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A Situational Analysis of Tobacco Control in Ghana : Progress, Opportunities and Challenges This is a repository copy of A situational analysis of tobacco control in Ghana : progress, opportunities and challenges. White Rose Research Online URL for this paper: https://eprints.whiterose.ac.uk/161044/ Version: Published Version Article: Singh, Arti, Owusu-Dabo, Ellis, Mdege, Noreen Dadirai orcid.org/0000-0003-3189-3473 et al. (3 more authors) (2020) A situational analysis of tobacco control in Ghana : progress, opportunities and challenges. Journal of Global Health Reports. e2020015. ISSN 2399- 1623 10.29392/001c.12260 Reuse This article is distributed under the terms of the Creative Commons Attribution (CC BY) licence. This licence allows you to distribute, remix, tweak, and build upon the work, even commercially, as long as you credit the authors for the original work. More information and the full terms of the licence here: https://creativecommons.org/licenses/ Takedown If you consider content in White Rose Research Online to be in breach of UK law, please notify us by emailing [email protected] including the URL of the record and the reason for the withdrawal request. [email protected] https://eprints.whiterose.ac.uk/ Singh A, Owusu-Dabo E, Mdege N, McNeill A, Britton J, Bauld L. A situational analysis of tobacco control in Ghana: progress, opportunities and challenges. Journal of Global Health Reports. 2020;4:e2020015. Viewpoint A situational analysis of tobactobacccoo ccontrolontrol in Ghana: progress, opportunities and challenges Arti Singh*, Ellis Owusu-Dabo†, Noreen Mdege‡, Ann McNeill**, John Britton††, Linda Bauld‡‡ Keywords: fctc, mpower, smoking, ghana, tobacco Journal of Global Health Reports Vol. 4, 2020 Tobacco use is the leading cause of preventable deaths in the world, with most of these deaths now occurring in low and middle-income countries (LMICs). Sub-Saharan Africa (SSA) is at an early stage of a tobacco epidemic and is, therefore, particularly vulnerable to rapid growth in tobacco consumption. More than a decade into the implementation of the World Health Organization’s Framework Convention on Tobacco Control (FCTC), State Parties in several countries in SSA, such as Ghana, have yet to fully fulfil their obligations. Despite early ratification of the FCTC in 2004, progress in implementing tobacco control measures in Ghana has been slow and much work remains to be done. The aim of this paper is to critically reflect on tobacco control implementation in Ghana, identify significant research priorities and make recommendations for future action to support tobacco control implementation. We emphasize the need for stronger implementation of the FCTC and its MPOWER policy package, particularly in the area of tobacco taxes, illicit trade and industry interference. Due to the decline of tobacco use in several high-income and conduct the research in tobacco control, particularly countries (HICs), the tobacco industry has sought to expand given that the health challenges in LMICs have tended to be into low- and middle-income countries (LMICs), particular- dominated by communicable diseases. 3,4 Second, engage- ly in Africa, Asia, and Eastern Europe. 1 As a result, it is ment with policymakers and government in LMICs is prob- estimated that if tobacco prevention and control policies lematic due to a dearth of researchers in these countries are not implemented, smoking prevalence in Africa will in- with the necessary substantive and methodological exper- crease by over a third by 2030, from 15.8 % in 2010 to tise who also have good links with relevant stakeholders. 4 21.9%, 1 the largest expected regional increase globally. To address these challenges the Tobacco Control Capac- This will result in millions of premature deaths from a range ity Programme (TCCP), a £3.4 million program funded by of diseases including non-communicable diseases (NCDs) Research Councils UK as part of the Global Challenges Re- such as cardiovascular disease, chronic respiratory diseases, search Fund (GCRF), is designed to support research insti- cancers and diabetes; and from communicable diseases tutions in LMICs to develop policy-relevant research in to- such as tuberculosis. bacco control with the aim of improving research capacity The World Health Organization (WHO) has provided in LMICs. 4 It involves academics from the United Kingdom guidance for countries to implement and manage tobacco (UK) who will work alongside research organizations in control policies to prevent this epidemic through the Bangladesh, Ethiopia, The Gambia, India, South Africa, Framework Convention on Tobacco Control (FCTC) in Pakistan, Uganda, and Ghana. As one of the countries par- 2003. 2 The FCTC remains one of the most successfully en- ticipating in the TCCP, Ghana has an opportunity to develop dorsed treaties with 181 parties (44 in Africa) currently up to three country-specific research projects with support signed up to it, representing 90% of the world’s popula- from researchers in the UK and other LMICs under the tion. 3 Despite this commitment, implementation of effec- themes of tobacco taxation; industry interference and illicit tive tobacco control policies and programs in LMICs is lack- trade. To inform the design of these research projects, the ing, subverted by the tobacco industry who continue to objective of this paper is to critically reflect on tobacco con- weaken and undermine policy development and execu- trol implementation in Ghana via a situational analysis. tion. 4 First, it will present an overview of the development of to- One of the most effective ways to strengthen tobacco bacco control in Ghana. Next, we consider the extent to control in LMICs is to address the current evidence gap which tobacco control policies have been implemented in by creating country-specific and policy-relevant research to Ghana. Finally, we identify priorities for future action to aid the development, implementation and evaluation of to- support tobacco control implementation in Ghana, which bacco control. There are two challenges to achieving this. will shape our future research priorities as part of the TCCP First, there is the lack of LMIC researchers with appropriate program. skills, resources and expertise to identify research priorities * School of Public Health, KNUST, Kumasi, Ghana † University of Edinburgh, Edinburgh, UK ‡ University of York, York, UK ** King’s College London, London, UK †† University of Nottingham, Nottingham, UK ‡‡ University of Edinburgh, Edinburgh, UK A situational analysis of tobacco control in Ghana: progress, opportunities and challenges DEVELOPMENT OF TOBACCO CONTROL IN GHANA 13-15. 13 Aside from the GYTS and the GHPSS, tobacco-re- lated data were also included in the Demographic Health Ghana has been a world leader in introducing anti-tobacco Service (DHS) conducted by the Ghana Statistical Services legislation, having been the first country to prohibit ad- among age groups 15-49 years and till date has been done vertising, under a government directive issued as early as 14 5 in 2002/3, 2008 and 2014. 1982. Ghana has also been an active member in the devel- There is scarcity of data on prevalence of tobacco use opment of the WHO FCTC, being one of the first five African th and the role played by demographic and socioeconomic fac- countries to become a party to the Convention, and the 39 tors from many countries in the African region including country to sign the FCTC (on the 20th June 2003), and rati- th 6,7 Ghana. Despite the scattered nature of the data, it is evident fying the Convention on the 29 November 2004. Ghana that the rates of tobacco use are lower in Ghana compared has also performed an active role by chairing committee st nd to other countries in the region and globally. Despite this, meetings at the 1 and 2 Conferences of the Parties, in every year more than 5000 people are killed by tobacco-re- Geneva (2006) and in Thailand (2007) respectively. It also lated disease and more than 5000 children (10-14 years old) played a significant role in tobacco control activities and and 491000 adults (15+ years old) continue to use tobac- programs worldwide such as the Framework Convention Al- co each day in Ghana. 15 Although cigarette smoking re- liance seminar for non-governmental organisations (NGOs) st mains the commonest form of tobacco used, other forms of in the Africa Regional Office (AFRO) region in 2007; the1 tobacco are also existent in Ghana; such as pipe smoking session of the Intergovernmental Negotiating Body on the (shisha), chewing, sniffing, smokeless tobacco and tawa use Protocol on Illicit Trade in Tobacco Products in Geneva in among young people. February 2008; and hosting the WHO sponsored Consulta- All studies conducted to date indicate wide gender di- tion on Regional Capacity Building for Tobacco Control in 8,9 versity with male smokers far outnumbering female smok- Africa. ers. 16–19 The most recent DHS in 2014 reports the preva- In 2012, the Government of Ghana passed the Public lence of cigarette smoking among males to be 4.8% and fe- Health Act (851) which includes the Tobacco Control Act males 0.1%. 14,20 Regional differences in smoking preva- that includes measures on smoking in public places; to- lence also exist in Ghana, with several studies demonstrat- bacco advertising, promotion, and sponsorship; and tobac- 9 ing higher prevalence of tobacco use among those living in co packaging and labelling and others. Following the Act remote areas (such as the Northern parts of Ghana); the in 2012, The Tobacco Control Regulations (L.I. 2247) en- th three regions in the Northern regions have the highest tered into force on January 4 , 2017, which provided 18 prevalence of tobacco use; 31.2% in Upper East, 22.5% in months for compliance with public smoking restrictions, Northern and 7.9% in the Upper West region. 19,21 In terms among other measures and 18 months for compliance with of age groups, 25-34 and 35-59 year-olds have a higher pictorial health warnings from the date the Food and Drug prevalence of cigarette smoking as compared to 15-24 year Authority (FDA) issued the new health warnings electron- 22,23 10 olds.
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