Only 13 low- and middle-income countries provide smokers with the full range of support needed to quit, leaving around 1.3 billion people without access to effective care, according to a new study. Researchers warn that major gaps in tobacco treatment remain, particularly in countries carrying the greatest burden of tobacco-related disease.
Researchers from the University of York, New York University and Harvard University found that most smokers worldwide have limited access to effective quitting services. Tobacco remains the world’s leading cause of preventable death, killing more than seven million people each year, yet treatment for tobacco addiction is still unavailable or inadequate for much of the global population.
More than 80% of tobacco users live in low- and middle-income countries, where healthcare systems often face substantial disease burdens while having fewer resources to help people stop smoking. Although many governments report that cessation support is available, the researchers found that only 13 lower-income countries provide the standard of care recommended by the World Health Organization (WHO), combining behavioural counselling with free or subsidised medication.
By examining healthcare delivery in countries including India and Vietnam, the researchers found that a complex mix of local factors influences access to smoking-cessation services. These include cultural attitudes towards smoking, government policies, healthcare financing, available resources and political interference from the tobacco industry. Such differences can significantly affect whether smokers are able to obtain appropriate treatment.
Because these barriers vary considerably between countries and communities, the researchers argue that smoking-cessation programmes need to be adapted to local circumstances rather than following a single global model. Professor Kamran Siddiqi, from Hull York Medical School, said healthcare systems have a fundamental responsibility to treat tobacco addiction, noting that effective interventions can be inexpensive to implement while producing substantial health and economic benefits.
The review, published in the New England Journal of Medicine, highlights several low-cost strategies that could expand access to cessation services even in countries with limited healthcare resources. These include national quitlines and mobile health services that provide advice remotely, as well as community health workers who can reach smokers living in rural and underserved areas.
The researchers also recommend making tobacco screening and treatment a routine part of healthcare. Approaches such as “Ask-Advise-Connect” allow healthcare professionals to identify tobacco users during regular appointments, advise them to quit and connect them directly with treatment. Proven smoking-cessation medications, including nicotine patches, cytisine and varenicline, are also considered cost-effective and should be more widely licensed and accessible. The researchers argue that governments or insurers should cover full courses of treatment so that cost does not prevent people from receiving help.
Professor Donna Shelly of New York University said ensuring equitable access to comprehensive tobacco-cessation support as part of standard healthcare is essential to preventing millions of tobacco-related deaths worldwide. The researchers conclude that expanding affordable, locally appropriate treatment could substantially reduce the global health and economic burden of tobacco, particularly in lower-income countries where most tobacco users live.
More information: Donna Shelley et al, Evidence-Based Tobacco-Cessation Strategies for Low- and Middle-Income Countries, New England Journal of Medicine. DOI: 10.1056/NEJMra2507061
Journal information: New England Journal of Medicine Provided by University of York
