Simon Barraclough

Gender equity and tobacco control: bringing masculinity into focus

Gender is a key — but often overlooked — determinant of tobacco use, especially in Asia, where sex-linked differences in prevalence rates are very large. In this article we draw upon existing data to consider the implications of these patterns for gender equity and propose approaches to redress inequity through gender-sensitive tobacco control activities. International evidence demonstrates that, in many societies, risk behaviours (including tobacco use) are practised substantially more by men and boys, and are also viewed as expressions of masculine identity. While gender equity focuses almost exclusively on the relative disadvantage of girls and women that exists in most societies, disproportionate male use of tobacco has profound negative consequences for men (as users) and for women (nonusers). Surprisingly, health promotion and tobacco control literature rarely focus on the role of gender in health risks among boys and men. However, tobacco industry marketing has masterfully incorporated gender norms, and also other important cultural values, to ensure its symbols are context-specific. By addressing gender-specific risks within the local cultural context — as countries are enjoined to do within the Framework Convention’s Guiding Principles — it may be possible to accelerate the impact of mechanisms such as tobacco pricing, restrictions on marketing, smoking bans and provision of accurate information. It is essential that we construct a new research-to-policy framework for gender-sensitive tobacco control. Successful control of tobacco can only be strengthened by bringing males, and the concept of gender as social construction, back into our research and discussion on health and gender equity.

The Use of Australian Health Care Services by Overseas Visitors: Some Data-Related Problems for Policy Makers

Very little is known about the usage of Australian health care services by overseas visitors. This is despite the fact that may visitors are entitled to treatment under Medicare due to the Federal governments policy of encouraging reciprocal health care agreements with a number of countries and the increased promotion of health care as an export commodity. It is therefore difficult to develop an overall picture of both the current level of use of Australian health care services by foreigners or to estimate projections of future demand. The absence of such data also means that it is not possible to be sure of the consequences of policies such as the easing of restrictions on medical visas and the promotion by the Australian government of a network of bilateral reciprocal health care agreements. In this article, federal government policy on the access of non-citizen visitors to Australian health care services is examined, various categories of visitors eligible for treatment under the Medicare scheme identified, and current methods of collecting data on visitors using Australian health services critically examined.

Issues and Policy Developments in the Official Collection of Australian Aboriginal Health Statistics

Drawing upon a variety of published reports, some of the historical and contemporary issues in the official collection of Aboriginal health statistics are discussed. Serious problems are revealed such as a past policy of excluding Aborigines from census counts, a restrictive official definition of Aboriginality, and a lack of uniformity in collection policies between the various states within Australias federal system of government. As a consequence of inadequate collection of health statistics, data on risk factors and information on social, cultural and economic factors affecting Aboriginal health, substantial gaps exist in the overall picture of Aboriginal health in Australia. Recent initiatives designed to foster national agreement on the collection of Aboriginal health statistics are chronicled and continuing problems with the collection of such statistics identified. (AMRJ, 1991, 21(1), 6–9.)

Improving Primary Health Care in Thailand: The Role of the National Medicinal Drug Policy

For two decades Thailands National Medicinal Drug Policy has sought to make effective and safe drugs of good quality available and affordable to all, and to promote the rational use of drugs. Using original policy documents, secondary sources and interviews with Thai informants, the history of the development and implementation of the policy are examined and salient issues associated with primary health and medicinal drugs in Thailand are identified. It is argued that the policy improved the accessibility and quality of essential drugs. However, further action is needed to reduce the level of irrational usage, to foster the use of traditional medicines and to encourage national self-reliance in the production of essential drugs. This discussion of policy development provides lessons for other countries working to establish their own medicinal drug policies.