Constructing public health policies in post crisis countries: lessons to learn from the associations between free-sugars consumption and diabetes, obesity and dental caries before, during and after sanctions in Iraq.

E Joury,Anwar R Tappuni,R Al-Kaabi

doi:10.1007/s10389-016-0745-4

Abstract

BackgroundThis article aims to provide evidence for an informed public health policy on free-sugar consumption in post-crisis countries.MethodsIraq was selected as a case study. A systematic search for published data on the prevalence/incidence of type-2 diabetes, overweight/obesity, dental caries and free-sugar consumption levels in Iraq was conducted using MEDLINE, the Iraqi Academic Scientific journals and relevant international organisations’ websites. Comparable data before (1980–1990), during (1991–2002) and after (2003–2015) the United Nations sanctions (UNS) were included.ResultsTen studies were included. Quality scores ranged between 3 and 7/8. Free-sugar consumption decreased dramatically during the UNS (from 50 to 16.3 kg/person/year) and started increasing afterwards (24.1 kg/person/year). Changes in type-2 diabetes, overweight/obesity and caries levels mirrored those of free-sugar consumption. Caries declined markedly during UNS and started increasing afterwards. Comparable data on diabetes and overweight/obesity were only available for the periods during and after the UNS. Both of these conditions started increasing with increased free-sugar consumption after lifting the UNS.ConclusionsThere is a need to develop a public health policy in post-crisis countries to maintain the reduction in free-sugar consumption, and hence promote both general and dental health, by integrating the common risk factor approach into the social determinant framework.

Highlights

The Middle East region has recently faced a marked increase in the burden of free-sugar-related non-communicable diseases (NCDs), type-2 diabetes, overweight/obesity and dental caries (Mirmiran et al 2010; Boutayeb et al 2012; Abid et al 2015)
Iraq is a country in this region that has relatively recently gone through a crisis of economic sanctions and war and at present is considered to be in the post-crisis era
Overall ten studies were included in the current review, two national studies conducted by the Iraqi Ministry of Health in collaboration with the World Health Organisation in 2000 and 2006, which included data on the prevalence of type-2 diabetes and overweight/obesity among adults, two community-based studies conducted in 2002 and 2010/2011 on the prevalence of overweight/obesity among children and six community-based studies carried out on the prevalence of dental caries among children (Table 1)

Summary

Introduction

The Middle East region has recently faced a marked increase in the burden of free-sugar-related non-communicable diseases (NCDs), type-2 diabetes, overweight/obesity and dental caries (Mirmiran et al 2010; Boutayeb et al 2012; Abid et al 2015). Many countries in the Middle East are suffering from crises relate to political conflicts and economic sanctions This is relevant to all conflict zones in Africa, Asia and other parts of the world. These political, economic and social negative events have a profound impact on a population’s different living aspects, including diet and nutrition (Guha-Sapir and D’Aoust 2010). The latter undergo changes during crisis time, leading to both negative and positive changes in the population’s health. This article aims to provide evidence for an informed public health policy on free-sugar consumption in post-crisis countries

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