Smoking, responsible for millions of deaths each year, continues its devastating path as public health policies, influenced by economic and political interests, perpetuate the exclusion of the most vulnerable. In a world where health has become a luxury, access to conventional treatments and harm-reduction products is a privilege reserved for a few, leaving millions without effective options to quit smoking.
Each year, millions of people worldwide develop serious illnesses as a result of combustible nicotine use.
Despite global efforts to combat this ongoing crisis, the reality is that many smokers cannot quit and, tragically, die from these illnesses.
Tobacco addiction, far from being the only culprit, persists due to the lack of access to cessation treatments and harm-reduction products.
In many regions, this shortage directly results from coercive and self-interested socio-political and economic mindsets that prioritize restrictive and profitable strategies over more compassionate, effective, and universal approaches.
Declaring that smoking is responsible for approximately 8 million deaths annually often masks the reality that this equates to the premature death of more than 15 people every minute.
In 2004, the World Health Organization (WHO) already attributed 5.1 million deaths to tobacco use, accounting for 9% of all deaths worldwide that year.
By 2019, the figure had risen to 8.67 million, and in 2024, it continues to claim lives at an alarming rate.
This situation highlights the urgency of reviewing and strengthening global tobacco control policies to prevent further escalation in the coming years.
With approximately 1 in 5 young men and 1 in 20 young women smoking, the WHO predicts that by 2025, at least 1.27 billion people will still be smoking, a decrease of only 30 million since 2020.
The Silent Epidemic of Health Inequalities
The most alarming aspect is that the burden of diseases and deaths caused by smoking is almost inevitably shifting to the least visible people in low- and middle-income countries.
Eighty percent of the world’s smokers live in these countries, a reality reflected in the rates of tobacco-related illnesses and deaths.
One in two smokers will die from smoking-related diseases. Thus, it is estimated that in the next year, more than 6.4 million people in low- and middle-income countries could die due to smoking.
This also means that the burden of smoking-related mortality will disproportionately affect these countries, potentially worsening health inequalities and placing significant strain on their healthcare systems.
In these regions, social, political, and economic resources to combat this epidemic are generally scarce or limited in availability.
Health, which should be an inalienable right, has become an inaccessible privilege for many people.
Local prohibitionist or denialist mentalities, many of them part of political pressure groups, seek to demonize and restrict the harm reduction paradigm.
Added to this are poorly implemented cessation services and the prohibitive cost of medications, products, and services for quitting smoking, revealing the harsh reality of a right that, in practice, has turned into a luxury available to only a few.
Comprehensive tobacco control, capable of saving millions of lives through non-combustible nicotine delivery technologies based on current scientific knowledge, is being hindered by a system that prioritizes profits over human well-being.
In many regions of the global south, including Africa, Latin America, and parts of Asia, the recommended treatments for quitting smoking—such as nicotine replacement therapies, medications like varenicline and bupropion, and behavioral support services—are scarce, limited, or, in some cases, nonexistent.
Even when available, they are often unaffordable for most people due to prohibitive costs or inefficient bureaucracy.
Although these treatments are considered essential to reducing smoking-related mortality, in many regions, they are the only legal and WHO-endorsed options and still fail to reach those who need them most.
At the same time, an intense cultural, political, and economic battle is being waged against non-combustible alternatives for nicotine consumption, which could be more accessible and effective than conventional treatments.
Instead of facilitating access to these alternatives, many nations impose bans or severe restrictions on harm-reduction products, exacerbating the situation.
This opposition, disguised under the guise of public health care, scientific prudence, and the precautionary principle, reveals a dangerous dynamic that puts millions’ health at risk by denying them access to more affordable and effective tools for quitting smoking.
Health as a Commodity: Monopolies, Power, and Inflated Prices
The powerful pharmaceutical market, dominated by large corporations and an insatiable core of investors, celebrates the obstacles to harm reduction while exercising significant control over the health industry and policies.
These large corporations often artificially inflate their product prices, making them inaccessible to most of the population.
Pharmaceutical companies have been accused of practicing shadow pricing, a cartel-like strategy in which they assign a monetary value to goods or services that do not have an explicit market price.
In this practice, competing companies raise prices in coordination to maintain high-profit margins without facing real competition.
However, Big Pharma’s influence also extends to regulatory processes and political decisions.
These large corporations have been criticized for using their power to influence policymakers, establishing regulations that allow them to maintain monopolies and high prices and avoid competition, directly affecting the accessibility of essential medications and procedures.
This capture of public health policies also suggests an obstruction to the implementation of harm reduction strategies that could alleviate the burden of smoking-related diseases.
Health as a commodity has become normalized, and as a result, corporate interests often conflict with collective health needs and goals.
Rather than being an accessible resource for all, dominant conventional treatments (as well as options that reduce the risks of smoking) have become luxury goods, restricted by high prices and limited coverage by private health plans.
Without the recommendation or access to harm-reduction products, quitting smoking becomes a heroic or unattainable option for many people in the global south.
For those who do not have the privilege of a good economic position or adequate health insurance, the cost of these treatments represents an insurmountable barrier, an unsustainable burden, especially for a significant portion of the most vulnerable 80%.
Moreover, significant bans or restrictions on tobacco risk and harm reduction products, while traditional cigarettes remain legally available, only worsen the situation.
The situation is even more critical in countries with deteriorated public health systems than in a multimillion-dollar private sector that is socially and politically active.
In many nations, especially low-income ones, public health systems are chronically underfunded, politically manipulated, and broadly deteriorated, severely limiting their capacity to implement effective smoking cessation programs.
A lack of resources often severely affects these programs, which require adequate infrastructure, trained personnel, and access to effective therapies.
The Right to Health Eroded and Harm Reduction Ignored
Health, a fundamental right, has become a privilege reserved for those who can afford it.
In a landscape where investment in smoking cessation programs is scarce, health systems are weakened or underfunded, and the harm reduction paradigm is excluded, public policies have succumbed to lobbying that prioritizes more lucrative treatment.
This scenario has eroded the state’s ability to offer accessible treatments, sacrificing collective well-being to maximize private profits.
The commodification of health has reached a critical point, and those treatments designed to combat one of the leading causes of preventable death, such as smoking, are, in addition to being of questionable effectiveness, out of reach for the most vulnerable populations.
In this context, the fight against smoking illustrates how health has ceased to be a right and has become a luxury.
The urgency of rethinking the global health system is evident; it is imperative that access to health ceases to be a privilege.
It is urgently necessary to redirect policies toward including the harm reduction paradigm and universal rights, where human life is prioritized over profit.
The current reality demands this transformation.
The concentration of power in public health, held by a few, perpetuates deep inequalities in access to and quality of services.
This phenomenon is acutely manifested in Latin America, where power structures and health systems are intimately linked to political, economic, and social factors.
In Mexico, for example, public health has been captured by bureaucracy and corruption, resulting in increased inefficiency that leaves the population in a situation of extreme vulnerability.
In Brazil, the belief in the superiority of private medicine has fragmented the country’s extensive and exemplary free universal health system, creating a formidable obstacle to policies that seek to guarantee health as a universal right.
The political complexity of health systems and opacity in financing and coverage hinder equity in access to essential services.
This challenge underscores the urgency of implementing policies that expand coverage and ensure equity and social justice.
Likewise, it is imperative that these policies include harm reduction strategies, recognizing that saving lives does not always involve the total eradication of risks but minimizing their effects when eradication is not immediate.
Only in this way can health be rescued from commodification, ensuring that it becomes a universal right, accessible to all, and not a privilege reserved for a few.