Beyond the sugar tax: public acceptability of a comprehensive food policy bundle in urban Ghana

Résumé

Background: The escalating burden of diet-related non-communicable diseases in Ghana has prompted the government to implement a 20% excise tax on sugar-sweetened beverages through the Excise Duty (Amendment) Act 1108 of 2023. While fiscal measures have garnered significant advocacy, public health experts emphasize the need for a "double-duty" policy bundle, including food marketing restrictions, front-of-pack warning labeling, and public food procurement policies. The problem is that public support for this broader bundle remains understudied in urban Ghana, risking implementation failure. Objective: This study evaluated the prevalence and socio-political determinants of public support for a comprehensive suite of food environment policies among adults in the Cape Coast Metropolis, Ghana, and explored underlying motivations. Methods: Convergent mixed-methods design. Cross-sectional survey of 450 adults (18-69 years) using multi-stage cluster sampling. Support measured via validated 5-point Likert scales. Twenty-four in-depth interviews provided qualitative depth. Results: Support was highest for front-of-pack warning labeling (81.4%), followed by marketing restrictions (76.8%), the sugar-sweetened beverage tax (71.2%), and public procurement (65.6%). Perceived policy effectiveness (adjusted odds ratio = 3.45) and trust in the Ghana Health Service (adjusted odds ratio = 1.92) were the strongest predictors. Qualitative findings revealed that support for the tax increases significantly if revenues are ring-fenced for the National Health Insurance Scheme. Conclusion: Policymakers should immediately prioritize front-of-pack warning labeling and marketing restrictions as highly acceptable "empowerment" policies, while simultaneously legislating transparent earmarking of sugar-sweetened beverage tax revenues for non-communicable disease treatment and prevention. Future research should test these policies post-implementation using longitudinal designs.

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