The overall health of individuals is impacted by lifestyle behaviours including healthy diets, physical activity, smoking and alcohol consumption. Unhealthy lifestyle behaviours particularly poor dietary practices, physical inactivity and smoking are major risk factors for conditions like overweight, obesity and chronic non-communicable diseases [1–3]. Research in Ghana indicates that the prevalence of obesity is increasing especially among women . The rising prevalence of obesity in Ghana is worrying because epidemiological studies have consistently shown an increased risk of morbidity, disability and mortality with obesity . Findings from a study using data from a nationally representative sample survey (World Health Survey 2003) conducted in Ghana revealed that about 18% of the respondents had been diagnosed with one or more chronic non-communicable disease(s) with 45% of them currently receiving treatment (Tagoe, Household burden of chronic disease in Ghana, Unpublished). Health reports show that the prevalence of lifestyle diseases (chronic non-communicable diseases) such as stroke, hypertension, type 2 diabetes, and other cardiovascular diseases are on the increase and are now among the top ten in-patient cause of death in Ghana .
Urbanisation, globalisation and nutritional transition are major drivers of unhealthy lifestyle behaviours in developing countries [7–9]. Rapid urbanisation and globalisation is accompanied by behavioural change which exposes many individuals to the risk of chronic non-communicable diseases and mortality. Fast paced economic transition has also resulted in reduced physical activity levels, decreased hours of rest and increasing levels of stress [8, 9].
The progressive increase in the burden of chronic non-communicable diseases has been attributed to several factors including longer average lifespan and risky lifestyle behaviours . Tobacco use, physical inactivity and diets high in saturated fat and salts constitute risk for conditions such as cardiovascular diseases, high blood pressure and elevated serum cholesterol levels [11–13]. While factors such age, sex and genetic susceptibility are non-modifiable many of the risks associated with chronic diseases are modifiable. Such modifiable risks include behavioural factors (e.g. diet, physical inactivity, tobacco use, alcohol consumption), medical conditions (e.g. dyslipidemia, hypertension, overweight, hyperinsulinaemia) and societal factors including include a complex mixture of interacting socioeconomic, cultural and environmental factors [14, 15]. Estimates by the World Health Organisation suggest that up to 80% of premature deaths from heart disease, stroke and diabetes can be averted with known behavioural and pharmaceutical interventions . According to the Archives of Internal Medicine (1997) , the prevention of hypertension by means of dietary salt reduction and weight loss over a short term has been successfully accomplished in clinical trials. It has also been identified that diets high in fruits, vegetables and low-fat dairy products are extremely effective in lowering blood pressure .
From the foregoing, it is evident that the increase in the incidence and prevalence of non-communicable diseases are linked to risky healthy lifestyle behaviours . Thus populations that exhibit risky lifestyle behaviours are also at risk of having a double burden of disease and poverty as is currently seen in developing also referred to as the Global South. In an effort to curb this pattern of disease and poverty many countries in the Global South have initiated and implemented health policies and intervention programs to help improve the health of their populations. Most of these interventions have, however, not yielded the expected results due to implementation problems and non-adherence to recommended healthy lifestyle behaviours.
The Ministry of Health (MOH) in Ghana as part of its effort to reduce the incidence of preventable diseases and to promote regenerative health in the country adopted the concept of "Regenerative Health and Nutrition (RHN)". The main objective of the program is to promote healthy lifestyles, dietary practices and mother and child care practices that would help eliminate the many diseases that impact on the health and well-being of Ghanaians. The concept of regenerative health and nutrition was adopted by the MOH from Dimona, Israel, where a community of more than 3,000 African Hebrews have lived for over 40 years without any recorded deaths among the people during this period . Due to healthy lifestyle behaviours (including the adoption of vegan diets), the African Hebrews have been able to eliminate hypertension, diabetes, cancer and other chronic non-communicable diseases from their community .
The program covers three main modules; (a) mother and child care (b) healthy lifestyle and (c) regenerative nutrition . Key interventions under the program are geared towards; healthy diet (increasing consumption of fruits and vegetables, drinking more water, reducing the intake of meat, salt and saturated oils/fats, reducing or eliminating smoking and alcohol intake); exercise (increasing daily physical activity including cardiovascular exercise); rest (adopting regular relaxation practices to minimise physical and emotional stress) and environmental sanitation (maintaining personal and environmental cleanliness and advocating for portable water use). Under these interventions it is recommended that individuals consume five servings each of fruits and vegetables and also drink eight glasses of water a day. Living in a clean environment is encouraged and smoking and alcohol consumption are to be avoided.
The Ghana Regenerative Health and Nutrition Program was adopted in 2005 and piloted in 2006. The initial pilot involved ten districts across seven administrative regions. As part of the pilot program about 700 change agents and 5000 advocates were trained . Change agents and advocates of the program are members of the community who are trained in the principles and practices of RHN and they in turn educate their community members . The program has trained over 50,000 change agents and advocates throughout the country over the four year period (2006 to 2010) . Mass communication through the use of both print and electronic media serves as a means of reaching the population with the messages of the program.
In this paper the authors compare the prevalence of unhealthy lifestyle behaviours among Ghanaian adults before and after the adoption of the regenerative health and nutrition program with a focus on behaviours including fruit and vegetable consumption, physical activity, smoking and alcohol consumption. This paper also assesses the trend and the socio-economic and demographic determinants of healthy lifestyle behaviours among Ghanaian adults prior to and after the introduction of this policy. The paper also highlights the implication of unhealthy lifestyle behaviour on morbidity and mortality in the country. The authors hope this paper will generate a new research agenda and also bring to bear the health challenges risky lifestyle behaviours pose to developing countries.