title: 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.
abstract: BACKGROUND
  This article aims to provide evidence for an informed public health policy on free-sugar consumption in post-crisis countries.
  
  
  METHODS
  Iraq 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.
  
  
  RESULTS
  Ten 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.
  
  
  CONCLUSIONS
  There 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.
authors.affiliation: Population and Patient Health, King's College London Dental Institute, Denmark Hill Campus, Bessemer Road, London, SE5 9RS UK ; Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Turner Street, London, E1 2AD UK.
authors.forename: E
authors.initials: E
authors.lastname: Joury
authors.affiliation: Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Turner Street, London, E1 2AD UK ; Directorate of Preventive Health Affairs, Directorate General of Health, Duhok, Kurdistan Region Iraq.
authors.forename: R
authors.initials: R
authors.lastname: Al-Kaabi
authors.affiliation: Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Turner Street, London, E1 2AD UK.
authors.forename: Anwar R
authors.initials: AR
authors.lastname: Tappuni
keywords: Crisis; Dental caries; Free-sugar consumption; Non-communicable diseases (NCDs); Obesity; Public health policy; Type-2 diabetes