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

Abstract

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.

Political Economy Analysis of Health Taxes (Tobacco, Alcohol Drink, and Sugar Sweteened Beverage): Case Study of Three Provinces in Indonesia

“…This insight is especially important as political work to- date on sub-national health taxes, is limited to a small set of research on SSBs taxes in the US(55). Our findings also align with previous studies emphasizing the importance of earmarking health taxes for public health rather than framing them as revenue-generation tools(56–59). Although, detailing the well-intention of the health tax generation invites counteractive arguments from anti-tax opposition (55).…”

Framing health taxes: learning from low- and middle-income countries

“…In Ghana, Singh et al assessed stakeholders’ perceptions on taxing tobacco, alcohol and SSBs. 29 They reveal how stakeholders’ understanding of health taxes was often limited and unclear. 29 In contrast to the Ethiopia team, Ghanaian government stakeholders and civil society actors argued in favour of health taxes primarily to generate revenue for health programmes.…”

“… 29 They reveal how stakeholders’ understanding of health taxes was often limited and unclear. 29 In contrast to the Ethiopia team, Ghanaian government stakeholders and civil society actors argued in favour of health taxes primarily to generate revenue for health programmes. 29 Their ability to decrease consumption of harmful products was a secondary aim.…”

“… 29 In contrast to the Ethiopia team, Ghanaian government stakeholders and civil society actors argued in favour of health taxes primarily to generate revenue for health programmes. 29 Their ability to decrease consumption of harmful products was a secondary aim. 29 Industry stakeholders opposed health taxes by highlighting their perceived impact on employment, limited revenue generation potential and growth of an illicit market.…”

“… 29 Their ability to decrease consumption of harmful products was a secondary aim. 29 Industry stakeholders opposed health taxes by highlighting their perceived impact on employment, limited revenue generation potential and growth of an illicit market. 29 The current economic crisis, close relationship between government and industry, lack of accountability (coupled with bribery and corruption) were understood to limit efforts to advance all health taxes.…”