A new win for Ghana: 20% tax has been imposed on sugar-sweetened beverages (SSBs), including flavoured juice drinks, sweetened tea, sodas, and energy drinks. Actioned by the Ghanaian Government as part of measures to reduce impacts of SSBs on public health, the country is now one of hundreds that have implemented World Health Organization-recommended interventions to prevent non-communicable diseases (NCDs).
This important policy action follows a comprehensive campaign by the Advocating for Ghana's Health Coalition, which asserts that an SSB tax will increase individual healthcare savings and promote the health of Ghanaians, especially children. The tax is expected to help reduce SSB consumption and have knock-on positive impacts for the general population of Ghana, which, like most African countries, is experiencing increases in nutrition-related NCDs, such as overweight and obesity.
"Excessive consumption of SSBs increases the risk of stroke, kidney failure, and heart diseases," said Professor Paul Armah Aryee of the University for Development Studies, during a public sensitization event held in Tamale, in Ghana's Northern Region in July 2022. James Mckeown, a member of the Coalition who organized the sensitization event urged the public to drastically reduce their intake of such drinks and switch to drinking water instead.
SSBs are a significant contributor to overweight and obesity, and children with these conditions have an elevated probability of developing other diet-related diseases, such as type 2 diabetes, hypertension, and stroke, later in life. "Poor diets are responsible for some 11 million deaths annually, with cardiovascular disease, cancers, and diabetes as the leading causes. What is the problem? We don't eat enough healthy foods like whole grains, nuts, seeds, fruits and vegetables," says Professor Amos Laar of the University of Ghana.
A team of Ghanaian researchers recently estimated the direct healthcare costs associated with obesity in the older adult Ghanaian population: compared with healthy-weight adults, overweight and obesity were associated with 75% and 159% more in-patient admissions, respectively. For adults with a healthy weight, the average health care cost per person per admission was US$35, whereas for overweight adults it was US$78, and obese adults US$132. The Ghanaian Government is therefore stumping up a staggering fee for these highly expensive – yet preventable – health conditions.
The enactment of the tax on SSBs is an important step forward to achieving Ghana's commitments to improving public health. Ahead of the bill's approval, the Advocating for Ghana's Health Coalition conducted relevant research and implemented an advocacy campaign to increase demand for the policy. In November 2022, the Coalition first presented a position statement to Parliament and key government ministries, departments and agencies, highlighting the need to enact and implement an SSB tax. On 20 December, the bill – the Ghana Excise Duty Amendment Bill, 2022 – was tabled, read and debated by Parliamentarians. In response, the Coalition presented a joint position statement commending Parliament for approving the bill at its second laying, but also identified and outlined key gaps in the bill – including the type of tax to impose – and offered recommendations to strengthen the proposed policy. The bill was read for the third time and approved by Parliament on 31 March 2023, and signed into law by the President on 3 April 2023.
Led by the School of Public Health of the University of Ghana, the Coalition is made up of groups including the Advocating for Health Project, Healthier Diets for Healthy Lives Project, the Ghana Public Health Association (GPHA), Ghana NCD Alliance (GhNCDA) and Ghana Academy of Nutrition and Dietetics (GAND), as well as the Coalition of Actors for Public Health Advocacy (CAPHA). Relying on existing evidence, the Coalition has argued that SSBs contain little or no nutrients and are implicated in several health problems, including obesity, tooth decay, and type 2 diabetes.
In order to raise awareness on the implications of sugary drink consumption and the need to develop healthy lifestyles, from February 2022 to June 2023 the Coalition wrote and published news articles and op-eds in the Ghanaian media, and held floats (street marches), virtual webinars, and public forums across the country with a clear message: 'SSBs are harmful to your health'. The Coalition's sensitisation efforts have further involved training local journalists on the relationship between unhealthy diets and NCDs so they can spread messages and help inspire behaviour change. Television and radio programmes are running in all 16 regions of Ghana, and advocacy champions and influencers identified by the Advocating for Ghana's Health Project are pushing project messages across social media.
As their evidence-informed advocacy work continues, the leader of the Coalition, Amos Laar, a Professor of Public Health and Nutrition maintains that "the government of Ghana has manifold opportunities and a responsibility to use public health policies to protect, promote, and assure the health of its citizens. One such opportunity is the enactment and implementation of this tax." The Coalition is currently hard at work engaging relevant government agencies that can identify the most effective ways to implement the policy, and more easily monitor and evaluate its impact, he adds.