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1 NOTE: This Is a Pre-Publication Version Made Available for Your Use NOTE: This is a pre-publication version made available for your use as a courtesy by the authors and the International Development Research Centre. A final, published version will appear in print and electronically in late 2010. GHANA Edith Wellington, John Gyapong, Sophia Twum-Barima, Moses Aikins and John Britton Executive Summary Despite considerable international activity in tobacco control including shaping the Framework Convention on Tobacco Control (FCTC), comprehensive national legislation has been a struggle to achieve. Accordingly, the most recent tobacco control efforts in Ghana, including the ATSA initiative, have focused on advocating for national comprehensive legislation. Unfortunately, the legislation has been stalled for more than five years. It is not clear how much support there is for the legislation in either the new cabinet or the national legislature. High-level changes in the health ministry have complicated these efforts so the advocacy community has been once again regrouping to assess the potential for high-level support. In the interim, the tobacco control community has identified other goals that may be more feasible in the short-term. With comparatively low prevalence rates (approximately 5%) and a public generally compliant with informal tobacco control norms – particularly smoke-free public places of various sorts (e.g. hospitals, educational institutions, public transport, etc.) – a formalization of existing rules and regulations with an emphasis on enforcement could be sought concurrent to the pursuit of the broader legislation. The Research and Development Division (RDD, formerly the Health Research Unit of the Ghana Health Service (GHS)) has been the principal lead of the ATSA team. While this unit is well poised to conduct health research (it has strong ties to the Universities of Ghana and Nottingham) and public education, it has limitations, as an official government entity, in advocating effectively for policy change. Civil society organizations, including Vision for Alternative Development (VALD) and Healthy Ghana, have begun to be more outspoken publicly about tobacco control issues, and their participation will be central to the success of current initiatives. Furthermore, engaging other parts of the government in tobacco control will also put pressure on policymakers to effect change. Recently, in a very encouraging development for the tobacco control community, the Food and Drugs Board has taken a more assertive role, particularly in the area of warning labels on packages. External donors have been supporting the push for broad national legislation. 1 Ghana1 2009 Population (World & Africa Ranking): 23, 832, 495 (46, 9) Geographical Size & Ranking: 238,533 sq km (88) 2008 GDP by Purchasing Power Parity (Rank):34.2 Billion US Dollars (100) GDP Real Growth Rate 2006-08: 6.4% 2008 GDP per Capita (Ranking): $1,500 US Dollars (197) Main Industries: Mining, Lumbering, Light Manufacturing, Aluminum Smelting, Food Processing, Cement, Small Commercial Ship Building, cocoa, rice, cassava (tapioca), peanuts, corn, shea nuts, bananas; timber Languages: Asante (15.8%), Ewe (12.7%), Boron or Brong (4.6%), Dagomba (4.3%), Dangme (4.3%), Dagarte or Dagaba (3.7%), Akyem (3.4%), Ga (3.4%), Akuapem (2.9%), Other (Includes English (official), 36.1%) Official Development Assistance – total commitments/disbursements (gross): 1675.4/825.8 Current USD Millions, 2007 ODA as a percent of GDP: 5.5% Largest Donors (disbursements): UK 152, Netherlands 142.2, EC 85.5, USA 70.7, Canada 54.5, Denmark 53.5, Germany 52.7, France 52.5, Global Fund 47, Japan 46.5 2007 Tobacco Production in Volume: Tobacco unmanufactured: 2700 tons, 75 World Rank 2007 Tobacco Exports: Tobacco unmanufactured: 2455 tons at $2,637 per ton, # 17 export Tobacco Imports: N/A Brief Description of Political System Type: Ghana is a constitutional democracy with a presidential system. Executive: The president is John Atta Mills as of January 2009. He is the chief of state and head of government. Cabinet: Members of the Cabinet or Council of Ministers are appointed by the President and approved by the parliament. Legislature: This is a unicameral parliament with 230 seats that are up for election every 4 years through direct popular vote. The 2008 election produced a legislature dominated by the National Democratic Congress (114 seats) and the National Patriotic Party (107 seats). Judiciary: Supreme Court 1 Sources: CIA World Factbook https://www.cia.gov/index.html; except Organization of Economic Cooperation and Development for development assistance statistics, and FAOSTAT for tobacco production. 2 Prevalence Summary: Early prevalence studies vary considerably in their results so it is difficult to determine whether tobacco use is increasing. Recent data seem to point to adult rates of 6% for men (although regional variations exist) and much lower for women. The 2005 GYTS indicates that 4.5% of 13-15 year old males were smokers compared to 3% of females. Amongst this age group, however, approximately 12% of both males and females used other forms of tobacco. In Ghana there are several common forms of tobacco use, though cigarette smoking is the most widespread. Other major forms of use include pipe smoking, chewing, sniffing and oral or nasal use of smokeless tobacco. There were no national prevalence data on tobacco use in Ghana until the early 2000s, and before that time, prevalence data were not representative of the whole country. Earlier prevalence data were in the form of small sample surveys and the Global Youth Tobacco Survey (GYTS). These surveys conducted between 1970 and 2008 showed prevalence rates ranging from 3% to 33% due to the variation in sample sizes, data collection tools and target population. Apart from the 2008 study on „Smoking uptake and prevalence in Ghana‟‟ undertaken in the Ashanti region, most of the earlier prevalence studies were concentrated in Accra and its environs. In a study on cigarette smoking habits of secondary school students in the Accra district of the Greater Accra Region in 1994, Adanu found that 4.1% of students in a particular mixed school had smoked before and 2% smoked cigarettes regularly (.N=100) In the survey, 88% of students reported that smoking was a problem among secondary school students. According to Adanu, those students who smoked were aware that school rules stipulated a punishment for those caught smoking in school (Wellington, Edith K 1994 Tobacco or Health in Ghana unpublished report to WHO, Ghana). Dennis-Antwi et al. (2003) in a national survey to determine the prevalence and social consequences of substance (drug) use among 2500 second-cycle and out-of-school youth found that 8.7% respondents had ever smoked cigarettes. Users were influenced to smoke by friends (31.7%) and social pressure (31.2%), and a higher proportion (71.3%) smoke in groups while about 28.7% smoke individually. For about six months prior to the study, of the smokers, 37.8% were regular smokers who smoked daily. About 27.1% of smokers had been smoking for about a year; 17.8% for 2 years; and 19.5% for 3 years. Apart from cigarette smoking, 27% of the users chewed or sniffed tobacco as a regular habit once or twice a day. In 2000, Ghana joined the Global Tobacco Surveillance System (GTSS) and undertook the first GYTS. This study was repeated in 2005 and 2009 and data from these surveys are the most representative for youth in the country. The GYTS focuses on youth aged 13 -15 and collects information in junior secondary schools. A total of 9,990 students participated in the Ghana GYTS in 2005. Table 1 presents some of the key findings including current smoking rates of less than 5% for males and females. 3 Table 1 – GYTS 2005 Prevalence Highlights For the current smokers, 18.5% mostly smoked at home. On the issue of environmental tobacco smoke 39% reported being around others who smoke in places outside their home, while another 39.6% thought that smoke from others is harmful to them (Wellington, 2005). The most recent national smoking prevalence data come from studies conducted as part of the GTSS and the Ghana Demographic Health Survey (GDHS). The first attempt at a national adult survey was in 2008 when the GDHS asked a few questions on the extent of smoking among Ghanaian adults. Women and men were asked if they currently smoke cigarettes or use other forms of tobacco. Results from the GDHS demonstrate that smoking in Ghana is higher in men than in women. Almost all women and 93% of men said they do not use tobacco at all and only 6% of men said they currently smoke cigarettes. Among men, the highest proportion of current smokers is in the Northern (11.9%), Upper East (11.6%) and Upper West (12.9%) Regions. Politics of Tobacco Summary: Ghana has demonstrated a commitment to tobacco control through international activities but has been slow to develop national tobacco control legislation. Much of Ghana’s success in tobacco control has come from administrative rules. A National Tobacco Control Steering Committee was set up in January, 2002 to draft a Tobacco Control Bill. While several politicians have expressed support for this Bill, after its introduction in 2005, it has not yet been passed as of early 2010. A number of NGOs have formed a coalition and are working to support the Bill. At the same time they are exploring other avenues for policy making including working with the Environmental Protection Agency and Ghana Tourist Board to develop and support smoke-free policies, and collaborating with the Food and Drugs Board to improve warning labels on cigarette packages. 4 Broadly speaking, Ghana has demonstrated commitment to tobacco control, particularly internationally. Notably, Ghana participated actively in the development of the World Health Organization‟s Framework Convention on Tobacco Control (FCTC), and was one of the first five African countries to become a Party to the Convention in November, 2004.
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