The Ghanaian Parliament on December 20, 2022 debated, voted, and approved a Bill to tax Sugar-Sweetened Beverages (SSBs) and other products – as per the Ghana Excise Duty Amendment Bill, 2022. In this series, I present my take on this policy intervention. In Part I, I outlined the health harms of SSBs and provided a justification for food-related health tax as a public health policy. Here, I restate some of the concerns and requests that a Ghanaian food activism coalition that I lead – “Advocating for Ghana’s Health (A4H) Coalition” submitted to the Government of Ghana prior to the passage of the Bill.
In Ghana, local evidence – including nationally responsibility surveys and local research show widespread availability, accessibility, relative affordability, and celebrity-endorsed advertisements of SSBs. These warrant urgent intervention by relevant actors, particularly, the government. The government of Ghana has an opportunity and a responsibility to act. Since 2012, the government pledged (in its first National Policy on non-communicable diseases (NCDs) to act – acknowledging its responsibility to protect, promote, and assure the health of Ghanaian citizens. The World Health Organization (WHO), other global, regional, and local health promoting institutions stand ready to support Ghana (and therefore, any jurisdiction desirous of protecting, promoting, and improving the health of their citizens).
The A4H Coalition derives motivations from this. The Coalition comprises Academia (led by the School of Public Health, University of Ghana), Civil Society Organizations (led by the Ghana NCD Alliance), Public Health Associations (led by Ghana Public Health Association), Nutrition/Dietetic Professional Group (Ghana Academy of Nutrition and Dietetics), as well as the Coalition of Actors for Public Health Advocacy (CAPHA). With support from the Global Health Advocacy Incubator, the A4H Coalition’s work seek to create a favorable environment and stakeholder buy-in for food-related fiscal policies (including SSB tax) in Ghana. The Coalition believes that if the Ghanaian government implements comprehensive policy measures that serve to limit availability of less healthy foods (e.g. energy-dense nutrient-poor foods, foods that contain too much salt, sugar, and harmful fats), while making available healthy foods (e.g. unprocessed, minimally processed foods including wholegrains, fruits, and vegetables); food actors (e.g. producers and consumers) will make immediate or strategic decisions to reduce availability, attractiveness and consumption of such less healthy foods, or increase availability, attractiveness, and consumption of healthier foods.
The Coalition is concerned about the escalating prevalence of overweight/obesity in Ghana particularly among women of childbearing age (this increased from 10% in 1993 to 40% in 2015. It’s troubled by the fact that dietary risk factors of NCDs, high blood pressure, elevated fasting plasma glucose and high body mass index are among the top 10 risk factors that drive the most death and disability combined, and alarmed by the increasing health and economic burden of these conditions (NCDs have been estimated as responsible for over one-third of all adult deaths in Ghana. Cognizant of the fact that currently available, albeit with patchy implementation, are several evidence-based interventions to reduce the burden of NCDs among populations, the A4H Coalition has, and will not relent on its calls to the government of Ghana to implement such evidence-informed interventions as SSB tax to save lives. The A4H Coalition recently appealed to the government of Ghana:
- to enact and implement SSB tax now. Thanks to the Government of Ghana for responding.
- as per WHO guidance, suggested to the Government to ensure a tax rate of at least 20%. The Government of Ghana paid heed.
- to implement a specific excise tax (which may be volumetric or nutrient-based). This is currently partly addressed.
- as national laws permit, earmark revenue accruing from the imposition of SSB taxes for health promotion interventions.
While we express our appreciation to the Government of Ghana for embracing the food-related fiscal policy intervention, a number of gaps have been identified in the policy and opportunities exist to address the gaps and strengthen the policy proposal. For instance, among the different types of SSB taxes available, excise taxes are preferred from a public health perspective and should be prioritized with a primary goal of provoking a behaviour change to correct for negative externalities and internalities. In jurisdictions with strong tax administration such as Ghana, the WHO recommends specific excise taxes calculated based on nutrient (sugar) content. Ghana may have to amend existing policies to allow earmarking of revenues accruing from the SSB taxes to address the harms caused by SSBs consumption, or to conduct relevant health research, or to fund social protection initiatives such as the Ghana School Feeding, and the Livelihood Empowerment Against Poverty (LEAP) Programmes or the National Health Insurance Scheme (NHIS).
Of note, the enactment and implementation of this policy is not without opposition. One of the ‘popular’ oppositional arguments to the enactment and implementation of SSB tax policies has been “where is the evidence that it has worked, or will work? Drawing on lessons from governments that have successfully enacted or implemented the tax policy, I would like to assure the Government of Ghana that the policy action has direct benefits on public health, as well as several positive externalities. If any, I am convinced as per available evidence that, the policy’s direct benefits and positive externalities significantly outweigh its negative externalities. Indeed, SSB taxes are now being pitched as a win-win-win strategy: a win for public health (saves lives, and averts health-care costs), a win for government revenue, and a win for health equity. A win for public health should be a win for industry. A healthy and productive public impact positively on government’s revenue generation and utilization, but also on the ability of food industries to thrive. Given that there is ample evidence in support of food-related fiscal policies (I will detail these in Part III of this series), anyone who opposes it might have ulterior motives.
The writer, “Amos Laar, PhD” is a Professor of Public Health Nutrition at the School of Public Health, University of Ghana, Legon and Principal Investigator (PI) of the A4H Project, the HD4HL Project and the ‘MEALS4NCDs Project’ and Co-PI of the Dietary Transitions in Ghanaian Cities. He is a Fellow of the Ghana Academy of Arts and Sciences.