For many years, the convenience of feigned helplessness of being between two opposing sides has been an escape route for decision-makers in many parts of the world. Today, we face one of the most glaring wages of war in health; the Parliament of Ghana is torn between industry opposition and heeding public health calls to pass the excise duty amendment bill on tobacco, alcohol, and sugar-sweetened beverages in response to the increasing burden of non-communicable diseases (NCDs).
As tempting as it is to keep applauding the government for proposing the bill, we must keep sight of the fact that the bill serves no actual public health interest unless it is fully passed into law and set in motion for implementation and enforcement. We are worried that a bill that seeks to protect Ghanaians’ right to life, especially the lives of our dear children and young people, is pending in Parliament after it passed the first and second readings in December 2022.
It is important to note that these industries do not care about anyone or anything besides making a profit. On the other hand, the intention of civil society and the public health community is public health-oriented and evidence-based; increasing taxes on unhealthy commodities would reduce excessive consumption, improve health outcomes, and provide not only a sustainable but also a reliable source of revenue to the government for health financing and other developmental projects.
The excessive consumption of sugar-sweetened beverages (SSBs), as well as tobacco and alcohol use, are among the five leading risk factors associated with non-communicable diseases (NCDs), along with physical inactivity and air pollution. NCDs are a big deal globally and in our local setting, killing over 41 million people worldwide annually, with over 94,000 of these deaths occurring in Ghana alone (WHO 2021).
The NCD Epidemic has been singly featured within the Sustainable Development Goals 3.4 and is currently being prioritized in Ghana’s Medium-Term Development Policy Framework (2022-2025), targeting a 30% reduction in the 94,400 annual NCD deaths in Ghana. Driven by this goal, it is questionable how we as a country intend to achieve the projected 30% decrease in NCD deaths by 2025 if we are unwilling to explore the evidence-based tax and other intervention that promises these developmental returns.
Ghana is not the first and will not be the last country to consider taxes as feasible for reducing the NCD epidemic; over eighty countries have implemented taxes specifically on sugar-sweetened beverages. An exemplary reference is always made to Mexico- the largest soft drink market in the world, with accompanying high rates of obesity and type 2 diabetes. Recognizing the strains on the nation’s productivity and healthcare spending, the Mexican government implemented one of the world’s first health taxes on SSBs in 2014.
In 2018, the South African government became the first in the African region to announce the introduction of an SSB tax as a public health measure to reduce the prevalence of obesity in the country. Concurrently, Nigeria began the year 2022 with an announcement by the Federal Government stating an imposition of a tax on SSBs as part of its Finance Act 2021. After the implementation of the SSBs tax, these countries have reported positive feedback on reduced consumption and higher revenue.
Interestingly, Dr. Juan Rivera, a professor of nutrition at the Mexican School of Public Health, used a data set of consumers and a commercial data set and found that after two years (2014-2015) of implementing the SSBs tax in Mexico, there was an average reduction in the purchases of SSBs by 7.6%. This is intriguing because the Mexican SSBs tax is less than 10% of the price per liter; however, its implementation resulted in a 7.6% reduction in consumption. This is one of the many shreds of evidence that confirms that taxes reduce consumption, improve health outcomes and generate revenue for the government.
The challenge of health financing is another burden of Ghana’s limping health system. The then Chief Director of the Ministry of Health, Dr. Sylvester Anemana, explained the financial constraints confronting the health system at the 2015 Health Summit held in Accra. He attributed the challenge to the government’s declining budget allocated to the Ministry of Health and the increasing coverage of the National Health Insurance Scheme (NHIS).
Being Ghana’s only public health insurance measure, the NHIS is struggling- covering over 60% of all healthcare costs per admission from 2014 to 2015 (Lartey et al. 2020). It is only natural that, with time, the NHIS has become redundant in rendering the benefits it promises. Unfortunately, being upgraded to a middle-income country, Ghana is no longer eligible for some foreign health financing grants making the health financing hurdle a difficult feat. The financing gaps are also evident in the quality of health services delivered, especially at the primary healthcare level.
The 2023 Community-Led Monitoring report compiled by the Ghana NCD Alliance showed significant dissatisfaction among consumers of health services, including people living with NCDs. The reported shortage of medicines and the unavailability of essential medical devices, such as glucometers and sphygmomanometers, even in facilities within the capital of Ghana. These findings highlight the need for immediate financing options to support the delivery of quality services at the community level- taxing health-harming commodities is a sure means.
In a Joy News interview on 10th March 2023, the Commissioner General of the Ghana Revenue Authority (GRA), Rev. Dr. Amissadai Owusu-Amoah emphasized that the GRA is poised to double its efforts in mobilizing revenue in the year 2023. Fortunately, the same country with this revenue goal is currently considering an Excise Tax Bill that has the potential to raise an extra annual revenue of 3.5 billion Ghana Cedis while protecting the health of citizens (UNDP Policy Brief on Health Taxes, 2022).
Speaking at a press conference hosted by the Vision for Alternative Development on the tobacco tax bill on 23rd February 2023, Dr. Alex Kombat, the Deputy Commissioner in charge of Research and Policy for GRA, confirmed that a continued delay in passing the excise duty amendment bill would hinder the GRA’s projection of curating a revenue of GHC 105 billion in 2023.
It’s disheartening that Ghana sits comfortably in the abundance of global and locally curated evidence, yet little effort is being made to curtail the health and economic woes of NCDs and risk factors. It is an open secret that the proposed tax bill is being confronted with industry opposition. We know the industry uses several tactics, such as making false economic hardship claims on mass media and spreading job loss threats. Meanwhile, contrary to industry arguments, taxes have tremendous health, social, economic, and environmental benefits.
In subtle ways, the industry is whitewashing itself by engaging in corporate social responsibility, sponsoring health-inclined programs, and presenting itself as ‘part of the solution’ to the mess they have knowingly caused. In real terms, all the industry cares about is remaining in business. Their political lobbying is skillfully tailored to delay, disrupt and deflect live-saving interventions but we will keep echoing the voice of public health interest. It is a matter of urgency that the bill is passed to reduce exposure to unhealthy commodities, especially among young people, children, and the vulnerable.
On this note, the civil society movement in Ghana led by the Ghana NCD Alliance and the Vision for Alternative Development, and other Civil Society actors insists that there’s no middle ground; Parliament must heed the calls of public health interest and ignore industry arguments.
Our message is simple- pass the bill NOW!
By:: Labram M. Musah, National Coordinator; Ghana NCD Alliance