The author, who is president of the Pfizer Foundation, spoke at a UN meeting this week on noncommunicable diseases.

The United Nations (UN) has been hosting its High-Level Meeting on Non-Communicable Diseases September 16–21 in New York City. This is an important opportunity to highlight the alarming incidence of chronic diseases in developing countries and determine attainable goals to address substantive risk factors, such as tobacco.

As part of the Pfizer Foundation’s participation in the meeting, I spoke at a luncheon symposium called “Women, Girls, and Smoking” on September 19. My presentation focused on a new Pfizer Foundation one-year grants program aimed at reducing the rising rate of female smokers in emerging markets. This blog post is adapted from my presentation earlier this week.

My fellow panelists included Adrianna Blanco from the Pan American Health Organization (PAHO) and Patricia Lambert from the Campaign for Tobacco Free Kids. We saw this as a unique opportunity to share trends in female smoking with an audience of nongovernmental organization (NGO) staff, private-sector leaders, donors, and policy makers.

That smoking kills and that laws and norms need to be arrayed against tobacco use is of little surprise to the public health community. In April a global health ministers meeting in Moscow focused on noncommunicable diseases, of which tobacco is the preeminent contributor. And in the same week, China announced new regulations on indoor smoking—public health professionals welcome this new step for China, because it is still in the early stages of grappling with smoking and tobacco use.

Lost in many of the conversations and initiatives on smoking, however, is a gender perspective. For women, the effects are particularly striking, both because smoking affects their health in a big way and because smoking is an epidemic that is still building. The effects of smoking on women are by now well understood: women who smoke are at a dramatically higher risk for cancers of the lung, mouth, pharynx, esophagus, larynx, bladder, pancreas, kidney, and cervix. In addition to direct organ damage, women who smoke also find it harder to conceive and are at increased risk of pulmonary and coronary diseases.

And because of many women’s roles in their households, they are also more at risk from the dangers of second-hand smoke. In almost every society, women are the primary caregivers and managers of their immediate and extended family units. The result is that women become ill from cigarettes, and their illnesses have wider effects on their families and on society as a whole.

Despite this knowledge, the world is on pace to see an explosion of smoking among women as the developing world becomes wealthier. By some estimates, according to a World Health Organization (WHO) report, about 80 percent of the world’s smokers live in low- and middle-income countries. By 2030, more than eight million people will die annually from smoking-related causes. And a disproportionate number of new smokers are likely to be women if current expectations prove to be accurate.

In antitobacco programs, public health marketing, and legislation, the particular concerns of women are not often emphasized. Despite women’s core role in modernizing societies and lifting them out of poverty, much antitobacco work is not gender specific. Data collected by governments do not regularly differentiate between men and women, antitobacco public health advertising is often pitched at men, and laws and regulations are not necessarily written with a focus on what motivates women to start smoking.

To address the rising rates of female smoking, particularly in emerging economies, local action will be required, as will culturally specific messages and materials, that make women more aware of how smoking can affect them; that foster policies that make smoking less attractive or feasible; and that empower women to make their own choices—free of advertising or false images.

If rates of uptake by women can be slowed or reversed, the savings in human lives, as well as social and economic costs to society will be sizeable. Our research and interviews suggest, however, that most public health programs in emerging markets lack the resources and expertise to implement women-focused and gender-specific tobacco control programs.

To meet this challenge, the Pfizer Foundation recently launched its pilot program (mentioned above) that aims to prevent smoking among women and identify best practices for effective gender-specific interventions and communications strategies. The Pfizer Foundation has partnered with Rockefeller Philanthropy Advisors to administer and manage this new program.

In partnership with thought leaders in the area of tobacco control, the Pfizer Foundation has identified two themes for grantees to use when piloting new models of health and outreach programs to help women stop smoking:

1. Developing gender-specific prevention programming (for women), including programs to reach subgroups of women (such as indigenous women and rural women)

2.  Supporting antismoking and antitobacco policies geared toward women, in the context of comprehensive tobacco control.

At the forum on Monday, I was encouraged to hear many public health officials recognize the importance of addressing the issue women and tobacco control and encountered many NGOs interested in programs focused on women and noncommunicable diseases.

By the end of this pilot program, we want to demonstrate:

  • Several effective operational models for addressing female smoking rates; and
  • Additional data to build the knowledge base on smoking trends for women.

We look forward to sharing program outcomes and lessons learned in future blog posts and forums.

We greatly appreciate the support from James O’Sullivan, Donzie Barroso, Joanne Greenstein, Erica Minor, Tej Shah, and Lexie Komisar from the Rockefeller Philanthropy Advisors team, and Atiya Weiss from the Pfizer Foundation, for their helpful comments and insights for this post.