𝐁𝐡𝐮𝐭𝐚𝐧’𝐬 𝐅𝐢𝐫𝐬𝐭 𝐋𝐞𝐚𝐝 𝐄𝐱𝐩𝐨𝐬𝐮𝐫𝐞 𝐒𝐮𝐫𝐯𝐞𝐲 𝐑𝐚𝐢𝐬𝐞𝐬 𝐑𝐞𝐝 𝐅𝐥𝐚𝐠𝐬 𝐟𝐨𝐫 𝐂𝐡𝐢𝐥𝐝𝐫𝐞𝐧’𝐬 𝐇𝐞𝐚𝐥𝐭𝐡

…𝑯𝒊𝒈𝒉 𝑳𝒆𝒗𝒆𝒍𝒔 𝑫𝒆𝒕𝒆𝒄𝒕𝒆𝒅 𝒊𝒏 76 𝒑𝒆𝒓𝒄𝒆𝒏𝒕 𝒐𝒇 𝑪𝒉𝒊𝒍𝒅𝒓𝒆𝒏; 𝑴𝒊𝒏𝒊𝒔𝒕𝒓𝒚 𝒐𝒇 𝑯𝒆𝒂𝒍𝒕𝒉 𝑼𝒓𝒈𝒆𝒔 𝑵𝒂𝒕𝒊𝒐𝒏𝒘𝒊𝒅𝒆 𝑨𝒄𝒕𝒊𝒐𝒏 𝒕𝒐 𝑷𝒓𝒆𝒗𝒆𝒏𝒕 𝑳𝒐𝒏𝒈-𝑻𝒆𝒓𝒎 𝑯𝒆𝒂𝒍𝒕𝒉 𝑰𝒎𝒑𝒂𝒄𝒕𝒔

By Rinzin Norbu,

The first National Blood Lead Level (BLL) Survey in Bhutan has revealed alarming levels of lead exposure among children, with three out of every four children tested displaying blood lead levels that pose significant health risks. Conducted by the Ministry of Health with support from UNICEF, WHO, IPSAHD, and the Faculty of Nursing and Public Health, KGUMSB, this groundbreaking survey brings Bhutan’s lead exposure problem into sharp focus, highlighting the urgent need for action.

The survey included approximately 3,000 children across Bhutan’s districts, offering a comprehensive picture of lead exposure among the nation’s youth. In addition, 124 pregnant or breastfeeding mothers and 207 children in monastic institutions were also tested. The results were staggering: 76 percent of children aged 1-6 were found to have blood lead levels of 3.5 micrograms per deciliter (µcg/dL) or higher, indicating potentially serious health impacts. An even higher percentage, 86 percent, was recorded among children in monastic institutions. Equally concerning, 59 percent of the women surveyed had elevated lead levels, putting themselves and their unborn or breastfeeding children at risk.

Lead, a potent neurotoxin, affects almost every organ in the body, with the brain being one of the most vulnerable. Lead exposure in children, even at minimal levels, can cause irreversible brain damage, lower IQs, hinder academic performance, and lead to a range of health problems. “Children are especially susceptible to lead exposure, as they absorb it more readily than adults,” noted Health Secretary Pemba Wangchuk. “Even minimal levels of lead can drastically affect their developing brains and bodies, resulting in cognitive and physical challenges. Importantly, no level of lead in the body is considered safe,” he added.

Wangchuk emphasized that addressing this critical issue is a national priority for the Ministry of Health, which is committed to collaborating with various stakeholders, including international partners, to mitigate lead exposure. “Collective action is essential for safeguarding the health of our children and communities,” he said.

UNICEF Bhutan’s Representative, Andrea James, highlighted the far-reaching implications of lead exposure, calling it a “silent and insidious threat” with particularly severe consequences for children under five. “Lead exposure impairs brain development, leading to lifelong cognitive, neurological, and physical challenges,” James said. She stressed that prioritizing children’s environmental health within national development agendas is crucial to creating a sustainable and resilient future for Bhutan.

The survey also highlighted potential sources of lead exposure in Bhutan, which were further linked to anemia in some cases. This finding aligns with global trends, as developing nations often face multiple, overlapping sources of lead exposure, including contaminated water, soil, household products, and industrial pollution.

Kinley Dorjee, a Research Officer with the Ministry of Health, explained the significance of the blood lead level threshold used in the survey. While the WHO considers blood lead levels of 5 µcg/dL as elevated, Bhutan used the U.S. CDC’s lower action threshold of 3.5 µcg/dL, which aligns with the detection capabilities of the portable lead care machine used in the survey. “This threshold allowed us to capture even the slightest traces of lead in the blood, giving us a more accurate view of lead exposure among young children,” Kinley Dorjee said.

He pointed out the stark contrast between Bhutan and developed nations such as the United States, where only 2.5% of children are reported to have elevated blood lead levels, approximately one in fifty. “In Bhutan, three out of four children have blood lead levels at or above 3.5 µg/dL, indicating an issue of national concern,”Kinley Dorjee added. The survey provides a valuable, nationally representative snapshot of blood lead levels among children aged 1-6, laying the groundwork for a focused public health response.

𝐇𝐞𝐚𝐥𝐭𝐡 𝐈𝐦𝐩𝐥𝐢𝐜𝐚𝐭𝐢𝐨𝐧𝐬 𝐟𝐨𝐫 𝐁𝐡𝐮𝐭𝐚𝐧’𝐬 𝐘𝐨𝐮𝐭𝐡 𝐚𝐧𝐝 𝐖𝐨𝐦𝐞𝐧

Dr. Phillip Erbele, Assistant Professor at the Faculty of Nursing and Public Health, explained the heightened vulnerability of children, infants, and pregnant women to lead exposure. “Children under five, as well as infants, often put objects in their mouths, increasing the likelihood of ingesting lead when it’s present on surfaces or items,” Dr. Erbele explained. He emphasized that young children’s developing brains are particularly susceptible to lead, as it readily crosses the blood-brain barrier, leading to significant developmental impacts.

Lead exposure also disrupts the absorption of vital nutrients like calcium, which are essential for growth in both children and pregnant women. “Lead interferes with the absorption of crucial nutrients,” Dr. Erbele noted, “resulting in developmental delays, reduced productivity, and diminished learning abilities.” Over time, this can contribute to a decrease in IQ, affecting educational achievements and potentially reducing Bhutan’s GDP by over 3 percent, he added.

In adults, lead exposure is linked to increased cardiovascular risks and higher mortality rates. Dr. Erbele highlighted that for nations with prevalent lead exposure, the economic toll is significant, with GDP losses exceeding 5percent. This economic impact is particularly pronounced in lower-middle-income countries and regions in Southeast Asia, where combined health and productivity losses due to lead exposure could reduce GDP by more than 9 percent.

According to World Bank economists, widespread lead exposure could reduce the GDP of South Asian countries by more than 9 percent. For Bhutan, this equates to an annual economic loss of around Ngultrum 21 billion. Lead exposure, therefore, is not only a pressing health issue but also a significant economic challenge, making it imperative for Bhutan to address the root causes of lead exposure swiftly and comprehensively.

The Ministry of Health and UNICEF are urging a collaborative approach to tackle the dangers of lead poisoning. A coordinated strategy involving advocacy, regular BLL screenings, and lead risk reduction measures must become integral to Bhutan’s health and development agenda. Addressing the sources of lead exposure through policy changes, educational campaigns, and enhanced regulation can help mitigate the risks for future generations.

“This is a national urgency,” stated Secretary Wangchuk. “We need a collective, multisectoral, and inclusive approach to stop the harmful effects of lead poisoning and solicit the support of policymakers to develop relevant policies and regulations.” UNICEF’s Andrea James emphasized that this effort must place children’s health at the center of Bhutan’s national development goals.

Bhutan’s first National Blood Lead Level Survey has revealed a significant public health issue affecting the nation’s children, mothers, and economy. The findings underscore the need for a comprehensive and sustained response from both governmental and international organizations. By prioritizing lead exposure reduction and fostering awareness at every level of society, Bhutan can work towards a lead-free future, safeguarding the health and well-being of its people and its economy.

As Bhutan takes its first steps in addressing this hidden health crisis, the survey serves as both a wake-up call and a roadmap. While the challenges are substantial, the resolve of Bhutan’s Ministry of Health, alongside UNICEF, WHO, and other partners, highlights a commitment to creating a healthier, more resilient Bhutan for future generations.