Expenditure surveys conducted in Ghana in the late 1950s and 1960s pointed to a curious conclusion, that Engel’s law – the assumption that, as income rises, the proportion of income spent on food falls – did not apply in Accra. Instead, poor workers in the city pursued a diminished but otherwise similar version of ‘the good life.’ This received a flutter of attention at the time, including from Polly Hill (1957), and has been reassessed more recently by Jane Guyer (2002). However, the proper history of this phenomenon, its validity, its endurance and its impact on urban health – and nutritional health in particular – has not been properly considered. Using anthropometric and demographic data (DHS, 1988-2014; Moradi, 2009), medical data and real wage data (Frankema and Waijenburg, 2012), this paper offers a broad exploration of the alterity of urban consumption in the Ghanaian context, as well as its relationship with health and economic survival in a rapidly changing city. While rooted in the ‘renaissance’ of African economic history, this paper will also speak to, build on and test social histories of gender and domestic reproduction in the Ghanaian capital (e.g. Akyeampong, 2000), alongside the rich seam of anthropological work relating to food and gender in urban Ghana (e.g. Clark, 1994; 2014). Situated in between these two lively fields of related but often autonomous historical enquiry, this paper will add to the economic history and historical epidemiology of urban Africa. Offering novel historical insight into contemporary health crises, this paper also hopes to contribute to timely questions around Africa’s apparent ‘epidemiological transition’ and the epidemics of obesity and heart disease which, occurring concurrently with endemic malnutrition, make up Ghana’s ‘double burden of disease’ (Agyei-Mensah & de-Graft Aikins, 2010).