Unhealthy eating is becoming common in urban communities in Ghana
Anybody who drives along the Mallam-Tetteh Quarshie highway and makes a stop at La Paz, in the Greater Accra region, would see a rapidly growing and urbanized community, with busy scenes of traders not far from the highway engaged in all sorts of commercial activities day and night.
This main road is one of the traffic-prone areas in Accra where heavy human and vehicular traffic are a daily occurrence. One of the major commercial activities around this area involves street hawkers doing business around traffic lights when vehicles slowdown to form queues, as the traffic lights turn red.
This makes it possible for these street hawkers to swarm the area as they cash in to make sales from various items on display such as assorted chilled sugary fizzy drinks, pastries and dough nuts. Due to the traffic build up at these traffic lights, there is a lot of jostling among these hawkers to catch the eyes of people in transit, including passersby who may be hungry or thirsty.
Increasingly, areas surrounding lorry stations, highways and major streets in several urban communities across the country are witnessing the spread of small fast-food joints selling fried rice, noodles, fried pork, fried chicken, sausages, with hawkers around these areas also doing quick business in the sale of different brands of sugary fizzy drinks.
This is also common at various bus stops along highways across the country. An example can be found at bus stops at Kpong, Atimpoku, and Juapong, located along the Accra-Ho highway. On this stretch, although it is still common to find hawkers selling traditional meals such as steamed maize meal “abolo” and red shrimps, it is now very common to see passengers and local community members buying fast foods and sugary drinks on sale, due to the rapid spread of fast food joints and street hawking at these major intersections.
Rapid urbanization across Ghana has brought in a flourishing enterprise around fast foods and the sale of fizzy drinks. What are the implications for the consumption of these processed foods, which include noodles, fried rice and pastries including fizzy drinks, especially on the health outcomes of urban dwellers?
Research and data coming in are showing that unhealthy eating habits and sedentary lifestyles are fast becoming a convergence point for the increasing cases of non-communicable diseases (NCDs) such as diabetes and hypertension.
Impact
Studies conducted on some selected modern retail outlets, for instance, have brought in data based on a classification of ultra-processed foods, with the Greater Accra alone, having approximately, 85% of total shelf area being occupied by unhealthy food categories, including ultra-processed food and high energy‐dense processed foods, in these outlets.
A Professor of Public Health Nutrition, Francis Zotor, of the Fred Newton Binka School of Public Health at the University of Health and Allied Sciences at Ho in the Volta region, has made available a document to Ghana Business News detailing some of these studies. It paints a dark picture on the impact of ultra-processed and other processed foods on health outcomes.
The document points out that the consumption of ultra-processed foods and other processed foods are increasing in Ghana and that these have been linked in multiple studies to higher risks of cardiometabolic problems (higher blood pressure, dyslipidemia, metabolic-syndrome features and markers that raise diabetes risk).
“These ultra-processed foods are foods and drinks that have been industrially formulated using ingredients that are not typically used in home kitchens. These usually have ingredients like added fats, sugars, salt, and additives such as flavourings, emulsifiers, and artificial colours,” it said.
1.4 billion people living with hypertension worldwide.
Aside these ultra-processed foods, there are also some locally produced foods with high levels of fat, salt and sugar that can be detrimental to health outcomes.
Examples of these processed foods are sugar-sweetened beverages (soft drinks, energy drinks, packaged fruit drinks), packaged snacks (chips, cookies, candy), instant noodles (e.g. indomie), industrial breads and cakes, processed meats (hot dogs, chicken nuggets) sweetened breakfast cereals, frozen ready meals, pizzas, or microwave dinners.
The document, referencing several studies conducted in and outside Ghana, captures one study carried out in Ghana in 2020, on salt and potassium intake among adults, aged 50 and above which indicated a median salt intake of 8.3g/day, above World Health Organisation (WHO) goal of <5 g/day, posing a high hypertension risk.
Other findings from the document show that fried rice is usually made with white rice, a refined carbohydrate with a high glycemic index and makes an argument that “whilst one is not advocating against the consumption of fried rice, its frequent consumption raises blood glucose more rapidly than whole grains, contributing to insulin resistance and higher diabetes risk over time.”
“Fried rice in moderation, prepared with healthier oils, lean proteins, and lots of vegetables, can fit in a balanced diet. But frequent consumption of large, oily, salty portions made with white rice raises risks for diabetes, hypertension, and other non-communicable diseases”.
Similarly, it said some studies on noodles, specifically indomie including observational and analytic studies found associations between frequent instant-noodle intake and increased cardiometabolic risk (higher blood pressure, adverse lipids, metabolic syndrome and measures linked with diabetes.
According to the document “some studies report stronger effects when intake is ≥2-3 packets per week. A single Indomie packet commonly provides around 1.6-2.5 g salt (roughly 600-1,000 mg sodium depending on serving and flavor) – a substantial portion of the WHO daily recommended limit (WHO recommends <5 g salt ≈ 2,000 mg sodium/day). Excess sodium raises blood pressure and cardiovascular risk”, it noted.
Adding that sugar sweetened beverages such as sugary fizzy drinks, which falls in the category of sugar sweetened beverages, “are directly linked to higher risk of diabetes, hypertension, obesity, fatty liver disease, cardiovascular disease, and other NCDs. Even one can a day can substantially increase long-term health risks…… a chronic high sugar intake stresses insulin regulation, leading to impaired glucose tolerance.”
According to the document, excess sugar (especially fructose) increases uric acid, which interferes with nitric oxide in blood vessels, leading to vasoconstriction and higher blood pressure.
It said sugar-sweetened beverages are strongly linked to diabetes, hypertension, obesity, fatty liver, kidney disease, cardio-vascular diseases (CVD), and dental disease. They provide excess calories with no nutritional value, making them a major, modifiable driver of the global NCD burden.
Children are also becoming victims of unhealthy lifestyles, making them easy targets for poor health outcomes in their future lives.
Madam Adzoa Kpobi, a teacher in one of the basic schools in Kade in the Eastern region in an interview with Ghana Business News, painted a picture of this situation where the selling of unhealthy meals are common just around her school, making school children victims.
According to her, from where her school is located to the end of a junction close by, which is about 150 meters, she can count as many as five or more fast foods joints, where noodles are sold just on that little stretch. Kade is no doubt just like other urban communities flooded with fast foods joints and hawkers selling fizzy drinks.
In the public school where she teaches, Madam Kpobi said during the first break of the day, quite a number of pupils buy snacks from the school compound, mainly made up of fried sausages, noodles, jollof rice and wakye (rice and beans). The only departure from these meals is during the second break of the day, when these children are fed under the government’s school feeding programme.
A single Indomie packet commonly provides around 1.6-2.5 g salt
She added that she has noticed that children in the public school where she teaches, usually don’t bring along snack boxes containing fizzy drinks due to poverty as compared to their counterpart in private schools, who would usually come to school with snack boxes containing sugary fizzy drinks because their parents are better placed to buy these types of snacks for them.
No doubt children are also becoming victims of unhealthy eating habits due to affluence and the spread of unhealthy lifestyles among the adult population.
Interventions
A few days ago, in September this year, the WHO released a new report titled “saving lives, spending less” revealing that an additional investment of just $3 per person annually in tackling noncommunicable diseases (NCDs) could yield economic benefits of up to $1 trillion by 2030.
The global body has also stated that “with 1.4 billion people living with hypertension worldwide, controlling high blood pressure in just 50% of people could prevent 76 million deaths by 2050 and save $100 billion annually in health care costs.
In another report, the WHO said more than half of people living with diabetes did not take medication for their diabetes in 2022. Diabetes treatment coverage was lowest in low- and middle-income countries, as contained in a WHO news release issued in Geneva in 2024.
It added that diabetes is a chronic, metabolic disease characterized by elevated levels of blood glucose (or blood sugar), which leads over time to serious damage to the heart, blood vessels, eyes, kidneys and nerves. The most common is type 2 diabetes, usually in adults, which occurs when the body becomes resistant to insulin or doesn’t make enough insulin. In the past three decades, the global body said the prevalence of type 2 diabetes has risen dramatically in countries of all income levels.
The WHO however, said diabetes can be treated and its consequences avoided or delayed with diet, physical activity, medication and regular screening and treatment for complications while also noting that one of the global targets for noncommunicable diseases is to reduce the prevalence of hypertension by 33% between 2010 and 2030.
It added that lifestyle changes like eating a healthier diet, quitting tobacco and being more active can help lower blood pressure.
It is gratifying to note that some intervention is being carried out in selected urban areas such Ashaiman and Madina, to enable an enhanced life cycle health promotion and prevention services at the household and community level under research that is taking place.
The project, funded by UK Aid, is known as the Community-led Responsive and Effective Urban Health (CHORUS) and is focusing on strengthening services at basic health facilities through the urban Community-based Health Planning and Services (CHPS) systems.
The project, through research, found out that there are gaps in preventive and promotive healthcare, with some CHPS facilities constrained by insufficient logistics such as glucose monitors and blood pressure equipment for monitoring.
It also found out that community health officers (CHOs) have limited knowledge on emerging urban-specific health issues such as NCDs among others.
“Unfortunately, we are not equipped. We don’t have anything. So instead of doing the action, we rather talk to the people…on the preventive side” the CHORUS project quoted one community health nurse as saying during the roll out of the project.
Under the CHORUS project, fortunately some glucose monitors and blood pressure equipment for monitoring were given out to health workers in Ashaiman and Madina to help in health promotion and education within these selected local urban areas.
Community health workers are therefore being empowered as part of the interventions to enable them deliver life-cycle health promotion and preventive services, including helping them to undertake public education, so that basic health care is made accessible to the vulnerable right from the cradle to the grave at the CHPS level in highly urbanized communities such as Madina and Ashaiman, in the Greater Accra region.
By Eunice Menka