When the smoke clears: Tobacco control in post-conflict settings

The paper particularly focuses on tobacco control. Globally, one in ten deaths is caused by smoking but in post-conflict zones tobacco usage rates are higher than global averages. This increase coupled with opportunistic industry activity and blackmarket trade poses long-term risks for public health.

The paper lays out effective tactics learnt from successes and failures in tobacco control and health policy from Vietnam, Iran and Croatia that can be used to limit the health threats to citizens in Iraq.

Prof Richard Sullivan, from the Institute of Cancer Policy and the Conflict & Health Research Group, 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 recorded collusion between smuggling rings and tobacco firms, success has been limited in post conflict settings.

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 surmise that these are poor as more children and young adults take up smoking but to date there have been very few long-term studies. What we have seen already is an increase in tobacco smuggling, higher tobacco usage in women and dramatically lower quit rates."

While overall global smoking prevalence has decreased 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 post conflict settings such as 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."