The increasing burden of non-communicable diseases (NCDs) on health facilities demands greater multi-sectoral actions for the implementation of NCD prevention activities.

NCDs are a major public health problem accounting for an estimated 62 percent of the disease burden in the country.

According to health officials, deaths from NCDs increased to 69 percent in 2018 from 53 percent in 2011. Among them, 53 percent died before 70 years.

Cardiovascular diseases were the major cause of death in the country at 28 percent, followed by cancer and chronic respiratory disease at 10 and nine percent. Diabetes accounts for four percent of the deaths in the country.

According to the annual health bulletin 2017, diabetic cases at health facilities increased three times from 4,097 in 2012 to 12,120 in 2016.

Similarly, 30,260 hypertension cases were reported in 2016, about 3,237 more than 2012, rheumatic heart disease cases increased from 718 to 920 and alcohol-related liver diseases from 2,059 in 2012 to 3,508 in 2016.

A research paper by Gyambo Sithey, Jayendra Sharma, Karma Lhazeen et al. published in the recent Bhutan Health Journal, “Taking action on prevention and control of NCD in Bhutan by strengthening Gross National Happiness (GNH)”, reviews new evidence to support a political priority for NCDs in the country. 

Gyambo Sithey said NCDs were the leading cause of preventable deaths and premature mortality in Bhutan.

“The growing epidemic of NCDs threatens the achievement of GNH,” the study states. “Effective action to prevent and control these diseases requires a whole-of-government approach.”

According to the study, one-third of the Bhutanese were overweight (33 percent) and hypertensive (35.7 percent), and 6.4 percent wasdiabetic. “The prevalence of modifiable risk factors is also very high.”

Although the national NCD action plan identified strategic action areas and implementation mechanism, the study states that it falls short of identifying a sustainable policy approach to integrate the global, regional and the national NCD action plan into policies across all sectors to underpin actions addressing NCDs in the country.

“Health sector alone cannot achieve the required reduction in NCDs as it has very little control over the risk factors of the NCDs,” Gyambo Sithesaid.

The study also presents an analysis of strategic policy opportunities for the health sector to integrate the ‘Multi-sectoral national action plan for the prevention and control of NCDs, 2015-2020’ into policies across all relevant sectors.

He said to achieve GNH, prevention and control of NCDs must be prioritised.

The study identified three specific opportunities for the health sector to engage strategically to strengthen action on NCDs and GNH.

The first is raising priority actions on NCDs within the existing GNH multi-sectoral committee by strengthening NCDs surveillance to generate actionable evidence and advocating the information to policy makers.

He said issues that have consensus among policy communities weremore likely to get political support. “Therefore, the health sector can provide strategic leadership and build stronger links with institutes like GNHC, National Statistics Bureau and Centre for Bhutan Studies and GNH Research, to mobilise consensus-building in addressing the NCDs.”

The second is advocating and promoting the shared agenda and determinants. This would strengthen health sector’s engagement with GHNC, the GNH multi-sectoral committee and the GNH policy formulation process.

He said that identifying, monitoring and strengthening the shared determinants would ensure the integration of the NCDs into policies across relevant sectors.

The third opportunity is integrating NCDs into policies across sectors. “The opportunity to address NCDs as a whole-of-government approach is embedded in the protocol for GNH policy formulation and the GNH policy screening tool,” it states.

The study suggests other ministries can also identify a shared agenda with GNH to bring their policy priorities into an existing policy development mechanism that support ‘win-win’ outcomes.

Dechen Tshomo