Yes! Taxation of sugar-sweetened beverages is a ‘Win-Win-Win’ Public Health Intervention

Overweight/obesity are currently on the increase in most developing countries. They are also risk factors for non-communicable diseases (NCDs) such as cardiovascular disease, type 2 diabetes, and an increased risk for some forms of cancer (Renehan et al., 2008;World Health Organization, 2015). In Ghana, nearly 43% of the adult population is either overweight or obese (Asenso et al., 2016). Particularly for women of reproductive ages (15-49), the prevalence of overweight/obesity increased from 25% in 2003 to 40% in 2015 (Ghana Statistical Service et al., 2015). The healthcare and economic burden associated with overweight and obesity and its related NCDs has become a public health concern. According to the Ministry of Health (MOH, 2022), NCDs have been reported as a significant cause of mortality and morbidity in Ghana. The burden of these chronic diseases in Ghana are projected to increase due to rapid urbanization, ageing and unhealthy lifestyles. Modifiable behaviors such as tobacco use, physical inactivity, the harmful use of alcohol and unhealthy diets (high salt and sugar intake, saturated fat), all increase the risk of NCDs; some of which are also risk factors for obesity, an independent risk factor for many NCDs. Recently, there has been an increasing concern for high levels of free sugar intake, to which sugar-sweetened beverages (SSBs) are a major contributor due to its health implications. There is ample scientific evidence to show that excessive consumption of SSBs is associated with weight gain, diet-related NCDs, dental caries and gout (WHO, 2015; Te-Morenga et al 2012; Malik et al 2017; Valenzuela et al.,2021; Ebrahimpour-koujan, 2020). They have little to no nutritional value as well.

Health taxes are considered effective policies that elicit a positive change in behavior, reduce the consumption of products that are considered risk factors for obesity and NCDs while advancing health equity and creating a wealthier treasury. The World Health Organization (WHO) in recent times, has endorsed the implementation of SSB taxes as a cost-effective way to curb obesity and its related NCDs (WHO, 2019; WHO 2022).

Therefore, we commend the government of Ghana as it implements its Excise Duty Amendment Bill, 2022 – to tax sweetened beverages and other commodities. The amendments include the imposition of excise duty (20 percent of the ex-factory price) on sweetened beverages including fruit juices (e.g. grape and vegetable juices unfermented and containing spirits whether or not containing added sugar or other sweetening matter).

Although public health advocates have been the major voice behind SSB taxes, it is important and may currently be more feasible than before to expand the coalition. A SSB tax advocacy team currently exists in Ghana and is being led by the A4H coalition; a coalition made of Academia (led by University of Ghana School of Public Health), Civil Society Organizations (led by the Ghana NCD Alliance), Public Health Associations (led by Ghana Public Health Association), and Nutrition/Dietetic Professional Group (Ghana Academy of Nutrition and Dietetics). As a coalition, we are therefore happy that the Government of Ghana, during its last parliamentary sitting announced the enactment of a 20% tax on SSBs. This act is a ‘Win-Win for Ghana’s Health and Government’s Revenue’. We believe now is the time to take action and by any means possible protect and safeguard the populations right to healthier foods.

Evidence from other countries that have implemented some kind of tax on SSB shows a reduction in the purchase and sales of SSBs, and consequently its consumption while having an additional benefit of generating revenue. For instance, Portugal generated €80 million (US$ 90 million) within the first year of implementing SSB tax. South Africa also generated of 3.2 billion rand (approximately US$ 200 million) within the first two years implementation. In Mexico, the SSB tax generated USD1.2 billion in its first year of implementation and over US$ 2.6 billion during the first two years of implementation (UNICEF, 2021; WHO, 2022). The implementation of this tax we believe will also lead to product reformulation, while raising public awareness about sugar consumption and its harms. Significant evidence from other countries shows that the taxation of SSBs led to most industries reformulating their products by reducing the sugar content (Goiana-da-Silva et al., 2018; Pell et al., 2020; Hofman et al., 2021). Overall, high tax rates on SSBs are likely to have a positive impact on health behaviors and outcomes (Wright et al., 2017).

We, therefore, call on the Government of Ghana to partner with public health campaigners and civil society actors to save lives and improve the health of Ghanaians. The main goal of the A4H project coalition is to improve the health of Ghanaians and therefore, the packaging of the Government’s mission on the taxation of SSBs should have the improvement of the health of Ghanaians as the ultimate goal.

Building and learning from the experiences of other countries, we implore the government to be transparent about how the taxes will be spent and how the general populace will profit from it; whether it will be used to enhance health and health equity, fund health-related activities, or promote other healthy policies. Revenue should be ring-fenced to support much needed preventative strategies towards obesity and diet-related NCDs. We also urge the government to determine the type of tax to impose, what the tax base will be (based on sugar content or the volume), and clearly define what the taxable products will be (UNICEF, 2021).

Perhaps lessons from the about 85 countries and small jurisdictions that have levied some kind of tax on SSBs may be helpful to Ghana (WHO, 2022). WHO is a staunch advocate ready to provide support, technically sound and effective measures to any country in protecting and improving the health of its citizens. The A4H Coalition stands ready to support the government in this regard.

We believe that this act of government is in the right direction. Indeed, the Ministry of Health working with academia, other government agencies and a civil society coalition is hard at work developing “comprehensive food-related fiscal policies; front of pack labeling; marketing restrictions of unhealthy foods and beverages, and public food procurement policy”. If other countries have been able to do it in the past decade, then Ghana can also do it.

The writer, Annabel Yeboah-Nkrumah, is a Project Officer at the A4H Coalition, University of Ghana School of Public Health