The Bhutanese Leading the way.
With growing concerns over lead exposure and its potential health risks, the issue was among the key topics highlighted during the 5th National One Health Symposium held in Tsirang.
The symposium, which focused on strengthening Bhutan’s preparedness against emerging health threats, brought together experts from the human, animal, and environmental health sectors.
One of the critical presentations was delivered by Dr Mongal Singh Gurung, Head of Bhutan Health Management and Information System (HMIS) and Research at the Ministry of Health (MoH), who highlighted the dangers of lead exposure, its sources, and the urgent need for a coordinated response.
His presentation emphasized that lead exposure is just one of many pressing health concerns requiring multi-sectoral collaboration, reinforcing the importance of integrated approaches in addressing public health challenges
Lead, as highlighted by Dr Mongal, is a widely available and commonly used element in daily life, and its severe toxicity. He said, “The problem is that lead is highly toxic, and until recently, we were unaware of just how dangerous it is.”
Dr Mongal emphasized that while lead poisoning poses a risk to everyone, children are particularly vulnerable, as their bodies absorb lead at a rate four to five times higher than adults. “When lead enters a child’s bloodstream, it directly affects brain development,” he said.
Lead exposure has severe health consequences across all age groups, including mental health disorders, kidney damage, anemia, seizures, and, in extreme cases, death. For newborns, it can lead to premature birth, low birth weight, slow growth, high blood pressure, ischemic heart disease, and stroke.
Children and young people are particularly at risk, as lead exposure can result in decreased IQ, developmental delays, learning difficulties, and behavioral problems.
Explaining the impact on brain function, Dr Mongal described how the human brain consists of 86 billion neurons, each forming hundreds of trillions of connections.
“When we think, neurotransmitters relay signals between neurons. However, lead disrupts this process by interfering with these connections, ultimately lowering intellectual capacity,” he said.
Discussing the economic impact, Dr Mongal referenced a 2023 study published in Lancet Planet Health, conducted by two World Bank economists. The study used economic modeling to assess the effects of lead exposure on health and the economy. Their findings revealed that IQ loss accounts for approximately 4 percent of economic loss, while cardiovascular-related mortality contributes another 6 percent.
For developing countries, including Bhutan, this translates to a staggering loss of nearly 9 percent of the national GDP. In Bhutan’s case, this amounts to an estimated annual loss of Nu 22–25 billion due to the effects of lead poisoning.
The National Health Survey 2024 targeted a sample population of 2,959 individuals, with a nationally representative focus on children aged 1–6 years. Additionally, the survey included 124 pregnant and breastfeeding women, 207 children under 13 years from monastic institutions, and 128 other household members.
Findings from the survey revealed alarming levels of lead exposure among Bhutanese children. Three out of four children aged 1–6 years (75.9 percent) had blood lead levels equal to or greater than 3.5 µg/dL. While global trends indicate a decline in lead prevalence as children grow older, Bhutan’s data suggests persistently high levels across all age groups.
Among pregnant and breastfeeding women, 58.9 percent showed signs of lead poisoning. More concerningly, lead exposure among children in monastic institutions, who are expected to have a lower prevalence as they grow older was recorded at 86 percent. Similarly, lead contamination in household items was found to be 80 percent, indicating widespread exposure risks in domestic settings.
A total of 2,418 items were tested, with each item undergoing three rounds of analysis. Among these, more than 44 percent of Jinlab samples exceeded the safety threshold for lead contamination. However, despite the high prevalence, some Jinlabs were found to be free of lead.
Dr Mongal emphasized the severity of lead contamination by referencing past incidents. “In 2015, Maggi noodles contained only 17.2 ppm of lead, yet they were banned,” he said.
Dr Mongal shared a prominent case from the survey in which a child was found to have dangerously high lead levels. However, when the team tested household items in the child’s home, none showed signs of contamination. “Somehow, the child’s grandmother was wearing prayer beads, and when we tested them, they turned out to be positive for lead,” he said.
He emphasized that prevention is key to addressing lead exposure. While Chelation therapy is available for individuals with extremely high blood lead levels specifically above 45 micrograms per deciliter, it comes with side effects and risks. Moreover, it only reduces lead levels in the blood but cannot reverse the damage already caused.
However, recognizing the level of lead exposure the MoH is laying the foundation for stronger health services, enhanced testing capabilities, and workforce development.
The ministry also plans to train health workers across the country which can decrease the potential cause for lead exposure.
