On the roadside of the Achimota police station, 38-year-old hawker Nana Ama Yeboah balances a tray of bottled water on her head, moving between rows of cars. This routine has long been her source of income, paying for her children’s school fees and keeping food on the table.
But the very environment that sustains her livelihood, thick with vehicle exhaust and dust, is now silently undermining her health and, by extension, the financial stability she struggles to maintain.
After months of headaches and dizziness, Ama collapsed on the job one evening.
At the Achimota hospital, she was diagnosed with hypertension, and the doctors theorised it could be from the nature of her work.
“I thought only people who eat plenty of meat or drink a lot of alcohol get hypertension,” she says. “I didn’t know that my daily work in the dust and smoke could cause it. I never thought it was something I should worry about.”
The pollution-hypertension link
For Ghana’s vast informal workforce, air pollution is not merely an environmental nuisance; it is a direct occupational health hazard.
Dr.Sandra Kwarteng Owusu, a medical practitioner and physician pulmonologist, explains the link:
“When we talk about risk factors for hypertension, we must highlight air pollution specifically for informal workers. Inhaling fine particulate matter (PM2.5) from vehicle exhaust and dust causes systemic inflammation and oxidative stress, which damages blood vessels and forces the heart to work harder. For a hawker like Ama, spending over ten hours a day in traffic is akin to smoking multiple cigarettes daily. This, combined with stress and poor diet, creates a perfect storm for cardiovascular disease.”
This is supported by research from institutions like the Kintampo Health Research Centre, which shows a strong correlation between urban air pollution and elevated cardiovascular risk profiles, a fact rarely addressed in occupational health policies that overlook the informal sector.
Hypertension is one of the leading causes of cardiovascular diseases in Ghana. According to the Ghana Health Service, nearly one-third of adults in the country are estimated to have high blood pressure.
Yet less than half are aware of their condition. Among those diagnosed, only a fraction receive treatment, and even fewer manage to keep their blood pressure under control.
The World Health Organization reports that non-communicable diseases such as hypertension and diabetes now account for more than 40 percent of deaths in Ghana. The shift from infectious diseases to chronic conditions poses new challenges for a health system already under strain.
Dr. Benjamin Toboh Adom, a medical practitioner, explains: “Hypertension is rising because of several factors. Urbanisation, poor diets, stress, air pollution, and limited physical activity all play a role. But the real danger is that many people do not know they have it until complications like stroke or kidney failure appear. That is why prevention and early detection are critical.”
Informal work and vulnerability
In a report put together by the Friedrich-Ebert-Stiftung, the informal sector in Ghana employs more than 80 per cent of the workforce.
Hawkers, drivers, and market women spend long hours outdoors, often exposed to air pollution, heat, and high levels of stress. For many, access to routine health checks and reliable health information is limited.
Ama’s daily routine exposes her to multiple risk factors. She spends more than ten hours inhaling exhaust fumes from vehicles, walking through dust, and carrying heavy loads. When she falls ill, she loses her income for the day, which has a direct impact on her children.
“Some mornings I cannot go to the street because I feel weak,” she says. “If I don’t go, I make no money. My children ask for food, but there is nothing to give them. It is like being punished twice—once by the sickness and again by the poverty.”
Her experience is not unique.
The diagnosis of hypertension sets off a devastating chain reaction, a domino effect that topples household finances and undermines national economic stability.
The first domino to fall is the immediate loss of income. Health is the sole capital of the informal worker. No work means no pay. For Ama, a dizzy spell means a day’s earnings lost. A hospital visit wipes out a week’s savings.
The Economic burden of hypertension
Hypertension not only affects health; it reduces productivity and household income.
The World Bank estimates that non-communicable diseases cost African countries billions in lost productivity each year. For individuals in the informal sector, the impact is immediate.
Ama explains: “When I feel unwell, I cannot work. That means no sales, no money. Even the hospital bills take the little I have saved.”
Her words reflect a cycle: poor health leads to reduced income, which makes it harder to afford treatment, which in turn worsens health outcomes.
For her children, the consequences are already visible. School attendance sometimes drops when there is no money for transport or supplies.
Prevention and management
Hypertension can be prevented and managed. The key lies in consistent health education and accessible screening services. Doctors recommend several steps.
Reduce salt in meals, eat more vegetables and fruits, engage in at least 30 minutes of physical activity most days of the week, avoid tobacco and limit alcohol intake, and check blood pressure regularly.
These steps are simple, but for people like Ama, implementing them is not always easy. Nutritious food often costs more than cheaper, starchy options.
Long working hours reduce the time available for exercise or medical visits. Regular screening services are also not widely available in informal markets or roadside spaces.
Dr. Christian Kwatchey, medical practitioner at the Atua Government hospital, emphasises: “It is not enough to tell people to change their lifestyle. We must take services to where they are. Mobile screening units in markets, bus stations, and street corners can detect hypertension early. That is the only way to reach those in the informal economy.”
Raising awareness in communities
Civil society groups and health foundations, such as the Novartis Foundation, are beginning to focus more on hypertension awareness. Campaigns in churches, mosques, and workplaces have encouraged people to check their blood pressure.
However, coverage remains uneven. Rural and low-income urban communities often receive the least outreach.
Strong and influential messages can make a difference. Public health experts cite the success of campaigns promoting HIV testing and malaria prevention as evidence that community engagement is effective. Hypertension campaigns need similar energy, tailored to local realities.
Ama says she now talks to fellow hawkers about her condition.
“When I meet them, I tell them, go and check your blood pressure. Don’t wait until you collapse like me. Some laugh, but some listen.”
Her personal advocacy, though small, represents how awareness often spreads in informal networks.
Policy and Structural Gaps
But the challenge goes beyond individual choices. Air pollution levels in Ghana’s major cities exceed the WHO safe limits. Urban planning has not prioritised pedestrian-friendly routes or cycling infrastructure, which could encourage active lifestyles.
Alex Johnson, head of transport planning at the Accra Metropolitan Assembly, argues for an integrated approach:
“We must stop treating hypertension solely as a personal failing. It is an economic and environmental issue. Transport policies must aggressively reduce emissions. Urban planning must create pedestrian-safe zones to reduce exposure. Most critically, health insurance must be expanded to cover routine screenings and affordable medication for chronic conditions. Preventing a stroke is far cheaper for the economy than treating one.”
Caleb Ahinakwah is a journalist specialising in science, climate, and environmental reporting.
