I have just returned from two weeks in Ghana, a fascinating and challenging country on so many fronts, but significant because I hardly saw a single Ghanaian smoking throughout my time in the country.

We went to Ghana because my brother-in-law (who lived out there until earlier this year) was getting married to a lovely lady from Bolgatanga, which is right up north near the border with Burkina Faso. This meant we travelled way off the tourist trail, took part in a Ghanaian wedding, and met far more Ghanaians at work and socialising than we would on a package tour. But we did not meet a single Ghanaian smoker. There were not even any puffers at the evening party (held outside) to celebrate the wedding, at which there was great music and much alcohol was consumed.

Cigarettes are not illegal in Ghana, but smoking is very much not part of the culture. According to the World Health Organization, the prevalence of smokers in Ghana is about 9.5% of men and 0.7% of women. However, my own experience was that these must have been very occasional or private smokers.

I had several discussions with Ghanaians and people who have lived in the country for years about why smoking was rare to non-existent.  I got the consistent answer that smoking was not socially acceptable because it never became popular before the adverse health messages were known.  It is still associated in the minds of Ghanaians with social inadequacy. Smoking in that country has become a symbol of a dissolute lifestyle; but not in an attractive, rebellious way, and more as an indication of social failure. Smoking in public was like hanging a sign around your neck saying “I am a failure,” as one person explained to me.

So the simple answer to those who say that it is not possible to have a culture which removes smoking from the norm is: “Go to Ghana and see such a society for yourself.”

Of course there is Western influence in Ghana that could change this. I was at a hotel in Accra where I saw a table which, unusually, included some smokers . . .  but all appeared to be speaking Italian.

David Lock is a barrister and QC, Landmark Chambers. He is a board member of Brook Sexual Health, a member of the BMA Ethics Committee, and a Honorary Professor at University of Birmingham. He has set up a website www.gplaw.co.uk, which pulls together law, guidance, and practice that affect general practitioners.

Competing interests: I am a member of the Labour Party and chair the West Midlands Branch of the Labour Finance and Industry Group. I am a non-executive board member of Heart of England NHS Foundation Trust. My wife is a doctor who is employed by Worcestershire Partnership NHS Trust.