role in forming damaging habits. There is no reason to assume it is any different for alcohol.

If Malta is serious about prevention, it will need the courage to make drinking less frictionless and less omnipresent in public life.

A new alcohol policy that was released for public consultation last summer could help but it may not be enough: the policy acknowledges that the gender gap for drinking is rapidly narrowing but makes no proposals to specifically target women drinkers.

Malta has done a great deal to close equality gaps over the past two decades.

But this is a somewhat ironic black spot: we’ve also narrowed inequality when it comes to dangerous habits that come with the risk of addiction, illness and early death. 

If done properly, education remains our most effective public health tool.