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.
Dr. Angelina Mwesige Kakooza, Associate Professor of Paediatrics in the Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences (MakCHS) received the 2025 TWAS-Fayzah M. Al-Kharafi Award in Medical Sciences. She was recognised for her research on neurodevelopmental disorders – particularly epilepsy, cerebral palsy, and nodding syndrome – and for advancing policy and research, mentorship, as well as local community interventions to enhance children’s health.
The award was given at the recent 17th General Conference of The World Academy of Sciences (TWAS) held in Rio de Janeiro, Brazil under the theme ‘Building a Sustainable Future: The Role of Science, Technology, and Innovation for Global Development.’ Organized in partnership with the Brazilian Academy of Sciences (BAS) and TWAS, the conference brought together leading scientists, policymakers, and institutional leaders from across the global South and beyond.
In her remarks after receiving the award, Dr. Kakooza said, “This award highlights the importance of neurodevelopmental disorders which are a great health problem worldwide, often diagnosed late and treated poorly,” said Kakooza. “It affirms my contribution to science in Africa, strengthens advocacy for gender equity in science and education and makes me a role model for others, increasing my influence in the scientific community.”
Dr. Angelina Kakooza Mwesige is a Ugandan scholar with over 25years teaching experience whose research focuses on neurodevelopmental disorders in children centred on their epidemiology, early screening, identification and community based interventions in Uganda. Her current areas of research cover studies on early detection and interventions for young infants at high risk of neurodevelopmental delay and disability in Nepal and Uganda; development of community engagement projects to empower adolescents living with epilepsy in Uganda reduce stigma in their communities; as well as development and testing of an interactive epilepsy smart phone application to improve resilience among them.
TWAS is a global merit-based science academy based in Trieste, Italy, and administered as a UNESCO Programme Unit. Read more here: https://twas.org/
In July this year, I joined a study tour to Imvepi Refugee Settlement in Uganda’s West Nile region under the RISK-WASH Project, led by Dr. Richard Mugambe. Established in 2017 in what is now Terego District, Imvepi is one of several settlements created to host people fleeing conflict in neighbouring South Sudan. Now home to more than 60,000 refugees, it reflects Uganda’s progressive refugee policy, anchored in the 2006 Refugee Act, which promotes the integration of displaced families within host communities, allocates land for livelihoods, and ensures access to national services. It remains a model both commendable and instructive for the region.
With nearly two million refugees and asylum seekers, most of whom are women and children, Uganda stands among the world’s leading examples of inclusive, community-based refugee protection. The RISK-WASH Project, implemented by the Makerere University School of Public Health (MakSPH) in collaboration with IHE-Delft, BRAC, and icddr,b, with support from the Dutch Ministry of Foreign Affairs, organised the three-day visit. The project builds evidence for better Water, Sanitation, and Hygiene (WASH) decision-making in humanitarian settings, developing practical tools to assess how exposure to unsafe water, poor sanitation, and environmental hazards affects the health of both displaced and host populations.
In Imvepi, that evidence takes human form. Water points run dry under intense demand or drought; latrines overflow during rains; fragile health systems strain to contain preventable diseases that flourish in such conditions. One nurse may attend to hundreds of patients in a single day, treating malaria, respiratory infections, and diarrhoeal diseases directly linked to inadequate WASH infrastructure. The images linger long after one leaves, especially when reflecting on the media’s role in shaping refugee narratives. What struck me most was how such realities are often reduced to statistics or fleeting headlines that reveal little about the lives behind them. I left Imvepi convinced that we, in the media, must not only report but listen differently.
When we cover refugees, we often begin with numbers. Yet behind every statistic is a heartbeat and a history the news cycle rarely pauses to hear. Refugee health, perhaps the most human measure of displacement, is still too often framed as a crisis rather than a continuum of resilience, policy, and rights. The World Health Organisation’s World Reports on the Health of Refugees and Migrants reminds us that refugees frequently experience poorer health outcomes than host populations, not because they are inherently vulnerable, but because access to care is often obstructed by law, language, and logistics. Health, like truth, then, becomes interestingly dependent on who is allowed to speak and who is heard.
It was in this spirit that, on October 3, 2025, we convened the Media Training Workshop on Refugee Health and Migration Reporting at MakSPH. The one-day seminar brought together twenty journalists from Kampala, Kyaka II, Adjumani, and other refugee-hosting districts. Our goal was not to add another humanitarian angle to the news but to rethink how the media can report with depth, ethics, and empathy. Working with partners such as Africa Humanitarian Action, Emesco Development Foundation, and Farmamundi, we explored the subtle power the media wields to either dignify or diminish, to clarify or distort, the lived realities of refugees, particularly in the realm of health.
During my session, “Refugee Health Reporting as Empowerment: Negotiating Accuracy, Dignity, and Context,” I invited participants to view journalism through the lens of Paulo Freire, the celebrated Brazilian transformative educator who wrote the Pedagogy of the Oppressed while in exile in 1970. Through his influential work, Freire argued that oppression persists when those in power control language and narrative, when others are spoken for rather than heard. Liberation begins, he said, when people “name their world.” That principle remains profoundly relevant to our craft as journalism and communications practitioners. Refugees must not remain objects of our storytelling; they are its subjects. Journalism, in its truest public function, becomes liberating only when it is dialogic, when we report with people, not merely about them.
This transformation begins with accuracy. In Uganda, refugees share the same health system as host communities, one already strained by staff shortages, drug stock-outs, and donor fatigue. Yet many stories stop at official statements or NGO press releases. Limited access, shrinking newsroom budgets, and bureaucratic gatekeeping tempt journalists to rely on polished humanitarian narratives. But when we do, we risk becoming megaphones for the powerful. Accuracy demands courage, the willingness to verify, to cross-check, and to step beyond curated camp tours. In refugee reporting, truth is not just a professional standard; it is an act of respect.
Still, truth without dignity can harm. Too often, images of refugees serve as shorthand for despair—dust, hunger, tents. Such imagery may evoke sympathy, but it often strips away humanity. From practice, I have seen journalists lower their lenses before asking names. I have also seen how a small shift in approach, say seeking consent, giving space, and listening before photographing, can restore dignity to both subject and story. Words matter too. Calling someone an “illegal immigrant” or describing an “influx” of refugees turns people into problems. Language should humanise, not flatten. To describe refugees as mothers, health workers, or students is to reassert their agency and affirm our shared humanity, something Freire would have deeply valued today.
And no story exists in isolation. Every health headline in a settlement echoes across systems of policy, climate, economics, and gender. A cholera outbreak in Kyangwali is not merely a medical event or isolated incident; it may be showing broken sanitation infrastructure and the politics of aid, which may result in a national disease outbreak. Context is the soul of credibility. Without it, even accurate stories can mislead. In Imvepi, I saw first-hand that refugees’ health challenges are inseparable from Uganda’s own development journey, from how budgets are made to how global partners value African hospitality. The more connections we draw, the closer we come to the truth.
By the close of the workshop, it was evident that empowerment in journalism is not a slogan but a discipline. It demands patience, humility, and persistence. It calls for the co-production of stories, revisiting them, verifying them, and allowing refugees to narrate their realities. It also calls on institutions to invest and fund field reporting, train correspondents in trauma-sensitive and peace journalism, and protect journalists pursuing uncomfortable truths. Without such support, even good intentions dissolve into soundbites.
I often return to Freire’s words of wisdom: “To speak a true word is to transform the world.” This means that words are not just passive descriptions but powerful tools for action and social change, especially when they are paired with critical reflection and a commitment to praxis (work and action). Refugee health journalism, at its best, is precisely that kind of speech: accurate, dignified, and deeply contextual. It is not merely charity reporting; it is solidarity reporting. For anyone, given the wrong circumstances, can become a refugee. And solidarity, unlike sympathy, does not look down; it stands beside. When we write from that conviction, our stories do more than inform. They humanise, connect, and remind us that telling the truth well is, in itself, an act of justice.
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Professor Nakimuli awarded at FIGO Congress for outstanding contribution to Women and Child Health
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