Ghana’s tax on sugar-sweetened beverages has a striking public-acceptance problem. Most consumers in a new study supported the idea of taxing sugary drinks, yet most also preferred a tax rate dramatically below the rate the country had actually introduced.
In a survey of 384 adults in the Cape Coast Metropolis, 67.7% supported the principle of a sugar-sweetened beverage tax. At the same time, 62.2% favoured a rate below 2%, even though Ghana had implemented a 20% excise tax in 2023.
The gap matters because health taxes depend on more than legislation. A tax can be economically meaningful while remaining poorly understood by the people whose purchasing behaviour it is intended to influence. The new findings suggest that support for the public-health objective and support for the size of the fiscal intervention are not necessarily the same thing.
The peer-reviewed study, published in BMC Public Health on 28 September 2026, provides an unusually timely view because researchers surveyed consumers between August and October 2023, shortly after the Ghanaian policy took effect.
Why Ghana taxed sugary drinks
Sugar-sweetened beverages sit at the intersection of consumer choice and population health. They can add substantial quantities of free sugar to diets without providing the satiety associated with many solid foods, and high intake has been linked in the wider literature to obesity, type 2 diabetes and other non-communicable diseases.
That has led governments to experiment with fiscal policies that make sugary drinks more expensive. The basic mechanism is straightforward: higher prices can discourage consumption, encourage substitution towards untaxed alternatives and give manufacturers an incentive to reformulate products. Taxes can also generate public revenue.
Ghana introduced a 20% excise tax on sugar-sweetened beverages in 2023 as non-communicable diseases became an increasingly important public-health concern. Yet the effectiveness and durability of such a policy can depend partly on whether consumers understand why it exists and regard it as legitimate.
Kasim Abdulai and Portia Bangkuu therefore examined consumer perceptions soon after implementation rather than waiting years to ask whether the tax had become socially accepted.
Researchers surveyed 384 adults in Cape Coast
The researchers conducted a descriptive cross-sectional study in selected urban communities in the Cape Coast Metropolis between August and October 2023.
The sample included 384 adults. Interviewers administered a structured survey covering sociodemographic characteristics, health opinions and perceptions of sugar-sweetened beverage taxation.
The analysis used descriptive statistics to map the distribution of responses and Spearman correlations to examine relationships between selected variables. The work was conducted in SPSS version 26.
This design is important for interpreting the results. The study describes attitudes and statistical associations at one point in time. It does not experimentally test how the tax changed purchasing, nor can it establish that particular beliefs caused support or opposition.
Health awareness was high
The clearest foundation for support was widespread recognition that excessive sugar consumption can be harmful.
Among participants, 81.8% believed that high sugar consumption is detrimental to health. That is a substantial majority and suggests that the health rationale behind reducing excessive sugar intake was not alien to the sampled consumers.
Support for taxation was lower than recognition of the health risk, but still represented more than two thirds of respondents. In total, 67.7% supported the principle of a sugar-sweetened beverage tax.
That distinction is revealing. Recognising a health problem does not automatically mean endorsing every policy designed to address it. Even so, the study found considerable acceptance of taxation as a policy instrument in principle.
The preferred tax was far below the actual rate
The sharpest tension emerged when participants were asked about the level of taxation they preferred.
Although 67.7% supported the principle of a tax, 62.2% favoured a tax rate below 2%. Ghana’s implemented rate was 20%.
This is not a small difference in policy intensity. It separates general approval of the idea from acceptance of the magnitude needed to create a meaningful price signal.
A consumer can believe that sugary drinks should be taxed while simultaneously believing that the tax should barely change the purchase price. From a public-policy perspective, those positions can coexist psychologically while producing very different practical consequences.
The finding therefore complicates simple claims that the public either supports or opposes sugar taxes. Support depends on what exactly is being supported: the health objective, the existence of a tax, the rate, the use of revenue or the expected effect on household budgets.
Belief in effectiveness tracked overall opinion
The researchers also examined whether consumer opinion was related to perceived effectiveness of the tax.
The relationship was moderate and statistically significant, with a Spearman correlation of ρ = 0.350 and p below 0.01.
In practical terms, people who held more favourable opinions of the tax also tended to see it as more effective. The correlation does not tell us which belief came first. Consumers might support a tax because they expect it to work, or judge it as effective partly because they already support it. Both could also reflect another underlying factor, such as health knowledge.
Age, by contrast, was not significantly associated with the relevant consumer opinion measure. The reported correlation was only ρ = 0.024, with p above 0.05.
That null result is useful because it cautions against assuming that attitudes can be explained simply by generational differences. Within this sample, age did not meaningfully track opinion in the way perceived effectiveness did.
Public acceptance is part of policy design
Taxes intended to change behaviour operate through economics, but their political sustainability also depends on legitimacy.
A policy that consumers view as arbitrary can face pressure for dilution or repeal. A policy whose rationale is clearly understood may be easier to sustain even when it imposes a visible cost.
The Ghanaian results suggest that communication cannot stop at telling people that excess sugar is unhealthy. Most participants already accepted that proposition. The larger communication challenge may be explaining why a tax needs to be large enough to alter prices and what happens to the revenue it generates.
The authors specifically highlight sustained public education and transparent communication about revenue use. Those recommendations follow logically from the gap between broad support for taxation and preference for a very low rate.
A useful comparison with South Africa
The findings are particularly relevant beyond Ghana because sugar taxes are already part of health policy elsewhere in Africa.
South Africa introduced its Health Promotion Levy in 2018. Earlier South African research has similarly found a complicated mix of support, limited awareness and disagreement over whether the levy is strong enough to alter behaviour.
That comparison does not mean the two countries should expect identical responses. Ghana’s study was conducted in selected Cape Coast communities, while South African studies have used different samples, tax structures and implementation contexts.
What the comparison does show is that fiscal health policy has a communication problem as well as a pricing problem. Consumers need to understand not only that a tax exists, but why its structure looks the way it does.
The study does not show whether the tax reduced consumption
The research should not be read as an evaluation of the tax’s effect on beverage sales, obesity or disease.
It was a cross-sectional perception study conducted shortly after implementation. The researchers did not randomly assign consumers to different tax rates, track the same households before and after the policy, or use retail purchasing data to estimate causal changes in consumption.
The results therefore answer a narrower but still important question: how did a sample of consumers in one Ghanaian urban setting perceive the policy at an early stage?
The sample also cannot be treated as nationally representative. Attitudes in Cape Coast may differ from those in Accra, smaller towns or rural communities. Income, beverage availability, local retail prices, education and exposure to public-health messaging could all shape views.
Self-reported opinions also do not necessarily predict actual purchasing behaviour. A respondent can support a tax while continuing to buy sugary drinks, or oppose it while reducing consumption when prices rise.
Why the 2% preference matters
The most policy-relevant number in the study may not be the 67.7% support rate on its own. It may be the coexistence of that support with the 62.2% preference for a tax below 2%.
That combination reveals a potential implementation gap. Consumers can accept the principle behind a health intervention while resisting the strength of the intervention required to make it consequential.
For governments, the implication is not simply that more persuasion is needed. Communication should explain the mechanism of the policy, acknowledge household cost concerns and make revenue use visible enough for citizens to judge whether the intervention is delivering public value.
For researchers, the next step is broader evidence. Nationally representative surveys could test whether the Cape Coast pattern appears elsewhere, while longitudinal purchasing data could examine whether support, awareness and actual behaviour change together over time.
The new study ultimately captures an important distinction in public policy. People may agree with what a government is trying to achieve without agreeing on how forcefully it should act.
In Cape Coast, support for taxing sugary drinks was substantial. Support for a tax anything close to Ghana’s actual 20% rate was much harder to find.
Source Information
Study: Taxation of sugar-sweetened beverages: an exploratory study on consumer perspectives in the Cape Coast Metropolis, Ghana
Authors: Kasim Abdulai and Portia Bangkuu
Journal: BMC Public Health
Published: 28 September 2026
Design: Descriptive cross-sectional survey conducted from August to October 2023
Sample: 384 adults in selected urban communities in the Cape Coast Metropolis, Ghana
Key findings: 81.8% viewed high sugar consumption as harmful, 67.7% supported the principle of an SSB tax, and 62.2% preferred a tax below 2% despite Ghana’s 20% rate. Consumer opinion correlated with perceived tax effectiveness at ρ = 0.350, p < 0.01.
DOI: 10.1186/s12889-026-29380-z
