School of Public Health, KNUST, Kumasi, Ghana
School of Social Work and Social Policy, University of Strathclyde, Glasgow, UK.
BMJ Glob Health. 2023 May;8(5). doi: 10.1136/bmjgh-2023-012054.
Non-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.
Semistructured 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.
Stakeholders 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.
These 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.
非传染性疾病（NCDs）占加纳全因死亡率的近 43%。在撒哈拉以南非洲（SSA）地区，不健康的商品（如酒精、糖和烟草）是导致 NCD 负担不断增加的一个重要因素。尽管对烟草、酒精和含糖饮料（SSBs）征收健康税再次受到关注，但在 SSA 地区，这些税收的采用和实施仍然有限。本研究旨在剖析相关的政治背景，并探讨在加纳征收健康税的机会和障碍的当前看法。
对具有代表性的利益相关者进行了半结构化定性访谈（n=19），这些利益相关者分别来自政府、民间社会、媒体和国际组织四个部门，并对九名行业利益相关者进行了两次小组访谈，访谈内容以相关文献和政策/宣传文件为依据。
利益相关者普遍认为，此类税收主要用于增加收入（用于卫生支出），而不是用于减少消费和改善健康。对 SSBs 征税似乎存在机会，利益相关者普遍支持对 SSBs 征税。通过对任何新税收提案进行“健康”框架的构建、生成关于此类税收潜在影响的加纳具体证据以及提高公众意识，可以增强这种支持。行业参与者和一些政府代表反对健康税，他们援引了对潜在非法贸易和经济损害增加的担忧。一些利益相关者还认为，政客和受影响行业之间的联系是一个重要的障碍。
这些发现确定了引入健康税的机会，但也强调了受影响行业利益相关者可能会产生抵制。然而，通过采取注重政策一致性（中央政府、卫生和经济部门之间）的战略方法，并努力加强利益相关者和公众的支持，可能会削弱行业的游说地位。这种努力可以得到研究的支持，以帮助展示不同设计的健康税对实现加纳卫生目标的价值，并更好地了解行业与政治之间的联系。
