637705

research-article2016
APHXXX10.1177/1010539516637705Asia-Pacific Journal of Public HealthLow and Binns

Editorial
Asia Pacific Journal of Public Health
2016, Vol. 28(2) 104­–106
Gender Issues and Public Health © 2016 APJPH
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DOI: 10.1177/1010539516637705
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Wah Yun Low, PhD1, and Colin Binns, MBBS, PhD2

Gender is one of the most important considerations in public health research and program imple-
mentation. Basic issues such as protecting women from violence, upholding their rights to prop-
erty and equality in access to health, education, employment, and political participation are
important to society and for public health. Gender inequality exists both within and outside the
health system and is linked with poverty, ethnicity, and sociocultural practices that hinder the
advancement of women. This is manifested as poor access to health resources, discrimination,
sexual abuse, and violence. For example, due to gender power imbalance and lack of negotiating
skills, in aspects of sexual and reproductive health, condom use may be difficult.1,2 This may lead
to unintended pregnancies and expose women to a higher risk of sexually transmitted diseases
and HIV infection. The issues of gender equality need to be continuously examined and addressed
throughout the Asia Pacific region and the education programs of our APACPH (Asia Pacific
Academic Consortium for Public Health) institutions.
Each year, the United Nations Development Programme publishes a report that includes the
gender inequality index.3 Between 1990 and 2015, progress has been made in most world regions
and the East Asia and Pacific regions are now at a similar level to parts of Europe. South Asia lags
behind and is only slightly ahead of sub-Saharan Africa. Of course, there is much variation
between and with the individual countries of APACPH. Goal 3 of the United Nations Sustainable
Development goals is our fundamental objective in public health; “ensure healthy lives and pro-
mote well-being for all at all ages.”3 Achieving goal 5, “achieve gender equality and empower all
women and girls” is an important prerequisite to achieving goal 3.
In basic public health statistics, women are often shown to better off than men. The best over-
all indicator of public health is life expectancy and in all countries of the Asian Pacific region,
women live longer than men and the gap is widening in many countries (Table 1).4
Until the 1980s, the Indian subcontinent was an anomaly where men lived longer than women,
but this was reversed by 1990. At the beginning of life, more boys are born than girls (and selec-
tive abortion is an issue), but infant mortality is higher in boys.5 Asia has the highest male-female
sex ratio at birth in the world, and this was the case in China, although this may change with
recent population policy reforms.6 But, health is more than just longevity and these overall sta-
tistics can obscure important gender differences in morbidity and quality of life.
Noncommunicable diseases, primarily cardiovascular diseases, respiratory diseases, diabetes
mellitus, and cancers are the leading causes of death and disability in the Asia Pacific region
responsible for 80% of all deaths in a region.7 Obesity is an increasing problem in our region and

1Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia

2School of Public Health, Curtin University, Perth, Western Australia, Australia

Corresponding Author:
Wah Yun Low, Research Management Centre, Faculty of Medicine, University of Malaya, Kuala Lumpur,
50603 Malaysia.
Email: lowwy@um.edu.my
Low and Binns 105

Table 1.  Life Expectancy (Years).

Male Female

Country 1990 2013 1990 2013

China 67 74 71 77
India 57 65 58 68
Japan 76 80 82 87
Malaysia 68 72 73 76
Vietnam 66 71 75 80

Table 2.  Overweight and Obesity in APACPH Countries (Excluding the United States and Australia).

Men Men Women Women

Group Overweight Obese Overweight Obese

East Asia 28.0 (26.2-29.7) 3.8 (3.5-4.2) 27·1 (25.5-28.7) 4.9 (4.5-5.4)
South Asia 20.2 (18.8-21.5) 4.8 (4.5-5.2) 22·5 (21.1-23.9) 5.2 (4.8-5.7)
Southeast Asia 22.1 (21.2-23.0) 4.8 (4.6-5.1) 28·3 (27.2-29.3) 7.6 (7.2-8.0)
High-income Asia Pacific 31.7 (30.4-33.0) 5.3 (4.9-5.7) 20·6 (19.7-21.6) 4.2 (3.9-4.5)

Abbreviation: APACPH, Asia Pacific Academic Consortium for Public Health.

there are slightly higher rates in women (Table 2).8 If the trend in gender-associated obesity con-
tinues, it will lead to increased chronic disease in women.
In the Asia Pacific region, there is a need for further research into gender differences in the
prevention and treatment of chronic disease. There are a number of large population databases
and cohorts that are available for analysis of gender issues. This journal has published extensive
analyses of large databases from Korea, China, Taiwan, and Japan. In this issue of the journal, we
are publishing 2 further analyses of gender issues using 2 large databases from Indonesia and
Korea.
In an urban Indonesian population, gender inequalities were found in the distribution of
hypertension, obesity, and hypercholesterolemia. However, in this study, these differences can be
accounted, at least in part, by the disparities in the socioeconomic factors between men and
women.9 This article supports the emphasis on gender inequities advocated by the United Nations
Development Programme.
In the study from Korea, Song and her colleagues used the Korea National Health and Nutrition
Examination Survey to examine gender-related effects of obesity on quality of life.10 Women
who were severely obese had 31% significantly lower quality of life index compared with women
with normal weight. However, the same trend was not found in men.
Gender differences are also found in tobacco consumption and with few exceptions, men
smoke more than women.11 Globally, about 3% of women smoke compared with more than 20%
of males.12 But increasingly, tobacco marketers are targeting women and the gender difference is
narrowing. In Australia, the overall prevalence of smoking is now 16% of adults and the gender
difference is diminishing.13 However, while the overall prevalence of youth smoking is now low,
more girls smoke than boys. Traditionally, in the Asia Pacific region, smoking was predomi-
nantly seen as adult male behavior, but now this social norm is changing as more girls and
women are smoking, the synergy of smoking, obesity, and changing diet, the gender gap in
chronic disease can be expected to close. Smoking is now the most prevalent preventable risk
factor in our region and as the proportion of female deaths due to tobacco is increasing, the
regional tobacco control program particularly targets women.14
106 Asia Pacific Journal of Public Health 28(2)

Women are more vulnerable to poverty, experience lower wages, have restricted accessibility
to economic opportunities, and their improvement is hampered by discriminatory attitudes.
APACPH has pledged to address gender differences in health and continuously ensure that wom-
en’s rights and health are protected through the consolidated efforts between the member institu-
tions in this region. This journal will continue to welcome papers addressing gender issues in
public health in the region.

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