By: Ernest Senanu Dovlo
Four-year-old Klenam is all dressed up for school on a Monday morning. She refuses to board her school bus because unlike the usual, she has no snacks.
It takes the intervention of her class teacher, Miss Senam who gets her a bottle of Fanta, some biscuits and toffees to get the little girl to join her colleagues on the bus.
Although this gets Klenam to go to school, harm is being done to her unknowingly.
A can of Fanta, which is 330ml contains 41 grams of Sugar. 5 grams of sugar is equivalent to 1 teaspoon of sugar. This means that little Klenam is consuming about 8 teaspoons of sugar contained in the Fanta alone.
This would mean that Klenam consumes 240 teaspoons of sugar if she takes a 330ml Fanta a day for 30 days.
It is worth noting that biscuits and others accompanying sugar-sweetened beverages are also mainly sugar-sweetened.
Klenam is just one of the many children in urban Ghana “snacking” their way into diabetes and other non-communicable diseases through lifestyle.
According to Unicef, Non-Communicable Diseases (NCDs), including diabetes cause a substantial proportion of deaths among adolescents. In 2019, approximately 20 per cent of the deaths among those aged 10-19 were caused by NCDs.
Like the NCD disability burden, however, there are key variations within these data by factors including age group and sex. NCDs cause about one in four deaths globally among girls aged 10-14, as compared to about one in five among boys in this same age group.
NCDs cause similar proportions of deaths among adolescents aged 15-19, due in large part to liver cirrhosis, drug use disorders, and other conditions.
Type 1 diabetes (T1D) is considered a public health threat due to the increasing number of patients, the early age of disease onset, and the severity of complications associated with it.
Globally, the incidence of T1D has increased by 2–5%.3 In the EURODIAB ACE Study (a collaboration of European childhood diabetes registers), an annual increase of 2.8% in T1D was recorded.
Other epidemiological studies, including the Diabetes Mondiale study (DiaMond) and the Search for Diabetes in Youth (SEARCH) studies, reported similar findings.
Despite increased efforts to understand the epidemiology of the disease, most sub-Saharan African countries, including Ghana lag behind in the areas of disease surveillance and diagnosis.
In October 2021, the Ghana Health Service (GHS) sounded an alarm about the high incidence of hypertension and diabetes among the public, including children, within the Accra Metropolis.
The acting Director of the Non-Communicable Disease (NCD) Directorate of the GHS, Dr. Efua Commeh blamed the health situation on lifestyle and added that the conditions as recorded at the health facilities were only the tip of the iceberg. The rise in the cases of diabetes in children according to Dr. Commeh has a correlation with sugar and sugar-sweetened beverages.
The amount of sugar that is safe to eat per day may depend on one’s total caloric intake, activity level, and other factors. In general, it’s best to avoid added sugars when possible because they do not contain beneficial nutrients. Eating too much sugar may contribute to preventable diseases.
Sugar is a type of carbohydrate. Simple carbs are things like table sugar, candy, and soda, as well as juice among others. Complex carbs are starches, and examples are bread, pasta, rice, and cereal. The difference between these two types has to do with the chemical structure, as well as how quickly they’re digested and absorbed. This means that the average Ghanaian takes in sugar on a daily basis because Ghana’s main meals are largely heavy on carbohydrates.
Sugar-sweetened beverages
Sugar-sweetened beverages (SSBs) on the other hand, are any liquids that are sweetened with various forms of added sugars. Examples are regular soda (not sugar-free), fruit drinks, sports drinks, energy drinks, sweetened waters, and coffee and tea as well as beverages with added sugars.
SSBs and diabetes
Consumption of SSBs increases the risk of developing type II diabetes mellitus. According to data gathered during the Nurses’ Health Study II, women who consumed one or more SSBs per day had an 83% higher relative risk of developing diabetes when compared to those who rarely consumed sweetened drinks.
Other studies have supported findings indicating that SSB consumption increases the risk of this chronic disease as well as others including obesity, and heart and kidney-related diseases among others.
WHO findings
According to the World Health Organisation (WHO), one in five adults and one in 10 children and teenagers are projected to be obese by December 2023 in 10 high-burden African countries if no robust measures are taken to reverse the trends.
The report finds that the prevalence of obesity among adults in the 10 high-burden countries will range from 13.6% to 31%, while in children and adolescents it will range from 5% to 16.5%. Africa also faces a growing problem of overweight children. In 2019, the continent was home to 24% of the world’s overweight children aged under 5.
While no data is available yet for Africa, a study published by the Journal of Infection and Public Health found that of the 2.5 million COVID-19 deaths reported globally by the end of February 2021, 2.2 million were in countries where more than half the population is classified as overweight.
“Africa is facing a growing problem of obesity and overweight, and the trends are rising. This is a ticking time bomb. If unchecked, millions of people, including children, risk living shorter lives under the burden of poor health. But we can resolve the crisis because many of the causes of obesity and overweight are preventable and reversible,” Dr. Matshidiso Moeti, WHO Regional Director for Africa is reported to have said.
Interventions
Health taxes are levied on products that have a negative public health impact, for example, tobacco, alcohol, and sugar-sweetened beverages (SSBs). These taxes are considered win-win-win policies because they save lives and prevent disease while advancing health equity and mobilising revenue for the general budget. They can also be used for specific priorities such as financing universal health coverage (UHC) or highly cost-effective yet underutilised population health measures.
The aim of health tax policy is to reduce the consumption of products deemed risk factors for non-communicable diseases by making them less affordable through higher prices. This is achieved with regular tax increases large enough to result in real price increases greater than economic growth.
Ghana
Academia led by the School of Public Health, University of Ghana, Legon, and Civil Society Organizations (CSOs) in Ghana led by Ghana NCD Alliance (GhNCDA), Ghana Public Health Association (GPHA), and Ghana Academy of Nutrition and Dietetics (GAND) is currently on a drive to get Ghana to implement the SSBs Tax.
Stakeholders across multiple agencies have endorsed the WHO Best Buys for controlling exposure to harmful products such as alcohol, tobacco, and unhealthy diets. Tax-related NCD prevention interventions exist for alcohol and tobacco, but those linked to unhealthy diets such as sugar-sweetened beverages (SSBs) tax do not exist.
The relevance and urgency of this initiative stakeholders say are derived from their scanning, and appreciation, of the local context.
According to them, the Ministry of Health is also currently engaging both state and non-state actors on the potential development of a food-based double-duty policy bundle to assure healthier diets in Ghana.
The policy bundle is seeking to achieve the following;
1. To identify a realistic legal pathway to enact the SSB tax in Ghana.
2. To generate, curate, and avail evidence to support advocacy, and scholarly activism, and to counter opposition from food & beverage industry actors.
3. To strengthen coalition-building, stakeholder sensitisation, media advocacy, policy advocacy, and evidence dissemination capacity of coalition members toward SSB tax advocacy.
4. To implement communication and media advocacy in support of the most appropriate and feasible pathway to enact an SSB tax in Ghana.
