By Alex Ababio | Ghanaian Watch
THE WOMAN WHO CANNOT BREATHE
Akosua Mensah, 74, has lived in the same compound house in Nima, a densely populated neighbourhood in Accra, for over forty years. She has seen the city change—the trees felled, the roads widened, the vehicles multiply. She has felt the air change too. “When I was younger, the air was lighter,” she says, her voice punctuated by a dry cough that has become permanent. “Now, when the harmattan comes, I cannot sleep. My chest tightens. My eyes burn. I feel like I am breathing sand.”
Mensah was diagnosed with Chronic Obstructive Pulmonary Disease (COPD) six years ago. She has hypertension and type 2 diabetes. She is one of hundreds of thousands of older Ghanaians whose health is being silently eroded by environmental degradation—by air pollution, extreme heat, and the slow violence of a changing climate.
Mensah’s experience is not anecdotal. It is epidemiological.
PART TWO: THE AIR THAT KILLS
Air pollution is now the second-leading cause of death in Ghana, according to the Health Effects Institute’s State of Global Air 2025 report. In 2023, approximately 32,500 Ghanaians died from air pollution-related diseases—a nearly 2 per cent rise from the previous year’s 31,900 deaths. Of these, 12,790 deaths were recorded among persons aged between 50 and 85, and 4,541 deaths among children under 10 years old.
The WHO’s 2020 study attributed 28,000 premature deaths annually to air pollution in Ghana. The 2025 Air Quality Life Index report put the figure above 32,000—a rise of more than 4,000 in just a few years. Health researchers say the danger is most acute for children under five and adults over 50, who face higher risk of respiratory and cardiovascular illness from polluted air.
The scale of the crisis is staggering. Air pollution now kills more Ghanaians annually than HIV/AIDS, malaria, and road traffic accidents combined. Globally, 7.9 million deaths in 2023 were caused by air pollution—a rate of 1 in every 8 deaths—with 90 per cent of these deaths recorded in low- and middle-income countries.
In Ghana’s major cities, the air quality is particularly lethal. A 2025 study published in Science of the Total Environment found yearly median PM2.5 concentrations in Ghanaian urban areas ranging from 50.79 to 67.97 µg/m³—significantly higher than the WHO recommendation of 5 µg/m³. Annual PM2.5 concentrations in major Ghanaian cities have at times measured up to 11 times higher than WHO guideline levels. In 2025, Ghana recorded an average PM2.5 concentration of 21.3 micrograms per cubic metre—over four times higher than the WHO’s recommended safe limit.
For older Ghanaians, these numbers are not abstractions. They are the air they breathe every day.
THE HARMATTAN HORROR
Every year, from December to March, the harmattan winds blow south from the Sahara, blanketing Ghana in a thick haze of dust. The Environmental Protection Agency (EPA) routinely issues health alerts, recommending that vulnerable groups—including the elderly—wear face masks and limit outdoor activities.
During the 2024 harmattan season, air quality monitoring stations at the University of Ghana and Adabraka recorded high dust levels. Since December 13, the Air Quality Index ranged between “unhealthy for sensitive groups” and “very unhealthy”. Dr. Allison Felix Hughes, Facility Manager of Afri-SET, confirmed the unhealthy air quality, warning: “It is during this period that you see the hospital admissions growing with cases of asthma, bronchitis, and other respiratory diseases”.
The EPA’s findings align with the Ghana Meteorological Agency’s forecasts of significant dust in the air from the Sahel region. Early December 2024 data from the Breathe Accra Project’s monitoring stations also showed high pollution levels across the country.
For older persons with pre-existing respiratory conditions, the harmattan season is not merely uncomfortable. It is dangerous. “The dust primarily consists of Particulate Matter (PM) 2.5—tiny particles that can penetrate deep into the respiratory and cardiovascular systems, impairing organ function and posing serious health risks”.
THE HEAT THAT KILLS SLOWLY
Ghana is getting hotter. The Lancet Countdown on Health and Climate Change 2024 data sheet reveals that from 2014 to 2023, adults over age 65 in Ghana experienced 5.7 times more heatwave days than the equivalent demographic from 1986 to 2005. Individuals were exposed to a moderate or higher risk of heat stress for nearly 3,200 hours per year during light outdoor activities—a 13.5 per cent increase compared to 1990–1999.
The Accra Metropolitan Assembly (AMA) has identified the elderly as being at highest risk of heat morbidity and mortality. Although only 5.5 per cent of AMA residents are elderly, they represent the highest physiological vulnerability due to chronic illnesses, mobility constraints, and limited ability to thermoregulate.
Accra is experiencing unprecedented levels of extreme heat due to accelerating climate change, rapid urbanisation, land-use change, and the intensification of the Urban Heat Island effect. “Age is a key determinant, as older adults and young children are less able to regulate body temperature, making them more susceptible to heat exhaustion, dehydration, and other heat-related illnesses”.
Extreme heat causes 4.6 million premature deaths annually—a level of heat-related mortality expected to rise under climate change. In Ghana, outdoor maximum daily temperatures regularly exceed 35°C, and vulnerability to heat is socially and economically differentiated, with pregnant women, young children, elderly people, and people with chronic health conditions most at risk.
THE DEMENTIA CONNECTION
A systematic review published in 2025 by researchers at Ghana’s University of Cape Coast identified air pollution and temperature as significant risk factors for dementia in sub-Saharan African adults. Long-term exposure to PM2.5 increases dementia risk by 40 per cent, with even higher risks for vascular dementia—a doubling of risk for every 10 μg/m³ increase in exposure.
Air pollution contributes to about one-fifth of the global dementia burden, with particularly severe impacts in low- and middle-income countries where exposures are highest and health systems are weakest. In Ghana, roughly three-quarters of households still rely on solid biomass fuels for cooking, exposing millions—especially women—to daily neurotoxic smoke.
The smoke that fills Ghana’s kitchens is a potent neurotoxin. Biomass combustion generates fine particulate matter at concentrations routinely exceeding 200 μg/m³ in poorly ventilated cooking spaces—more than 40 times the WHO air quality guideline.
For older Ghanaians, the cognitive damage from decades of smoke exposure, traffic pollution, and heat stress accumulates silently. “Unlike strokes or heart attacks, which announce themselves dramatically,” notes the Think Global Health analysis, “the cognitive damage from decades of smoke exposure, traffic pollution, and heat stress accumulates silently. By the time families notice memory problems, substantial brain damage has already occurred”.
PART SIX: THE COPD CRISIS
Chronic Obstructive Pulmonary Disease (COPD) prevalence in Ghana has tripled, rising from 0.1 million to 0.3 million cases, while incidence increased by 215 per cent and Disability-Adjusted Life Years (DALYs) by 171 per cent.
In Ghana, household air pollution from solid fuel use accounted for 40 per cent of COPD deaths, followed by ambient air pollution at 25 per cent. Projections show continued increases in prevalence and incidence, particularly among adults aged 40–64, with mortality increasing significantly at the age of 60, with males at higher risk.
The WHO assessment identified “the capacity of health-service staff to provide geriatric care is limited both in their number and skills mix,” leading to “the inappropriate labelling of all illnesses among older people as due to old age”. This diagnostic inertia means that treatable respiratory conditions are often dismissed as inevitable ageing, with fatal consequences.
THE GLOBAL CONTEXT
Ghana’s environmental health crisis must be understood in the context of broader African and global experience. A 2024 study published in Frontiers in Public Health analysed global trends in particulate matter pollution-related deaths among older adults from 1991 to 2021. It found that ambient particulate matter pollution-related older adult deaths increased from 1,745,000 to 3,850,000 globally, while household air pollution from solid fuels accounted for 2,100,000 deaths.
High ambient particulate matter burden was concentrated in Asia, Africa, and the Middle East, while high household air pollution burden was found in parts of Africa and South Asia. Females consistently experienced higher age-standardized DALY rates than males for both forms of pollution across all regions.
In 2023, nearly 5 million deaths among people over age 70 were linked to air pollution, with about 3 million attributed to PM2.5. Air pollution was linked to 29 per cent of all global dementia deaths in 2023, with the largest burdens seen in Africa and Asia.
The comparative evidence demonstrates that while Ghana’s crisis is severe, it is not unique. But the policy response in Ghana has been far weaker than in comparable countries. South Africa’s Heat and Health Early Warning System for Gauteng province has shown that heat-related mortality among older adults increases significantly as maximum temperatures exceed 30°C, with lower thresholds of 31°C and 32°C resulting in more deaths because they occur more frequently. Kenya has integrated heat-health surveillance into disease monitoring and developed forecast-based heat alerts.
Ghana, by contrast, has no national heat-health early warning system. A 2026 study published in Climate and Development assessed the integration of older adults’ vulnerability in Ghana’s climate adaptation policies and found “an exclusion of older adults in climate adaptation policies and the non-existence of age-specific policies on climate adaptation”. The study revealed “a neglect of older adults in the formulation and execution of climate adaptation policies, which underscores a wider systemic disregard”.
THE HEALTH SYSTEM FAILURE
A 2024 World Bank Climate and Health Vulnerability Assessment for Ghana identified critical gaps in the health system’s capacity to respond to climate-related threats. The report found that “health issues related to heat, air pollution, and infectious diseases are on the rise with the elderly, youth, and children being particularly vulnerable”. It called for “urgent action to strengthen the resilience of Ghana’s health system against the adverse effects of climate change”.
The report recommended implementing a 10-year plan to make Ghana’s health sector resilient to climate change, enhancing coverage of climate-sensitive conditions in health information systems, and upgrading health facilities with climate-smart codes.
Yet the current reality falls far short. The WHO assessment found that “there are no guidelines or standards on health-care provision or rehabilitation services for older people” and that “the capacity of health-service staff to provide geriatric care is limited both in their number and skills mix”. A 2026 study in the Journal of Cross-Cultural Gerontology found that SSNIT pensioners in Greater Accra had “at best a moderate social, physical, psychological, and environmental quality of life”.
The physical environment itself is a determinant of health. In Sekondi-Takoradi, older residents in Zongo communities face hidden dangers from extreme heat in their homes. “I use wet towels to cool my children, but the elderly can’t handle the heat,” one resident told Adom Online.
THE LEGAL VOID
Ghana’s National Ageing Policy, adopted in 2010, promised “Ageing with Security and Dignity.” Fifteen years later, the WHO assessment concluded that “very little has happened towards implementing the National Ageing Policy and Implementation Action Plan”. There is no National Council on Older People. There are no geriatric care guidelines. The policy has never been funded.
The absence of a social pension compounds the crisis. Of the over 2 million Ghanaians aged 60 and above, fewer than 300,000 receive SSNIT pensions—a coverage rate of just 5 per cent. The Livelihood Empowerment Against Poverty (LEAP) programme reaches 350,580 households, with elderly persons constituting 27 per cent of beneficiaries, but its overall reach is limited to 1.5 per cent of the national population.
The UN Intergovernmental Working Group on the Rights of Older Persons, established in April 2025, presents a historic opportunity to address this gap. In July 2027, the working group will discuss the outline of a new treaty. In November 2027, the Chair will present a first draft.
Ghana’s experience offers critical lessons for the drafting process. Environmental degradation is not merely an environmental issue—it is a human rights issue. The right to health, enshrined in Article 12 of the International Covenant on Economic, Social and Cultural Rights, is violated when older persons are forced to breathe toxic air, endure lethal heat, and die from preventable respiratory diseases.
WHAT MUST BE DONE
The recommendations are clear and urgent.
First, Ghana must establish a national heat-health early warning system, building on the models developed in South Africa and Kenya. This system should include forecast-based heat alerts, integration of heat-health surveillance into disease monitoring, and targeted outreach to older persons in high-risk areas.
Second, the EPA must strengthen enforcement of air quality regulations. The Environmental Protection (Air Quality Management) Regulations, 2025 (L.I. 2507) provides the legal framework. But enforcement requires resources, political will, and accountability.
Third, the health system must be made climate-resilient. This means training health workers in geriatric care, developing protocols for heat-related illness and respiratory disease, and upgrading health facilities with climate-smart codes.
Fourth, older persons must be included in climate adaptation planning. The 2026 study in Climate and Development found that older adults are excluded from climate adaptation policies. This must change. Older persons’ associations should be represented on climate adaptation committees at all levels.
Fifth, the UN treaty on the rights of older persons must explicitly recognise the right to a healthy environment. The treaty should require states to take measures to protect older persons from environmental health hazards, including air pollution, extreme heat, and climate-related disasters.
CONCLUSION
Akosua Mensah’s cough has not improved. The harmattan will return. The heat will intensify. The air will grow thicker.
But her story—and the stories of millions of older Ghanaians—is now part of a larger conversation. The UN treaty on the rights of older persons is being drafted. The July 2027 session will discuss the outline. The November 2027 session will present the first draft.
Ghana’s experience—both its policy failures and its potential for reform—can inform the development of a treaty that is truly fit for purpose. The question is whether Ghana’s policymakers will engage with the process, and whether the treaty will have the enforcement mechanisms to ensure that the next Akosua Mensah does not spend her final years struggling to breathe.
The numbers demand urgency. The stories demand action. The treaty demands engagement.
This is the third in a multi-part investigative series on the crisis of care for older persons in Ghana. The series is produced by Ghanaian Watch with support from the African Liberators Economic Institute.