NCDs becoming public health concern in Bhutan

Phurpa Wangmo

Non-communicable diseases (NCDs), also known as chronic diseases, tend to be of long duration and are the result of a combination of genetic, physiological, environmental and behavioural factors.

It has been noticed that the most common NCDs among Bhutanese are alcoholic liver disease, hypertension, cervical cancer, stomach cancer, diabetes, heart and kidney disease.

Despite Health Ministry’s continuous effort in mitigating the issue, there is still rise in cases. Public health advocacy and health screening have become priority activities to prevent and ensure early detection of NCDs especially the lifestyle related diseases and nutritional disorders which is increasingly becoming public concern.

MoH has been creating lots of awareness on NCDs to the public and they have also started to institutes public health advocacy program which will soon cover all the 205 gewogs but people are still considering NCDs as mild and neglect the sign and symptoms of the diseases.

Pema Lethro, National Professional Officer (NPO) at the World Health Organisation (WHO) said, “NCD especially the lifestyle related diseases and nutritional deficiency disorders are increasingly becoming a public health concern that accounts for approximately 69 percent of the mortality in the country”.

He also stated that modifiable behaviours such as tobacco use, physical inactivity, unhealthy diet and the harmful use of alcohol, all increase the risk of NCDs.

“The main reasons behind the increase of NCDs are due to the lack of knowledge and awareness of symptoms,” he added.

Pema Rinzin, 32 year old man from Samdrup Jongkhar said, “I am not really aware on types of NCDs except high blood pressure and diabetics. It is very difficult to know the symptoms of diseases and I rarely visit hospital for checkup”.
“Whenever I get sick, I go directly to medical shop and buy the medicines”, he added.

Zangmo, who is a farmer in Trashigang Dzongkhag said that she is aware of some of the diseases related to NCDs but not really aware on symptoms and causes.

She said, “I have high blood pressure and I visits BHU monthly, Health Assistant advise me to consume less oil and salt and also to do physical exercises”.

An unhealthy diet is one of the 5 main risk factors for NCDs and the promotion of a healthy diet is one of the recommended components for policies and programs in the Global Action Plan against NCDs. WHO recommends mean population intake of at least 5 servings (400g) of fruits and vegetables as part of a healthy balanced diet which provides a rich mix of nutrients and bioactive substances for the prevention of diet-related non-communicable diseases.

Pema Seldon 19 year old girl said, she is not really aware on NCDs and its burden. During her schooling days, she took lots of unhealthy diets and currently she weighs 130 kilograms.

She also said, “I joined Zumba classes and gym last year but it was really difficult for me to quit the junk food. I was even diagnosed with prediabetes and hypertension”.

“I think we have become a habit to consume more unhealthy diets and salty food which we cannot live without”, added Pema.

Pema Lethro NPO said, “Unhealthy diets and a lack of physical activity may raise blood pressure, increased blood glucose and obesity. These are called metabolic risk factors and can lead to cardiovascular disease, the leading NCD in terms of premature deaths”.

According to the Bhutan STEPS survey report 2019, the highest proportion of respondents with insufficient levels of physical activity was in the youngest age group across gender and Prevalence of insufficient physical activity is higher amongst urban residents than rural residents and western region has the highest prevalence of insufficient physical activity.

The report also states that the global epidemic of overweight and obesity is rapidly becoming a major public health problem that paradoxically coexists with under nutrition in many developing countries. The increasing prevalence of overweight and obesity is associated with many chronic diseases including type 2 diabetes mellitus, cardiovascular disease (CVD), stroke, hypertension, nonalcoholic fatty liver disease, and certain cancers.

Beer was the most consumed form of alcohol with 45.2 percent, followed by Ara with 23.5 and other home-brewed alcoholic drinks such as changkoe, bangchang or shingchang with 14.8 percent, wine 8.5 percent and spirits 7.9 percent.

Sanga Choden who resides at Trashiyangtse said that she is aware on alcoholic liver diseases and especially pregnant women are more aware on NCDs as she is checked thoroughly during the pregnancy days till 40 weeks but she is culturally influenced to drink changkoe(rice fermented alcohol) after her delivery.

She added, “My mother would give me changkoe after my delivery to have enough supply of breast milk and also fried cheese and butter which I knew from Doctor that it was very unhealthy for me and my baby”.

NCDs found a place in Sustainable Development Goal which targets by 2030, reduce by one third premature mortality, harmful use of alcohol, achieve universal health coverage and strengthen the implementation of the WHO framework convention on tobacco control in all countries.