Only 13 low-and middle-income countries offer smokers the full support needed to help them quit, leaving around 1.3 billion people without access to effective care, according to a new study.
Researchers at the University of York, New York University, and Harvard University, found that despite tobacco being the world's leading cause of preventable death, killing more than seven million people annually, the vast majority of the world's smokers are without access to quitting services.
More than 80% of tobacco users live in developing nations, where health systems face the highest disease burden but offer the least assistance.
While many governments state that support is available, researchers discovered that just 13 lower-income nations provide the gold standard of care recommended by the World Health Organization (WHO), which includes a combination of behavioral counseling and free or subsidised medication.
Examining healthcare delivery in countries including India and Vietnam, researchers showed that access to care is heavily shaped by local factors, including cultural norms, government policy, healthcare funding models, and political interference from the tobacco industry.
Because these challenges vary by region, researchers emphasised that quitting programmes must be tailored to each nation's specific landscape rather than relying on a one-size-fits-all model.
Professor Kamran Siddiqi, from the Hull York Medical School, said "Healthcare services have a fundamental responsibility to treat people with tobacco addiction. Evidence shows that such interventions are not only cost-effective and easy to integrate but also drive substantial health and economic improvements."
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 quitlines and mobile health apps that deliver remote advice at scale, as well as access to community health workers to provide guidance in rural regions, 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.
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 must be covered by governments or insurers to eliminate financial barriers.
Professor Donna Shelly, 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."
