If we really want to reduce the burden of tobacco-related death and diseases, the most important action is to get current smokers to quit.
About 70% of current smokers want to quit, and 40-50% try annually. Most of them make an attempt without receiving any kind of help. The results are disappointing: only one in 10 succeed.
Quitting smoking is not easy. The main reason is that most smokers are tobacco-dependent, and that is a chronic relapsing condition.
Scientific evidence indicates that there are effective pharmacological and non-pharmacological interventions for smoking cessation that double, or even triple, the chances of success. And that combining different types of interventions increases these possibilities.
So, we know what to do, but we don't apply.
This is very true for Latin American countries, the vast majority of which are States Parties to the WHO-FCTC, and are committed, under Article 14, to promote and apply measures for smoking cessation and treatment.
Article 14 is one of the least applied WHO-FCTC provisions in the region, according to the 2022 Report on Tobacco Control of PAHO.
Even more worryingly, it indicates that in recent years there has been no progress in the region.
Most Latin American countries are far from meeting the Art. 14 “minimum standards”, of having:
- accessible smoking cessation services
- at least one evidence-based medication, such as NRT.
- a national quitline.
Only three Latin American countries have implemented these standards: Brazil, El Salvador, and Mexico
Thus, we are far from the Art.14 objective of helping ALL smokers to quit
Why is this happening?
There are several reasons we can argue:
1. Lack of trained human resources in smoking cessation, which goes hand in hand with insufficient or non-existent financial resources allocated to tobacco control in general, and cessation in particular.
2. Great difficulties in the accessibility and affordability of effective medications for cessation in the vast majority of countries.
3. We could add that, in recent times, the Tobacco Industry is taking advantage of these gaps to promote its new products as valid resources for cessation, when there is no solid evidence to support this, and when at the same time it continues with its systematic lobbying, in all countries, to prevent or undermine any effective tobacco control measure implementation.
Regarding access to effective smoking cessation medications :
*NRT*- 23 of the 35 countries have NRT available, but only 12 of them include NRT in their national Essential Medicines lists, although WHO included NRT in its list of essential medicines many years ago.
*Bupropion*- is available in 27 countries (although in several of them only as an antidepressant medication)
*Varenicline*: available in only 18 countries.
To conclude, we want to emphasize that:
§ It is time for health authorities and decision-makers to understand that to improve Latin American population health, they must recognize the importance of smoking cessation and treatment interventions, and invest in them.
§ Smokers don't need lectures, THEY NEED HELP.
§ We have effective, evidence-based medications to help smokers to quit. The recent inclusion of bupropion and varenicline in the WHO Essential Medicines List is an excellent opportunity for countries to include them in their national lists. To achieve that, the MoH tobacco control focal points should work jointly with those responsible for the National Essential
Medicine List, and have the support of academia and civil society.
• Tobacco and Public Health: *From theory to practice. *PAHO Campus
virtual course, 2016
• Smoking Cessation: A Report of the Surgeon General,2020
• PAHO *Report on Tobacco Control for the Region of the Americas 2022*
*Dr. Eduardo Bianco*
Director, International Policy Education
Web: NextGenU.org <https://nextgenu.org/>
*Chair, WHF Tobacco Expert
HIFA profile: Eduardo Bianco is a medical doctor and Cardiologist, Certified Tobacco Cessation Expert with a Master’s in Prevention and Treatment of Addictive Disorders. Currently, he is Chair of the World Heart Federation Tobacco Expert Group. Dr. Bianco’s research examines tobacco control and cessation, and he is a prominent member of several organizations that address tobacco control in Latin America. Dr. Bianco has worked for 25 years in Uruguay and Latin America to promote and train in smoking cessation treatment and tobacco control policies. He is also the former Regional Coordinator for the Americas of the Framework Convention Alliance and former Technical Director of the MOH Center for International Cooperation for Tobacco. He is a member of the HIFA project on Mental health: meeting information needs for substance use disorders. Email: ebianco AT nextgenu.org https://www.hifa.org/projects/mental-health-meeting-information-needs-su... https://www.hifa.org/support/members/eduardo