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Bhutan witnessed an increased burden of Non-Communicable Diseases (NCD) both in terms of morbidity and mortality.
As per the Bhutan STEPS Survey, the rise of NCDs has been driven primarily by four major risk factors: tobacco use, harmful use of alcohol, physical inactivity and unhealthy diets. Reducing these modifiable risk factors is essential in reducing the burden of NCDs in the country
Health Minister Dechen Wangmo said despite enabling environment in place, yet the survey is showing that the health of the nation in the last five years has not made any improvement.
Looking at the indicators of a healthy nation, none has been achieved, said the health minister.
The Health minister talking about drinkers in the country said that although those drinking before the legal age has decreased, the percentage of drinkers from 18 to 69 is still high.
Similarly, the youth tobacco survey indicates that the country has more young people engaging in the habit. It says it is the right time to reflect on the strategies that are in placed are really working or not.
Lyonpo said in the five years the health of the nation has remained same. The minister said the ministry has the highest political will at the moment. She also expressed that the ministry is targeting every population to screen for NCDs.
Harmful use of Alcohol
As per the STEP survey, 2019, more than two-fifths or 43% of respondents were current drinkers, 16% former drinkers while 41% had never consumed alcohol in their lifetime. From among the current drinkers. Beer seems to be the common alcoholic beverage among the Bhutanese population. Alcohol-related violence, injuries, conflict with law and regulation was frequent as revealed by the study.
In comparison to 2014, the percentage of current drinkers had decreased by 7% (from 50% in 2014 to 43% in 2019). The survey findings of heavy episodic drinking among men at 22% particularly in the younger age group 25-39 years providing evidence of the harmful use of alcohol.
While many systems are in place, the implementation bottlenecks need to be ironed out and implementation approaches should be strengthened across all sectors as indicated by alcohol pricing and taxation review.
Tobacco use
The survey revealed that 23% of all respondents currently used tobacco products of any kind. The smoking pattern were seen with socio-economic status with younger generations and those with higher education and higher wealth quintile preferred smoking while the older group with lower wealth quintile and non/less the primary level education used smokeless tobacco products.
The 2019 STEPS survey also found that one out of two Bhutanese were indulging in chewing both betel and areca nut products (doma & paan). The Report on Bhutan Global School-Based Student Health Survey 2016 found even higher results with almost two-thirds of the students (65.8%) reporting that they consumed betel or betel nut products. The rising trend of tobacco use in Bhutan is despite adopting the Framework Convention on Tobacco Control (FCTC).
Cervical Cancer
With cervical cancer elimination as one of the flagship programs for the 12FYP, Bhutan is at the forefront of promoting women’s health. To achieve elimination, a comprehensive approach to prevent, screen and treat, has been initiated. This survey found that more than half (54%) of women (15-69 years) reported that they had undergone cervical cancer testing.
The most common reasons cited for not testing were, “did not know where to get tested”, embarrassment, fear, time factor, etc. Almost all cervical cancer cases (99%) are linked to infection with high-risk human papillomaviruses (HPV) and recommends an effective primary (HPV vaccination) and secondary prevention approaches (screening for and treating precancerous lesions) to prevent most cervical cancer cases.
The survey noted an increase in the percentage of women aged 30-49 years, who have ever tested for cervical cancer, from 64.1% to 82.1% between 2014 and 2019 and from 50.7% to 54.8% amongst women aged 18-69 years for the same period. With more focus in the coming years, the percentage is likely to increase and achieve cervical elimination in Bhutan and it is recommended to strengthen the services to reach the unreached population.
Mental Health
The survey reported that 0.7% of respondents have attempted suicide while 1.2% of respondents seriously considered attempting suicides. The survey showed 0.4% of respondents have moderately severe depression, 1.6% has moderate depression and 12.3% have mild depression.
Further, 0.2% of respondents have severe anxiety, 1.5% has moderate anxiety and 7.5% have mild anxiety. Socio- economic factors are an important component of mental health with respondents aged 15-24 years who are women, live in urban areas, have a primary to middle school level education, and lower household wealth, most likely to report seriously considering attempting suicide.
The annual health Bulletin also reported an increasing depression Incidence (per 10,000 populations) as 6.0 in 2017, 9.6 in 2018 and 10.4 in 2019. These trends warrant an acceleration of prevention approaches. Mental health is one of the important domains of GNH. Without addressing the mental health, Bhutan’s path in making GNH a real goal is at stake. Therefore, the government must adopt a collaborative approach in addressing mental health issues and gaps in Bhutan according to the report.
Meanwhile, the STEP survey is a measure of NCD indicators and so it is recommended to conduct this survey every five years so that the health ministry immediately develop policy and actionable interventions to address NCD risks in Bhutan.
Meanwhile the survey found that 44.9% of Bhutanese are obese or overweight, 28% had raised BP, 1.9% had raised sugar level and 11.1% had raised cholesterol level.
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