Context
Iraq became a Party to the WHO Framework Convention on Tobacco Control (FCTC) on 17 March 2008. In line with Article 12 of the WHO FCTC, a tobacco control law was introduced in 2012, with a primary focus on promoting public health awareness about the dangers associated with tobacco use. Annually, a national tobacco control plan is implemented to enhance public knowledge and foster negative attitudes towards tobacco consumption.
To address existing gaps and challenges, such as the difficult implementation of the tobacco control law due to current conditions in the country, interference from the tobacco industry and the widespread availability of affordable tobacco products, the Ministry of Health has developed a comprehensive national campaign against smoking. The objective of this initiative aligns with the guidelines outlined by the WHO FCTC, aimed at bridging the gaps and addressing the challenges faced by Iraq in tobacco control.
Initiative
In order to implement the national tobacco control plan of 2018 and the strategy for prevention and control of noncommunicable diseases from 2018 to 2023, and in line with the recommendations of the National Committee of Tobacco Control held in the Ministry of Youth and Sports, a comprehensive national campaign against smoking was launched for a continuous three-week period in October and November 2018. This campaign, in line with the guidelines of the WHO FCTC, specifically targeted the millions of individuals visiting the Holy City of Karbelaa during a religious event, aiming to raise awareness of the health risks associated with tobacco, particularly waterpipe smoking, for both smokers and non-smokers due to secondhand smoking.
The campaign was carried out in collaboration with religious leaders, and various awareness materials such as posters, videos, etc. were produced and printed to be distributed to the visitors through mobile health teams, involving the participation of most health directorates. Additionally, the Ministry of Health arranged a dedicated section within the 45th National Baghdad Exhibition to spread health awareness among the general public. This involved the use of diverse health education materials and direct face-to-face interactions and interviews with the public.
Furthermore, several health directorates organized seminars and educational lectures on the harmful effects of tobacco, both within and outside health centers, and conducted field visits to schools participating in the anti-smoking schools project. Many ministries, health directorates, and nongovernmental organizations participated in this initiative, contributing to the provision of free exhibition space, printing educational materials for the campaign, and offering symbolic gifts featuring the logo of the National Tobacco Control Committee. Notable participating ministries and authorities included the ministries of interior, housing and development, commerce, industry, culture, finance and the National Tax Authority.
In a first for Iraq, a carbon monoxide analyzer machine was utilized at the exhibition to support smoking cessation services. Smokers visiting the exhibition displayed a keen interest in measuring the toxicity levels resulting from their tobacco use. Despite the unavailability of necessary medications such as Bupropion and nicotine replacement therapies in healthcare facilities, smokers expressed a strong willingness to purchase them from the local market in order to quit smoking.
Challenges and lessons learnt
The success of this initiative can be attributed to the extensive media coverage received, as well as the participation of influential policymakers and notable figures including the Minister of Health's consultant, the Minister of Communication, the Deputy Minister of Commerce, the Director General of Traffic, the Director of Baghdad's Traffic and several prominent media and cultural celebrities. The media attention shed light on tobacco control activities and paved the way for future collaborations in this field. Additionally, the public's keen interest in availing smoking cessation services and staying updated on developments in this area was noteworthy. The tobacco control section of the exhibition received a certificate of appreciation from the General Director of Exhibitions and Commercial Services in the Ministry of Commerce for its active participation in the 45th National Baghdad Exhibition.
However, several challenges were encountered during the implementation of this initiative. The tobacco industry made attempts to promote their products, taking advantage of the large number of visitors to the national exhibition. Nevertheless, these violations were identified as tobacco promotion and the exhibition coordinators took appropriate actions. Another obstacle was the lack of availability of nicotine replacement therapy in smoking cessation services, which hindered efforts to encourage more smokers to quit. Originally, it was planned for a pharmaceutical company to participate in the event and showcase their nicotine replacement therapy products to smokers, offering free samples to incentivize smoking cessation. However, this was not possible due to the products not being registered with the Ministry of Health, a lengthy process. Furthermore, the challenging political and social conditions in the country limited the ability to carry out similar initiatives in other provinces of Iraq.
Impact
The impact of the initiative was evident in the heightened health consciousness among the general public regarding the detrimental effects associated with tobacco consumption, with particular emphasis on the younger generation and adolescents. It successfully fostered active engagement from the public, as well as healthcare professionals, in promoting health awareness. Moreover, decision-makers were equipped with enhanced knowledge and understanding to adopt tobacco control measures. The initiative also exerted pressure on both governmental and nongovernmental organizations to implement tobacco control activities through various means such as seminars, educational lectures and other effective approaches.
Next steps
Future actions involve the annual repetition of mass media campaigns on tobacco hazards, as outlined in the National Tobacco Control Plan issued by the Ministry of Health. These campaigns will involve a wider range of state institutions, thereby strengthening health awareness about the detrimental effects of tobacco through national and international events. Additionally, periodic educational seminars and symposiums will be conducted outside of healthcare facilities. It is imperative to enhance smoking cessation services in primary healthcare settings, ensuring the provision of necessary resources such as C0-analyzers, nicotine replacement therapy, hotlines and other relevant resources. Efforts will be made to strengthen and foster collaboration with governmental and nongovernmental organizations, with the active participation of decision-makers in upcoming tobacco control activities and events.
References
MPOWER measures to reduce demand for tobacco
WHO Framework Convention on Tobacco Control
Story originated in 2019.