Addressing health equity and inclusion

Equity must be at the centre of every THR strategy. The populations with the highest burden of smoking, low-income groups, women in informal or precarious work, people with chronic illnesses, individuals with mental health conditions, and those in rural or marginalised communities, are often the least able to access cessation support or safer nicotine products. Without an explicit focus on equity, THR risks becoming an intervention available only to those with financial means or access to urban health services.

Ensuring equitable access to THR requires addressing three interconnected gaps: affordability, availability, and awareness. Affordability is crucial; safer nicotine products are often priced out of reach for low-income users due to high import costs, restrictive taxation, or limited local supply. Tiered tax systems, targeted subsidies, or vouchers distributed through primary care or community programmes can help ensure that cost does not become a barrier to switching from smoking.

Availability also matters. In many LMICs, safer nicotine products are concentrated in urban centres, leaving rural populations dependent on unregulated informal markets or with no access at all. Expanding distribution through community drug shops, mobile health units, and primary care clinics can help ensure that safer alternatives reach those most in need.

Awareness is equally important. Vulnerable groups often have limited exposure to reliable information about THR, and they may face higher levels of stigma or misinformation. Community-based education, delivered through trusted messengers such as community health workers, women’s groups, religious leaders, or peer networks, can counter misconceptions and provide practical guidance on safer switching.

Addressing equity also means recognising the social and cultural dynamics that shape tobacco use. For example, women in many LMICs face strong social stigma around both smoking and nicotine use, which discourages them from seeking support. Tailored, gender-sensitive messaging and safe spaces for women to access information and products are essential. Similarly, people with chronic illnesses or disabilities may require adapted communication methods and targeted guidance from healthcare providers.