Tobacco cessation services remain scarce in low- and middle-income countries

Only 13 low- and middle-income countries provide smokers with the full support needed to help them quit, leaving about 1.3 billion people without access to effective care, a new study shows.

Researchers at York University, New York University, and Harvard University found that although tobacco is the leading cause of preventable death globally, killing more than seven million people annually, the vast majority of the world’s smokers do not have access to smoking cessation services.

More than 80% of tobacco users live in developing countries, where health systems face the greatest burden of disease but provide the least help.

While many governments reported that support was available, researchers found that only 13 low-income countries provided the gold standard of care recommended by the World Health Organization, which includes a combination of behavioral counseling and free or subsidized medication.

By studying health care delivery in countries such as India and Vietnam, researchers have shown that access to care is greatly influenced by local factors, including cultural norms, government policy, health care financing models, and political interference from the tobacco industry.

Because these challenges vary by region, researchers emphasized that smoking cessation programs should be tailored to fit each country’s landscape rather than relying on a one-size-fits-all model.

Health care services have a primary responsibility for treating people with tobacco addiction. Evidence suggests that such interventions are not only cost-effective and easy to integrate, but also lead to significant health and economic improvements.

Professor Kamran Siddiqui, Hull York Medical School

The review, published in the New England Journal of Medicine, recommends several low-cost, high-impact strategies that can expand support even in resource-limited settings. These include national smoking cessation lines and mobile health apps that provide widespread remote counseling, as well as access to community health workers to provide guidance in rural areas, and routine screening, such as the “Ask-Advise-Connect” system, which enables doctors to screen patients and link them directly to treatment during regular visits.

The researchers stress that proven smoking cessation medications, such as nicotine patches, cytisine, and varenicline, are cost-effective and should be licensed worldwide. They argue that full courses of these treatments should be covered by governments or insurance companies to remove financial barriers.

Professor Donna Shelley, from New York University, said: “Ensuring equitable access to comprehensive tobacco cessation support as standard care is a vital step towards preventing millions of tobacco-related deaths globally.”