Health Equity

Progress in tobacco reduction is one of the most significant public health successes of the past few decades, however the benefits of this success have not been felt equally across Canadian society.  Research shows that as tobacco use has decreased in the general population, it has also become disproportionally concentrated within the least-privileged population groups in our province.^{1 2 3 4}As a result, tobacco use is a significant contributor to the health equity gap between socio-economic groups in Alberta.  In order to improve health equity in Alberta, tobacco reduction must be a public policy priority with a focus on policies that are proven to decrease tobacco use inequalities.

Whether comparing income, education, occupation level, or other socio-economic indicators, the least privileged population groups demonstrate a tendency to start smoking at a younger age, to smoke more cigarettes per day, and to be less likely to stop smoking compared to those who are more privileged.⁵ The distinction has become so pronounced that some of the most disadvantaged members of society are exhibiting smoking rates double the rates of the general population⁶ and quit rates that are one-half of those of the highest socio-economic groups.⁷

In one Canadian study, the odds of smoking were almost four times higher among those who had not completed secondary school compared to those with a university degree.⁸

What is perhaps most troubling is that tobacco use-related inequalities appear to be some of the only health-related inequalities in Canada that have been increasing over the last 10 years.⁹ Inequalities in tobacco use are also larger amongst younger adults than older adults,¹⁰ indicating that the widening gap is not likely to correct on its own.

To ultimately eliminate these disparities, tobacco reduction programs and policies must be implemented in a way that achieves equitable benefits for all.¹¹

Reducing the prevalence of tobacco use requires greater attention to populations carrying a disproportionate burden of use and dependence. Policies that focus on adolescence and young adulthood, a time when most people begin using tobacco, are especially important to reduce tobacco-related disparities. Policies to reduce tobacco-related disparities include:¹³

1. Increasing the price of tobacco products;
2. Increasing the number of people protected by comprehensive smoke-free laws;
3. Reducing exposure to targeted tobacco industry advertising, promotions, and sponsorship; and
4. Improving the availability, accessibility, and effectiveness of tobacco cessation services for populations affected by tobacco-related disparities.