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When the smoke clears… tobacco control in post-conflict scenarios

At the time of writing, the Iraq army is engaged in a door-to-door battle through the Old City of Mosul, in the latest push to oust Daesh insurgents from the west of the city.

This is only the latest advance in a battle now entering its fifth month, and a war against extremist forces that follows a decade of Western occupation and near-constant conflict.

And yet, in a region riven by war and violence spanning decades, the leading causes of death in Iraq remain coronary heart disease and stroke, preventable diseases driven by tobacco use.

Considering the lessons in tobacco control of post-war Vietnam, Iran and Croatia, researchers from Kings College London weigh the successes and hurdles of tobacco regulation in a post-conflict scenario.

Their review is published in ecancermedicalscience.

Prof Richard Sullivan, from the Institute of Cancer Policy, London, UK and one of the authors of the review states “[Tobacco control] is essential but we recognise that this requires strong governance which is often missing. What is also clear is that what countries self declare to WHO around their tobacco control measures (and other NCD risk factor control measures) often does not hold up under practical scrutiny.”

Taxation is reported by many institutions, including the WHO, as the most effective means of reducing demand, but between low import duties, open corruption, and collusion between smuggling rings and American tobacco firms, success has been limited.

As for the longer-term prospects of disease development in the region, Prof Sullivan cautions “We know very little about the long term effects; we can summise that these are poor as more children and young adults take up smoking but to date there have been very few long term studies.”

“We are seeing an increase in tobacco smuggling, usage in women and dramatically lower quit rates.”

Globally, one in ten deaths is caused by smoking.

While overall smoking prevalence has decreased world-wide over the last 25 years (29.4% to 15.3%), population growth has meant that the overall number of smokers has increased by almost 60 million people.

Those rates are even higher in Iraq, an established importer/exporter of cigarettes, with a large smoking population (31% of men and 4% of women).

“This work was part of the KCL Conflict & Health Research Group thematic research into NCD control in conflict.” says Prof Sullivan, “We know countries in conflict undergo radical changes in their exposure to pro NCD risk factors, yet there is little country specific analysis; working with collaborators from Iraq we were able to conduct this country specific research which provides a more practical, focused example of the issues and threat that tobacco plays in the conflict and post conflict environments”.

Source: ecancermedicalscience

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