An exploration of stakeholder views and perceptions on taxing tobacco, alcohol and sugar-sweetened beverages in Ghana

• Published in: BMJ global health Vol. 8; no. Suppl 8; p. e012054
• Main Authors: Singh, Arti, Smith, Katherine, Hellowell, Mark, Logo, Divine Darlington, Marten, Robert, Suu Lwin, Kaung, Owusu-Dabo, Ellis
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd 01.05.2023; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: Alcohol; Beer; Beverages; Cigarettes; Commodities; Excise taxes; Ghana; Health policy; Humans; Nicotiana; Obesity; Original Research; Overweight; Public awareness; Qualitative study; Raw materials; Risk factors; Stakeholders; Sugar; Sugar-Sweetened Beverages; Tax increases; Tax rates; Taxation; Taxes; Tobacco; Ghana; Qualitative study; Health policy
• ISSN: 2059-7908; 2059-7908
• DOI: 10.1136/bmjgh-2023-012054

BackgroundNon-communicable diseases (NCDs) account for nearly 43% of Ghana’s all-cause mortality. Unhealthy commodities (such as alcohol, sugar and tobacco) are an important factor in the growing NCD burden in the region of sub-Saharan Africa (SSA). Despite health taxes on tobacco, alcohol and sugar-sweetened beverages (SSBs) gaining renewed attention, adoption and implementation in SSA remain limited. This study aims to unpack the contextual politics and to examine current perceptions of opportunities and barriers for health taxes in Ghana.MethodsSemistructured qualitative interviews (n=19) conducted with purposively sampled stakeholders representing four sectors: government, civil society, media and international organisations, and two group interviews with nine industry stakeholders, informed by a review of relevant literature and policy/advocacy documents.ResultsStakeholders had a general belief that such taxes are primarily useful for revenue generation (for health spending) rather than for reducing consumption and improving health. There do appear to be opportunities for health taxes with stakeholders broadly supportive of taxing SSBs. This support could be strengthened via ‘health’ framing of any new tax proposals, the generation of Ghana-specific evidence about the potential impacts of such taxes and greater public awareness. Industry actors and some government representatives opposed health taxes, citing concerns about the potential to increase illicit trade and economic harm. Some stakeholders also believed that links between politicians and affected industries represent an important barrier.ConclusionThese findings identify opportunities to introduce health taxes but also underline the potential resistance from affected industry stakeholders. Nevertheless, a strategic approach that focuses on achieving policy coherence (between central government, health and economic ministries), combined with efforts to strengthen stakeholder and public support, may weaken the lobbying position of industry. Such efforts could be supported by research to help demonstrate the value of different designs of health taxes for achieving Ghana’s health goals and to better understand industry–political links.