Food, Health, and History in Twenty-first-Century Ghana
History is repeating itself today, at the Tamale Teaching Hospital. Extensively modernised and refurbished since it was upgraded from a regional hospital in the early 2000s, its old buildings have been renovated and added to. The number of beds has doubled, and several new units have been established, including high-tech neonatal intensive care. With external runways and awnings sculpted into long metallic waves, the new, main building is an imposing presence in the low-lying city. Throughout much of the hospital, the signage is rendered in a uniform red and yellow. The text for ‘Consulting Room 1’, ‘Maternity Ward’, ‘Blood Bank’ and ‘Diet Therapy’ is rendered in bright red on a bright yellow background. On the left side of these signs is a photograph of a Lucozade bottle, overlaid with the words ‘fast-acting glucose energy.’
In order to emphasise its biomedical effect, the line which underscores these words spirals into a heart rate monitor. This is not only the case in Tamale, Lucozade sponsors public hospital and polyclinic signage across Ghana. The promotion of a carbonated, sugary drink as a healthful source of energy derives from Lucozade’s earlier history in Britain, where it was initially sold through pharmacies, advertised in medical journals, and was often brought, alongside grapes and flowers, for friends and relatives in hospital.1 In Britain, however, by the 1980s, and amidst slowly emerging concerns about the health effects of sugar, Lucozade pivoted from health drink to sports drink, a market position which is still vigorously maintained.2 Its continued promotion in Ghanaian hospitals, despite even firmer understandings of the relationship between sugar and ill-health, has the faint echo of Nestlé nurses and their hawkish promotion of breastmilk substitutes in the mid-twentieth century.3 As with the epidemic infant malnutrition which resulted at least in part from these marketing practices, cause and effect manifest materially at Tamale Teaching Hospital too. Posted on the door of the Diet Therapy room is an advert for a Ghana Dietetic Association conference on the management of diabetes.
The political economy of diet and disease
Capitalism’s innate drive to create new tastes and new needs have long been a central tenet of both food history and the history of pharmaceuticals; the epidemiology of the dietary disease is shaped by the development of these new tastes, tastes for foods and for ways of eating.4 Emerging medical and nutritional demands are also increasingly addressed via marketised solutions to disease management—through health-foods, nutrition supplements, or the long-term prescription of pharmaceuticals for chronic illness. This symbiotic relationship is evidenced in the close association between the food and pharmaceutical industries. GlaxoSmithKline, for instance, produces drugs which are commonly used to treat diabetes and, until 2013, also produced Lucozade. Although codified as non-communicable diseases, both infant malnutrition and chronic diseases of adulthood, such as type-2 diabetes, have been seen to spread quickly in periods of increased capitalisation. Ghana’s economic transformation under British-colonial government saw the devaluation of domestic labour, the promotion of breastmilk substitutes, and epidemics of childhood malnutrition.5
As with these earlier epidemics, the rapid increase of chronic disease following the onset of Structural Adjustment in the mid-1980s must also be considered with reference to the nature of food, feeding and public service provision in what is a broadly ‘neoliberal’ political economy.
Throughout history, the transition to wage labour has been secured by cheap foods and the devaluation of the domestic economy, in terms of food acquisition and preparation. Given that these responsibilities have historically been ascribed to women, neoliberal economics has increased the workload of what has been described as ‘a quiet army’ of wives, co-wives, mothers, grandmothers, and aunts.6 Economic liberalisation has also pressured Ghanaians into working longer hours, while increasingly unaffordable housing has pushed poor people out of city centres. These changes have had a significant impact on eating habits. In a 2000 study of urban food security, the poorest fifth of households spent nearly 40 per cent of their entire food budget on snacks and meals away from home, as compared to only 25 per cent in the highest group.7 As early as the 1990s, and in a significant break from the past, families began to relegate fufu to Sundays alone.8 In Ghana, as elsewhere, diets with a more holistic nutritional value are being replaced with those made up of long-lasting and energy-dense foodstuffs; fresh fruit, vegetables and animal produce are more difficult to pack and transport and more likely to spoil than processed foods. These are the cheap, easy, tasty, and often innutritious foods which prop up increasingly strained domestic economies in Ghana, and around the world, and these are also some of the structural causes of epidemic chronic disease.
Chronic illness and the role of history
Unlike infant malnutrition or infectious disease, however, the onus for chronic diet-related illness is more readily placed on the individual.9 Classified as ‘lifestyle diseases’, or the consequence of ‘overconsumption’, epidemics of diabetes or heart disease do not wield the same political capital as epidemics of ‘malnutrition’ or ‘undernutrition.’ Instead, as fat studies scholars and activists have most prominently argued, the onset of chronic diseases, and proneness to chronic disease, is often seen as a failure to comply with the ‘healthist’ expectations of ‘biocitizenship.’ A failure to be thin enough, to exercise enough, or to eat well enough to avoid such diagnoses later in life.10
Although diet is not the only cause of chronic disease, illnesses which are at least partially determined by food are fast becoming the primary cause of morbidity and mortality in Ghana. In the post-adjustment economy, it is unsurprising that preventative nutrition is loudly promoted through greater individual engagement with the diversifying market for foods. Travel a few miles along Liberation Road, for instance, from the University of Ghana campus in Legon and into the centre of Accra, and you will pass billboards for rice and tomato paste, both advertised as being fortified with various vitamins; adverts for sunflower oil, naturally low in cholesterol; and for condescend milk, which has the protein and calcium necessary for a good start to the day. Driven by the threat of chronic disease, and individual responsibility for its prevention, these adverts trade on the blurring distinction between food and drug, eating and medicating.
The market for enhanced foods flourishes in the neoliberal political economy, but it also draws on emerging scientific understandings of the relationship between health and the environments in which we live. Here, food is an important ‘exposure’ which shapes an increasingly ‘plastic’ body.11 This, the field of epigenetics, produces a ‘body that is heavily impregnated by its own past … imprinted by the evolutionary and transgenerational time’.12 In this respect, as Hannah Landecker has argued, ‘metabolism is in history’, and histories of food, nutrition and the sciences which bind them are essential for understanding and challenging the trajectories of these emergent epidemics.13
- ‘They like Lucozade. and They Keep It Down’, Proceedings of the Royal Society of Medicine, 50.2 (1957), ii.
- On the history of sugar in nutritional medicine see, Rachel Meach, ‘From John Yudkin to Jamie Oliver: A Short but Sweet History on the War against Sugar’, in Proteins, Pathologies and Politics: Dietary Innovation and Disease from the Nineteenth Century, ed. by David C. Gentilcore and Matthew Smith (London: Bloomsbury Academic, 2018), pp. 95–108.
- John Nott, ‘“No One May Starve in the British Empire”: Kwashiorkor, Protein and the Politics of Nutrition Between Britain and Africa’, Social History of Medicine, 34.2 (2021), 553–76.
- Sidney W. Mintz, Sweetness and Power: The Place of Sugar in Modern History (New York: Penguin, 1986); Joseph Dumit, Drugs for Life: How Pharmaceutical Companies Define Our Health (Durham, N.C.: Duke University Press, 2012).
- Nott, op. cit..
- An excellent introduction to this point is Pamela Sparr, ‘Feminist Critiques of Structural Adjustment’, in Mortgaging Women’s Lives: Feminist Critiques of Structural Adjustment, ed. by Pamela Sparr (London: Zed, 1994), pp. 13–39; or, in the same collection but with a focus on Ghana, Manu Takyiwaa, ‘Ghana: Women in the Public and Informal Sectors under the Economic Recovery Programme’, in Mortgaging Women’s Lives: Feminist Critiques of Structural Adjustment, ed. by Pamela Sparr (London: Zed, 1994), pp. 61–77.
- Daniel G. Maxwell and others, Urban Livelihoods and Food and Nutrition Security in Greater Accra, Ghana (Washington, D.C.: International Food Policy Research Institute, 2000), p. 61.
- Gracia Clark, ‘From Fasting to Fast Food in Kumasi, Ghana’, in Food Consumption in Global Perspective: Essays in the Anthropology of Food in Honour of Jack Goody, ed. by Jakob Klein and Anne Murcott (Basingstoke: Palgrave Macmillan, 2014), pp. 45–64 (p. 57).
- Megan Vaughan, ‘Conceptualising Metabolic Disorder in Southern Africa: Biology, History and Global Health’, BioSocieties, 14.1 (2019), 123–42; Sara Glasgow and Ted Schrecker, ‘The Double Burden of Neoliberalism? Noncommunicable Disease Policies and the Global Political Economy of Risk’, Health & Place, 34 (2015), 279–86.
- Susan Greenhalgh, Fat-Talk Nation (Ithaca, N.Y.: Cornell University Press, 2015).
- Hannah Landecker, ‘Food as Exposure: Nutritional Epigenetics and the New Metabolism’, BioSocieties, 6.2 (2011), 167–94.
- Jörg Niewöhner, ‘Epigenetics: Embedded Bodies and the Molecularisation of Biography and Milieu’, BioSocieties, 6.3 (2011), 279–98 / pp. 289–90.
- Hannah Landecker, ‘Postindustrial Metabolism: Fat Knowledge’, Public Culture, 25.3 (2013), 495–522 (p. 497).