Health
The Sugar That Killed My Mother: A Generation Drowning in Cheap Drinks, Cigarettes and Lies
On October 15, 2021, the beep of a glucose monitor flatlined in our living room. My mother, Rebecca Nabiteeko (R.I.P.), took her last labored breath as her veins, swollen, burning, and numb, finally surrendered to a decade-long siege by diabetes. Her final days were a cruel liturgy: mornings began with insulin injections, and nights ended with prayers to a God who never answered. “Nsaba Yezu, mpone obulwadde bwa sukaali,” she prayed for deliverance from the sugar sickness. The same sickness that caused numbness of her feet, then her sleep, and finally her life. I miss her.
In our little cramped Kyebando-Kisalosalo home, medication such as pregabalin, Metformin, and Insulin Mixtard—became part of the day’s meals and everyday companions as relatives. We memorized their shapes: the amber vials crowding the dining table, the syringes tucked like shrapnel in drawer corners. Her body was a battleground. Her faith, a fragile ceasefire.
Her story is not unique. It is now becoming every household’s and a Ugandan story. Our country is under attack! While HIV, cholera, and malaria dominate headlines, a quieter killer stalks Uganda: non-communicable diseases (NCDs) like diabetes, hypertension, and cancer now claim 1 in 3 lives, eclipsing infections as the nation’s grim reaper.
“Our clinics are grappling with constant drug stockouts. For hypertension, diabetes, and asthma medications, funding covers just 2% of the actual needs,” reveals Dr. Freddie Ssengooba, a professor of health economics at Makerere University School of Public Health (MakSPH).
In one of the Health Policy Advisory Committee (HIPAC) meetings of Uganda’s Ministry of Health, where key stakeholders gather, a concerning reality about medicine availability was shared.
In schools, teenagers trade 500-shilling cigarettes like sweets. In markets, soda and unregulated sweetened juices flow cheaper than clean water. Uganda’s health system, already strained by several public health issues, is buckling under the NCD surge. “80% of the early 335 COVID-19 deaths in Uganda had NCD comorbidities as an underlying condition,” stated Dr. Eric Segujja, a public health systems researcher, while coronary heart disease, once rare in Africa, now claims 12% of Uganda’s disease burden.
This is a plague of policy, profit, and paralysis, a war where lobbyists outgun public health advocates and sugar drowns out science. My mother didn’t just die of diabetes. She died in a system that incentivizes manufactured epidemics while pushing back on public health responses.
At a dissemination meeting on the political economy analysis of health taxes on unhealthy commodities in Uganda at Kabira Country Club in Kampala in late January this year, Dr. Ssengooba emphasized that, “When discussing NCDs, we need to be very practical.”
Adding that, “Currently, we rely heavily on a few donors and pharmaceutical companies, who provide us with a set of donated drugs each year. If these donors begin to reduce their support, similar to what we’re seeing with the US in the coming days, we will face even greater challenges. This is a critical issue: as we talk about NCDs, there’s no provision within the national budget to address medicine shortages. While there are healthcare professionals trained to manage these diseases, they may end up advising patients to purchase medicines from pharmacies—something that’s not affordable for many, especially those without financial means.”
The culprits? Cheap, sophisticated distribution channels and aggressively marketed unhealthy commodities. For instance, between 2015 and 2023, beer production rose by 42%, soft drinks by 67%, and cigarette sales surged despite taxes.
A presentation titled “Impact of Taxation on the Production, Sales, Revenue, and Consumption of Selected Unhealthy Commodities in Uganda: A Nine-Year Analysis” reveals a significant increase in the production of non-alcoholic beverages, particularly sugar-sweetened drinks, over the years. The highest production levels in the country were recorded during the 2022/2023 financial year. Richard Ssempala a Makerere University lecturer at the School of Economics and a current PhD candidate at Osaka Metropolitan University in Japan, who is also one of the researchers, attributes this growth to the rise in the number of factories and small-scale firms entering the market, coupled with low tax rates on these commodities.
Are Health Taxes, a “Best Buy,” Stalled by Competing Interests?
The World Health Organization (WHO) ranks health taxes on tobacco, alcohol, and sugary drinks among its top “Best Buys” to curb NCDs. Yet in Uganda, implementation faces fierce resistance. Dr. Henry Zakumumpa, a health systems and NCDs researcher at Makerere University, says industry lobbyists have impressed upon government technocrats, people, and commissioners at the Uganda Revenue Authority that when you increase taxes, then there will be distortion of the economy due to low consumption and the government won’t get those taxes, which he says is not true.
“When the taxes remain low, we as public health advocates realize that we shall not achieve our objective of reducing consumption of cigarettes and tobacco because they become affordable. Young people in secondary schools can afford cigarettes, which, of course, as we know, lead to cancer and heart disease. The tobacco industry is interested in maintaining taxes at a level where they’re ineffective, where they are so low that the prices are so low and young people can afford them,” said Dr. Zakumumpa.
But do health taxes work?
Studies that have been conducted elsewhere have shown that, when you increase taxes, the government increases revenue, and also the population reduces consumption of harmful products.
While the industry argues that taxes generate government revenue, a 2017 report by the Center for Tobacco Control in Africa (CTCA), based on a World Bank study, revealed that for every dollar the Ugandan government receives in tobacco taxes, it spends four dollars treating tobacco-related diseases. The government incurs costs at the Cancer Institute, Lung Institute, and Heart Institute, treating individuals with lung cancer, throat cancer, and heart disease linked to smoking in their youth.
“The industry has been successful in misinforming the public, even government officials, by scaring them that if they increase taxes, the economy will suffer and the government will lose revenue, which we have found is actually misinformation,” argues Dr. Zakumumpa.
Dr. Segujja explains, “Health taxes collide with national priorities like the industrialization growth trajectory that the government is pursuing and getting a bulk of the population from the subsistence to a cash economy. Manufacturers of alcohol, tobacco products, and sodas advance this as the rationale for their businesses and, along the way, were attracted to the country with tax incentives to contribute to this objective. Now, they argue new levies will kill jobs and take them out of business.” Industry lobbying has kept Uganda’s tobacco taxes at 30% of retail prices, far below WHO’s 70% recommendation.
The Chemical Hook
For the smokers, every puff injects their veins with 70 cancer-causing chemicals. Smoking doubles their risk of diabetes or that 90% of lung cancers trace back to this habit. But they know one thing: they can’t stop and this is how big tobacco engineers addiction in Uganda’s backyard
“Tobacco is one of the most addictive products,” explains Dr. Zakumumpa. “But do you know why? Manufacturers lace it with nicotine—a chemical trap designed to hook you for life.”
The irony is as bitter as the smoke. In rural Uganda, farmers have chewed raw tobacco leaves for generations without addiction. But in the hands of multinationals like British American Tobacco (BAT) and Marlboro, those same leaves are chemically altered. Nicotine, absent in natural foliage, is added like a sinister seasoning, transforming a plant into a predator.
Profitability of their businesses thrives through repeated consumption by a bulk of consumers.
“They want you as a tenant for life,” Dr. Zakumumpa says. “Even when your lungs scream, your wallet empties, or your blood sugar spikes. When the poor can’t afford cigarettes, they smoke less. The rich? They fund their own demise,” he adds notes.
But isn’t this the science of slavery?
Science demonstrates that nicotine is not only addictive, but also a master manipulator. It rewires brains to crave more, while tar and formaldehyde, some of the 7,000 chemical substances, carve silent graves in lungs. Yet Uganda’s tobacco taxes remain among the lowest globally, keeping packs accessible to teens.
“This isn’t commerce,” Dr. Zakumumpa argues. “Its chemical warfare, and the casualties are in our wards, gasping for air.”
He advises those who are addicted to enroll in nicotine reduction therapies and healthcare treatment at centers designated to help people with tobacco addiction.
“There is something called the National Care Centre (NACARE); we have Serenity Centre Uganda. We have about five centers which treat people who have tobacco addiction and who want to leave tobacco because it’s a chemical addiction, so they should approach the School of Public Health, they can approach us researchers, we can link them to these centers and they will leave and drop this habit,” says Dr. Zakumumpa
Revenue vs. Health, the Fiscal Tightrope
Uganda’s dilemma mirrors a global challenge. While health taxes could reduce NCD risks and fund healthcare, policymakers fear economic fallout usually advanced by opponents of tax increases. “Taxes on unhealthy commodities are sensitive, fought against by companies”—acknowledges Ssempala. Yet data from his nine-year analysis demystified this: Production and sales of taxed goods like beer and sodas keep rising, even as revenues plateau. During COVID-19, sales dipped briefly but rebounded sharply.
The Ministry of Health’s Dr. Oyoo Charles Akiya remains pragmatic:
“We need compromise. If manufacturers won’t accept higher taxes, let’s mandate health warnings or limit marketing to children.”
Dr. Akiya is the Commissioner of Health Services-Non-Communicable Diseases, and he hopes there can be a path forward through coalitions, evidence, and political will. Despite hurdles, advocates see hope. South Africa’s success in taxing sugary drinks and Kenya’s tobacco levies offer blueprints.
Regionally, a coalition of East African NCD managers is advocating for unified policies. The 4th Global NCD Alliance Forum, held at the Convention Centre in Kigali, Rwanda, on February 13, 2025, was the first of its kind in Sub-Saharan Africa. The event brought together 700 advocates, experts, and ministerial representatives from over 66 countries working in NCD prevention and care. This forum is a key global health forum as we race to the 4th UN High-level Meeting on NCDs, scheduled for September 2025 in New York.
“Change requires top-down pressure,” says Dr. Akiya.
With multinationals at the centre of manufacturing these commodities, exerting enormous pressure sometimes may prove difficult to confront as individual countries.
“We’re engaging the AU and UN to put NCDs on presidential agendas.” Locally, the Ministry of Health is mobilizing patients with lived experience: “They matter the most. The media plays a crucial role in this endeavor and holds significant importance for us. We cannot leave them out in these efforts. The leadership at the Ministry of Health, the minister, and the PS [Permanent Secretary] are all passionate about NCDs,” he added.
Is it a race against time or a behavioral issue?
As Uganda’s youth embrace processed snacks and tobacco, the clock ticks. “Every day without action, we lose more people to preventable diseases,” warns Professor Ssengooba.
The other day, Mubiru (not his real name) was jogging on the street, and a motorcycle taxi called Boda Boda knocked him, and he has just come out of the cast. He’s trying to manage NCDs; he got injured. At a Kampala hotel buffet, 28-year-old Miriam (not her real name) stares at her plate—a mountain of matoke, fried rice, boiled rice, vegetable rice, roasted gonja (plantain), and three golden potato wedges. “Finish it all,” her aunt insists. “Food is a blessing!” But Professor Ssengooba sees a different truth in these heaping portions: “Our plates have become battlegrounds. We pile carbohydrates like trophies—fried, boiled, mashed—while our bodies crumble.”
Uganda’s love affair with carbohydrates has turned toxic. Meals once centered on balanced staples like beans and greens now drown in oil and starch. “We’ve confused ‘tasty’ with ‘excessive,’” he says, adding that “at weddings, funerals, and even home dinners, its six carbohydrates competing on one plate. Why? Tradition says ‘more is generous.’ Science says, ‘more is deadly.’”
At what cost? Surging diabetes and hypertension rates. “We’re eating our way into clinics,” he warns. Yet change faces cultural roadblocks: How do you convince a nation that less on the plate isn’t disrespect—but survival? In this high-stakes battle between public health and profit, Uganda’s choices will shape a generation’s survival.
Davidson Ndyabahika is the Communications Officer, Makerere University School of Public Health.
Health
Professor Nakimuli awarded at FIGO Congress for outstanding contribution to Women and Child Health
Kampala, Uganda – Makerere University School of Public Health (MakSPH) and Estonia’s Tallinn University of Technology (TalTech) have launched a two-year collaborative project to transform health informatics education and practice in Uganda, positioning the country as a regional leader in digital health. Unveiled earlier this month at MakSPH and supported by the Estonian Centre for International Development (ESTDEV), the initiative aims to build a skilled digital health workforce and accelerate Uganda’s transition to a data-driven health system, while aligning the country’s digital agenda with global best practices through partnership.
This strategic collaboration builds on the success of MakSPH’s Master of Health Informatics (MHI) programme. The MHI is one of the eight master’s degrees hosted at the School and was first introduced in 2016, jointly delivered with Makerere University College of Computing and Information Sciences (Mak-CoCIS). The two-year graduate training equips students with skills in health information systems design, data analytics, and digital health leadership through a hybrid model of face-to-face, online, and self-paced learning. So far, since its inception, nearly 50 graduates have completed the programme, many of whom have now gone on to lead national and regional health data initiatives. In August last month, the School received 26 new entrants for the MHI 2025/2026 cohort, reflecting its rising demand.
Now, the new project, launched on September 9, 2025, links TalTech’s MSc in Digital Health, one of Europe’s pioneering programmes introduced in 2009, with MakSPH’s Master of Health Informatics to strengthen curricula, mentor faculty, and give students exposure to global best practices. The goal is to create a skilled workforce capable of leading Uganda’s digital health transformation. The initiative is co-led by Prof. Peeter Ross, Professor of e-Health at TalTech, and Prof. Nazarius M. Tumwesigye, Professor of Epidemiology and Biostatistics at MakSPH. They are joined by Doris Kaljuste, Programme Director of the MSc in Digital Health, and Mr. Michael Anywar, Doctoral Student at TalTech and the initiator of the collaboration, as well as Ms. Irene Wanyana, MHI Programme Coordinator and PhD Candidate at Karolinska Institute, Sweden, and Mr. Chris A. Balwanaki, the Coordinator for the project at MakSPH.
Prof. Ross, a leading global authority on e-health and head of the Digital Health Research Unit at Tallinn University of Technology, commenting on the project and the link between health and technology, stressed that while health itself is not technology, the intelligent integration of digital tools is indispensable for making healthcare more efficient, affordable, and accessible. He underscored that this collaboration marks a key step in that direction, with capacity development and academic exchange key to sustainable digital transformation.
“Capacity building is critical. In Estonia, when the nationwide health information system was being launched, about a third of the budget went into training healthcare professionals. This required training trainers first, underscoring the strategic role of academia. Estonia has a master’s programme in digital health, while Makerere University offers a blended Master of Health Informatics. Together, these programmes can expand training across Uganda and beyond,” Prof. Ross explained, adding that the collaboration also gives Estonia the chance to test digital health solutions in a large, English-speaking population, while Uganda benefits from Estonia’s decades of experience and avoids common pitfalls.
Estonia, a Northern European country currently with about 1.37 million people and covering a total area of 45,339 km², is seen as one of Europe’s leaders in digital innovation. About 99 per cent of its public services are reportedly delivered online, and its health information system records nearly every citizen’s medical history from birth to death. The X-Road platform in the country enables secure, encrypted data exchange, while e-prescriptions cover almost all prescriptions nationwide. Meanwhile, the Digilugu.ee patient portal allows citizens to access their health records, track activity logs, and even generate certificates, a system widely trusted by users. The Estonian team revealed that the integrated digital health ecosystem shows how technology, governance, and policy work together to provide efficient, patient-centred care.
Conversely, Uganda’s growing digital ecosystem makes the timing of the collaboration strategic. The country currently has more than 43 million mobile subscriptions, over 26 million internet users, and more than 33 million mobile money accounts, creating fertile ground for scaling digital health solutions. With this, strengthening health informatics will build a skilled workforce needed to design, implement, and manage these solutions effectively.
The MakSPH Project Co-lead, Prof. Tumwesigye, hailed the partnership as a turning point for the MHI programme, noting that modules such as Health Analytics are being upgraded to give students hands-on experience in developing tools to digitise public and private health systems. He said Estonia’s model, where digital innovations are widely adopted and lead to measurable improvements, offers a blueprint Uganda can adapt to move beyond paper-based systems, improve data quality, and train graduates to design solutions that strengthen health outcomes.
“Uganda is still behind in digital health use. We rely heavily on paper-based systems, experience long delays in transmitting data from primary health facilities to the national level, and face issues with data quality, including missing or inaccurate figures. Strengthening our programme will help address these challenges and produce graduates who can design solutions that lead to better health outcomes. Learning from TalTech University and Estonia’s digital health success will help us put Uganda on a better footing for the future,” Prof. Tumwesigye observed, noting that Estonia’s model stands out for ensuring digital innovations are widely adopted and deliver measurable improvements in health system performance.
The Programme Coordinator, Ms. Irene Wanyana, noted that since its launch in 2016, the Health Informatics training at Makerere University has made a strong impact, earning a reputation as one of the leading graduate programmes of its kind in the region. She observed that faculty members and students have been instrumental in designing, developing, and supporting national health information systems critical to Uganda’s health sector. These include UgandaEMR, an advanced electronic medical record system now deployed in more than 1,700 health facilities; the Weekly Stock Status System, which enables real-time tracking of essential medical commodities; and the Early Infant Diagnosis Laboratory Information Management System (LIMS), which improves the management of HIV testing data for infants.
Still, the programme has contributed to the development of PrEP and DREAMS/OVC tracking systems, supporting HIV prevention and care for vulnerable populations such as adolescent girls, young women, and children. The graduate training has also strengthened national HIV surveillance through the Centralised Blood Screening (CBS) dashboard, advanced the Uganda Health Information Exchange Platform to improve interoperability, and facilitated the migration of critical health data systems into the Ministry of Health’s national data centres, continuing to ensure that health information is secure, reliable, and accessible nationwide.
Ms. Wanyana is optimistic that with the new collaboration with TalTech University in Estonia, MakSPH’s Health Informatics programme is poised to deliver even greater innovations and impact to transform Uganda’s digital health system. In September 2024, four of our MHI students, Mr. Edwin Ayebare, Mr. Brian Twesigye, Mr. Enock Mwesigwa, and Mr. Iving Mumbere, won a global Award of Distinction at the Open Group India Awards for Innovation & Excellence in New Delhi. Competing against 22 university teams worldwide, they were recognised for their innovative application of enterprise architecture to address real-world health system challenges, attesting to Makerere University’s global competitiveness.
Speaking at the launch event, H.E. Girisch M. Nair, Honorary Consul of Estonia to Uganda, emphasised that Estonia’s experience offers Uganda a practical blueprint for building interoperable systems, standardising health data, and strengthening national health information infrastructure. “This collaboration is a platform for us to aspire more. Imagine a patient in Bundibugyo with a secure digital ID linked to their electronic health record. Wherever they go, authorised health workers can access their records, prescriptions are issued electronically, and medicines are dispensed at registered pharmacies. This generates rich, actionable data that helps plan better, reduce waste, and improve health outcomes.”
There is evidence of the Estonian Consul’s remarks. A new study conducted in 2023 by a team from Makerere University School of Public Health, led by Assoc. Prof. Peter Waiswa, published this September in BMJ Global Health, confirmed that supporting Ugandan districts to adopt digital payments significantly improved the efficiency of mass vaccination campaigns in the country, reducing delays, cutting administrative bottlenecks, and enhancing transparency. The findings from this and similar multi-country studies by the same team show that with targeted support, cashless systems are both feasible and practical for strengthening public health.
For Mr. Jamiru Mpiima, an alumnus of MakSPH and graduate of the Health Informatics programme, these developments underscore the critical need for a skilled workforce to design, implement, and manage digital health systems effectively. Speaking on behalf of Mr. Paul Mbaka, Head of the Division of Health Information at Uganda’s Ministry of Health, Mr. Mpiima shared the Ministry’s progress in digitising health information systems, from electronic medical records to the electronic community health information system, and the lessons learned along the way. He urged stronger collaboration between MakSPH and the Ministry, particularly in training future health informatics professionals and building institutional capacity to manage change in Uganda’s digital health sector transformation.
During the launch, MakSPH Dean, Prof. Rhoda Wanyenze, commended the remarkable speed of the Estonia–Makerere collaboration, noting that within a year, early conversations had already matured into a funded joint project. She emphasised that this milestone marks not just the start of a promising partnership, but also a unique opportunity to embed it more firmly within Uganda’s health system. Prof. Wanyenze called on all partners, the Ministry of Health, Makerere University, and the Estonian counterparts, to pursue a strategic tripartite arrangement, stressing that such collaboration could greatly strengthen Uganda’s digital health systems, accelerate technological innovation, and deliver measurable improvements in national health outcomes.
Health
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