What is the state of gender equality in the world? What do data tell us about progress towards the commitments made in the Beijing Platform for Action, which, 25 years after its adoption, remains the most comprehensive road map for advancing women's rights worldwide. Importantly, in adopting the 2030 Agenda for Sustainable Development in 2015, Member States reaffirmed, in Sustainable Development Goal 5, that gender equality is central to the achievement of sustainable development for all by 2030. As has been done at five-year intervals since the adoption of the Beijing Platform for Action, The World’s Women 2020 takes stock of progress in advancing women’s rights, empowering women and girls and ensuring gender equality in the world community.

The World’s Women 2020 is a collection of 100 stories providing up-to-date assessments of progress towards gender equality in the following six critical areas, including, under each area, the impact of COVID-19 on women: (a) population and families; (b) health; (c) education; (d) economic empowerment and asset ownership; (e) power and decision-making; and (f) violence against women and the girl child.

See, for example, health risk factors including data on tobacco smoking and alcohol consumption (see related figures on the report website).

Key points:

• Tobacco use kills more than 8 million people annually around the world: over 7 million people die from the first-hand use of tobacco and around 1.2 million non-smokers die from exposure to second-hand smoke. 
• Globally, men are 4.5 times more likely to smoke than women: the gender difference is largest in Eastern and South-Eastern Asia, where men are almost 13 times more likely than women to use tobacco; the gender gap is smallest in Australia and New Zealand where the ratio is 1.3, closer to gender parity.
• Since 2000 there has been a decline in smoking rates among both sexes, although the decline has been less pronounced among men.
• In 2016, more than 3 million people died as a result of the harmful use of alcohol, representing 1 in 20 deaths worldwide: the vast majority, more than three quarters, of those deaths were among men.
• In 2018, men consumed more alcohol than women worldwide, an average of 9.8 litres per man versus 2.6 litres of alcohol per woman aged 15 and older.
• In 2016, 39% of adults aged 18 and older (39% of men and 40% of women) were overweight. About 13% of the world’s adult population (11% of men and 15% of women) were obese. Women are more likely than men to be obese both as a result of biological and lifestyle factors, in particular lower rates of participation in physical activity and insufficient time for personal care and leisure.
• Emerging research shows that smoking may also be associated with a negative progression and adverse outcomes of the Coronavirus-19 (COVID-19) disease, which works to the disadvantage of men, who are more likely to smoke than women (4.5 times more likely, globally). Severe obesity has been also found to be associated with higher in-hospital mortality and, in general, worse in-hospital outcomes related to COVID-19.

Background
A health risk factor is anything that increases the likelihood of an individual developing a disease or injury. Risk factors can be demographic, social, economic, environmental, biological or behavioural in nature, although in most cases they are a combination of all of these factors.

The set of risk factors contributing most to the burden of disease is changing. In 1990, the leading risk factors for early death and disability were child wasting, short gestation for birth weight and low birth weight for gestation. In 2017, the leading factors were high blood pressure, smoking and high blood sugar.1

There are significant differences in the prevailing risk factors affecting the health of people in developed and less developed regions. In developing regions, prominent risk factors include undernutrition, unimproved water and sanitation facilities, poor hygiene and indoor smoke from solid fuels. In developed regions, the harmful use of alcohol and tobacco, poor diet and lack of exercise contribute substantially to the burden of non-communicable diseases, although the effects of non-communicable diseases are on the rise in developing regions as well. Across regions, unsafe sex remains the main risk factor for sexually transmitted infections, and for HIV/AIDS in particular, while gender norms, ideals of masculinity and power relations fuel a relatively high level of unintentional injuries and interpersonal violence.

Morbidity and mortality rates for many diseases are aggravated by exposure to specific modifiable risk factors, including tobacco use, harmful use of alcohol, unhealthy diet, physical inactivity and polluted air.

Current situation
Tobacco use is a major contributor to illness and death from non-communicable diseases. Tobacco in any form kills and sickens millions of people every year: the use of tobacco is one of the biggest public health threats, killing more than 8 million people a year2 around the world (up from more than 5 million deaths in 2010).3 More than 7 million of those deaths are the result of first-person tobacco use while around 1.2 million are the result of non-smokers being exposed to second-hand smoke.4

Tobacco use is a major risk factor for chronic respiratory and cardiovascular diseases. Among women, smoking is also associated with breast cancer.5 In 2018, men were 4.5 more likely to use tobacco than women. Globally, in 2018, the prevalence of smoking among men 15 years and older was 38.6%, compared to 8.5% among women of the same age. A decline in smoking rates has been observed since 2000 for both sexes, but the decline has been slower among men (23%) than among women (49%).

During the period 2000—2018, the number of male tobacco users in the world increased each year, peaking in 2018 at 1,093 million.6 The number of users is projected to decrease, assuming countries maintain current efforts in tobacco control.7 Since 2000, the number of female tobacco users has been declining in all regions (244 million in 2018, an estimated 100 million fewer than in 2000).8
 
The difference in smoking prevalence between women and men is reduced in higher income countries (see figure I). For instance, in Australia and New Zealand the gender gap is lower than 5 percentage points, and in Europe and Northern America the gender gap was measured at about 11 percentage points in 2018.

The gap may be associated with women having a greater control over their own resources in high-income countries and with the marketing strategies of the tobacco industry, which target women, especially young women.9

The gender difference is most marked in Eastern and South-Eastern Asia, where more than 50% of men smoke, compared to only 4% of women. In all regions it is vital to reduce the use of smokeless tobacco products, especially in countries where they enjoy great popularity, for example in South-Eastern Asia, where smokeless tobacco use among women is far more prevalent than smoked tobacco use (11.5% and 1.6%, respectively).10

Smoking has also been reported as a potential risk factor for COVID-19 as it is harmful to the immune system and its ability to respond to infections, specifically, because of its effects in upregulating receptors in the airways.11 In a recent review, it was reported that smoking may be associated with a negative progression and adverse outcomes of COVID-19.12 The higher prevalence of male smokers of all ages in Italy, especially among the elderly,13 may explain their higher predisposition to COVID-19.14

1 in 20 deaths result from harmful use of alcohol

Alcohol consumption can have an impact on the incidence of diseases, injuries and other health conditions, including their outcomes. The health and social harms from drinking alcohol occur through three main interrelated mechanisms: (a) toxic effects on organs and tissues (resulting, for instance, in liver disease, heart disease or cancer); (b) development of dependence, whereby the drinker’s self-control over his or her drinking is impaired, often involving alcohol-induced mental disorders, such as depression or psychoses; and (c) through intoxication, that is, the psychoactive effects of alcohol in the hours after drinking.15

In 2016, more than 3 million people died as a result of harmful use of alcohol – 5% of global deaths for the year —and over 75% of those deaths were among men.16 For women, cardiovascular diseases are the most common cause of death connected to alcohol use (41.6% of all alcohol-related deaths among women), while for men, injuries (28.7%) and digestive diseases (21.3%) are the most common alcohol-related deaths.17 The differences between women and men are even greater when considering the burden of disease as expressed in disability-adjusted life years.18 Estimates for 2016 show that the number of years of life lost due to premature death and disability related to alcohol consumption is four times higher for men than for women (106.5 million years for men versus 26.1 million for women).19

In addition, the association of alcohol consumption with engagement in unprotected sex20 has been shown to increase the risk of experiencing unintended pregnancy.21 Alcohol-attributable harms are underestimated, especially for women, as alcohol is a contributing factor to intimate partner violence perpetrated against women.22 The relationship between alcohol and intimate partner violence is a complex one and should be looked at within the context of broader gender inequalities and harmful gender norms and behaviours.
 
Worldwide, men consume almost four times more alcohol than women

In 2018, worldwide men consumed an average of 9.8 litres of pure alcohol per year compared to 2.6 litres among women, with no significant change observed over the last 10 years (see figure II). It is less common for women to be current23 drinkers than men, and when they drink, they drink less than men. 

Globally, the highest overall rate of alcohol consumption for both sexes is in Australia and New Zealand and Europe and Northern America, where men consume at least three times more alcohol than women (on average, 16 litres for men versus 5 litres for women) (see figure II). The lowest alcohol consumption is recorded in Northern Africa and Western Asia, where the gender difference between women and men is even more pronounced (almost five-fold). The harmful use of alcohol not only increases the risk of one of the major non-communicable diseases, as described above, but it also plays a role in suicide and road traffic accidents and is frequently associated with the higher mortality rates among men than women due to these causes.24

In terms of global prevalence, in 2016, it was estimated that 53.6% of men and 32.3% of women were current drinkers.25 Worldwide, in 2016, the prevalence of drinking decreased among women (from 37.3% in 2000), although estimates of the absolute number of women who are current drinkers has increased.26 Alcohol consumption among women has additional implications. For example, women who drink during pregnancy may increase the risk of preventable health conditions, both for themselves and their newborn children, including stillbirth, spontaneous abortion, premature birth, intrauterine growth retardation and low birth weight. Alcohol use also increases the risk of foetal exposure to alcohol due to drinking during pregnancy or delayed recognition of pregnancy.27