With bodies sweating and faces dripping, the demonstration keeps moving along the asphalt, chanting slogans in English like “Eat healthy, stay healthy!” and “Too much oil is bad!” or even “Drink clear water and reduce the risk of obesity and diabetes!”
Despite the early hour, it’s already very hot in the streets of Accra, the capital of Ghana. The group of around 50 people, mostly young, have marched from the small, colourful streets of the Osu district to the wide avenues surrounding the Parliament building. Over a crackling microphone, an organizer exclaims, “We call on the government to protect the masses, to protect our children in schools, to protect the Ghanaian people by raising taxes on all unhealthy food products!”
Organized by the Coalition of Actors for Public Health Advocacy (CAPHA) in the spring of 2025, the march aims to promote a set of public policies soon to be debated in Parliament. Since the first national policy to combat non-communicable diseases was introduced in 2012, a movement to improve the diet of the Ghanaian population has gradually been established. An initial tax on beverages containing added sugars was passed in April 2023, despite intense lobbying from the food industry. A good thing, because the situation is dire.
Sweetened beverages are responsible for an estimated 2.2 million new cases of diabetes per year worldwide, and 21% of new diagnoses in sub-Saharan Africa.
“Ghanaian society is in danger. If we don’t change things now, the consequences will be immense in a few years’ time,” says Comfort Quarshie, coordinator of the Ghana Coalition of NGOs in Health. The grey-haired woman — wearing a white T-shirt that reads “Restrict food marketing”, one of the proposals put forward by the movement — points out the availability of junk food and sweetened beverages on every street corner. While activists hold high their placards with statements like “Healthy food is medicinal” or “Don’t let ads decide what you eat,” the demonstration mingles with women traders carrying on their heads display cases filled with fried snacks, such as bofrots (doughnuts) or kebab skewers. The demonstration passes numerous flashy advertisements for sweetened beverages and other processed foods, scattered all over the city, right up to the vicinity of schools.
As with alcohol and tobacco, taxing harmful foods is a proven strategy in many countries. In fact, in 2024, the World Health Organization (WHO) published recommendations for governments on tax policies to encourage healthy nutritional choices.
As is the case in many countries, Ghana is facing a major nutritional transition, fuelled by rapid urbanization, globalization and economic development. The traditional grain- and fibre-rich diet is giving way to ultra-processed foods, rich in sugar, salt and fat.
“We don’t want them to leave, we just want them to sell healthy products.”
A study published in 2022 by researchers at the University of Accra shows that processed foods now account for the largest share of Ghana’s urban food environment. Obesity, cardiovascular disease and diabetes are skyrocketing as a direct consequence of this change in lifestyle and increasing sedentariness. Worldwide, the prevalence of diabetes among adults rose from 7% to 14% between 1990 and 2022. In Ghana, while average prevalence remains low, some regions have adult diabetes rates of 39%, according to a study published in 2024. Moreover, according to the latest Births and Deaths Registry data from 2022, hypertension, also associated with a poor diet, is now the leading cause of death, followed very closely by heart disease, stroke and diabetes.
The latest population census figures are equally staggering. In 1993, 10% of women of child-bearing age were overweight or obese; by 2022, this figure had risen to 50%. Among men of the same age, 4% were obese and 17% overweight in 2022. The census also collected data on eating habits: 37% of women aged 15 to 49 had consumed sweetened beverages and 28% had unhealthy foods in the preceding 24 hours. For children aged 6 to 23 months, the figures are 32% and 33%, respectively. At the time of the survey, a third of them had not eaten a fruit or vegetable in at least a day...
Comfort Quarshie explains that women are particularly affected, as they are often the ones who run stalls in the market and on the streets. They sit for hours on end, so as not to miss any sales opportunities. As a result, they have no choice but to eat whatever fast food they can get their hands on, and they don’t engage in daily physical activity.
Among members of a household or in the same individual, it is possible to be obese and have nutritional deficiencies.
In this context, the popularity of sweetened beverages (soft drinks, energy drinks, sugary juices, lemonades, etc.) is a scourge. A study published in early 2025 in Nature Medicine estimated that sweetened beverages were responsible for 2.2 million new cases of diabetes per year worldwide, and 21% of new diagnoses in sub-Saharan Africa. In fact, it is here, as well as in Latin America, that the deleterious effect of these beverages is strongest. In Ghana, the coalition’s research revealed massive advertising campaigns featuring celebrities, and the widespread availability of these beverages, which occupy 20% of food shelves. Naomi Akyama, 53, has paid the price for a sedentary lifestyle and lack of dietary diversity. A sandal seller at the Dome market for over 20 years, she was diagnosed with type 2 diabetes at the age of 38, when she ate almost exclusively Ghanaian food. Fufu (cassava and plantain paste), banku (corn and cassava paste), white rice: Ghana’s main dishes are rich in starch and carbohydrates. Eaten three times a day, they too can promote the development of diabetes, especially since Naomi consumed them with her favourite malt beverage, which is as sweet as Coca-Cola.
Naomi regularly suffers from headaches. “Sometimes I feel so weak that I can’t go to work,” she recounts in a hoarse voice, half-reclining on a forest-green sofa. On the white walls of the sparsely furnished living room, family portraits display several smiling generations. But in the room where two of her sisters, her daughter Esther and her grandson Ethan are also present, the mood is less cheerful.
Naomi’s sisters, Gladys Ohemaa and Rose Owusu, in their 60s, also have diabetes. Four years before her diagnosis, Gladys suffered a stroke. “I was really surprised because my parents ate these dishes too, but they caused diabetes for me.” So all the women in the house had to adopt a diet that is more varied in nutrients and rich in fibre: reduce the amount of fufu, increase the amount of soup and plantains, drink oat milk and, above all, give up soda.
Ghana, like other developing countries, is torn by the two extremes of malnutrition: obesity occurs alongside undernourishment, which is still very much present. Malnutrition indicators have dropped by half on average over the past 30 years, but 17% of children still show signs of stunted growth, and 6% of children under 5 suffer from emaciation (extreme thinness).
For Amos Laar, professor of public health nutrition at the University of Ghana, the two problems are intimately linked. “Because they’re inexpensive, ultra-processed foods and sweetened beverages are accessible to poor people who might be thought to be suffering from undernutrition. The conditions that expose them to undernutrition are the same as those that expose them to overweight and obesity,” he explains.
The researcher leads the academic section of the activist movement, which is the source of the scientific evidence underpinning the new policies. In the course of his work, he noted that the double burden of malnutrition was sometimes found in the same geographical areas, among members of a household or in the same individual: it is possible to be obese and have nutritional deficiencies. Half of Ghana’s female population is overweight or obese, yet 41% of women also suffer from anaemia.
The UN’s State of Food Security and Nutrition in the World Report 2024 argues that 2.83 billion people worldwide are unable to afford a healthy diet and recommends dual-purpose actions to combat not only undernutrition and nutrient deficiencies, but also overweight and obesity. This is exactly what the Ghanaian coalition is proposing.
Officially created in 2022, the coalition brings together researchers from five public universities, as well as associations and unions. “I like doing research, but if it doesn’t reach the stage where individuals benefit directly from it, then there isn’t much of a point. Academics are done working on their own,” says Amos Laar, clearly passionate about the movement, smiling and speaking energetically as he points to diagrams from one of the supporting studies.
Supported by the International Development Research Centre (IDRC), the coalition has carried out a number of projects to gather data on the link between the nutritional environment and health, mobilize government players and pave the way for laws that will protect the public. In 2022, the Advocating 4 Health project, co-funded by IDRC, led to a change in tax policy on sweetened beverages.
50% of those surveyed have reduced their consumption of sweetened beverages, and 31% have replaced them with water or fresh produce.
The latest ongoing project, also partly funded by IDRC, is dubbed HD4HL for Healthier Diets 4 Healthy Lives and aims to inform the public, as well as conceptualize and push through a far-reaching set of policies. The four measures include mandatory labelling of products’ nutritional values, supplying healthy food to public institutions such as prisons and schools, restricting marketing to certain foods and geographical areas, and imposing taxes on products that are too sweet, salty or fatty.
These policies are in line with the “best buys” defined by WHO: interventions that have proven their cost-effectiveness and feasibility in the fight against non-communicable diseases in low- and middle-income countries. The coalition has organized numerous seminars, public forums, awareness-raising marches and media campaigns. By integrating government players such as the Ministry of Health, the Food and Drugs Authority and the National Development Planning Commission, the coalition actually benefits from a pre-authorization of its legislative work. This highly innovative approach paid off in 2023, when the government voted and enacted the 20% tax on sweetened beverages.
The coalition succeeded in passing the tax on these beverages as part of an amendment to the excise duties also affecting tobacco, alcohol and plastic containers, because the brands only became aware of the campaign at the last minute.
Amos Laar was following the debates in Parliament on March 31, 2023, online and from another continent, late into the night: “Between the second and third reading, when there isn’t supposed to be a debate, parliamentarians tried to challenge [the amendment], and 17 petitions were filed. Fortunately, the Speaker of the House determined that they should have come forward earlier.”
Bribing legislators, and even scientists, is a well-known corporate tactic to prevent such taxes from being passed. Dr. Kasim Abdulai, director of operations, CAPHA, saw this: “Sometimes, we find that some of the actors we work with on a regular basis, who used to condemn unhealthy products in the strongest terms, soften up. You can sense when someone has made concessions.”
The lobbies returned to the fray in February, when the government of the new president elected at the end of 2024 presented its budget. The Food and Beverage Association of Ghana (FABAG) has been active on all fronts against “nuisance taxes,” to no avail. The government confirmed the 2023 law, which in just a few months brought in 1.3 billion Ghanaian cedis, the equivalent of 133 million Canadian dollars. Despite the apparent conflict of interest, Amos Laar insists that this is not an open war against industry: “I always say that nobody is against industry. We don’t want them to leave, we just want them to sell healthy products.”
The measure is beginning to prove its worth. An assessment by the movement’s scientific section, currently being published, reveals that 50% of those surveyed have reduced their consumption of sweetened beverages, and 31% have replaced them with water or fresh produce. However, although the vast majority of the population noticed the price increase, not everyone made the connection with the tax, of which only half had heard about. Ghana is going through a major debt crisis, and inflation, which temporarily exceeded 50% at the end of 2022, has pushed up the price of all food products. Beverages are among the victims, and the price increase linked to the deterrent tax has therefore been drowned out by general inflation, weakening the message of awareness.
Another limitation of the tax is that it also applies to... water. The national product classification groups all mineral waters, with or without added sugar, and flavoured and non-alcoholic beverages into a single “water” category, subject to tax.
To avoid this major criticism, of which they are well aware, scientists have been working on a nutrient profiling system for two years. This system classifies over 6,000 foods according to their nutritional composition and will serve as the basis for the new tax policy. Instead of imposing a fixed rate, the new version of the law proposes to adapt the tax percentage to the sugar, salt and fat content of the products sold. The database will also be used to promote certain products and diets. “Once these policies are in place, they will help to clean up our food environment and reduce consumption of unhealthy food products. Non-communicable diseases will then gradually begin to decline,” predicts Dr. Abdulai. Despite interference from the agrifood industry, all stakeholders are optimistic that the policy block will be enshrined in law before the end of 2025.
The program described in this article and production of this report were made possible by support from Canada’s International Development Research Centre.
This article was originally published in the July-August 2025 issue of Québec Science magazine.
Share this page