A five-year multi sectorial action plan will address the major risk factors of non-communicable diseases in the country 

Plan: Accounting for 53 percent of all deaths in the country, non-communicable diseases (NCDs) have today surpassed the burden of infectious illnesses to become Bhutan’s biggest health challenge.

Among the deaths caused due to NCDs, records with the health ministry show that cardiovascular diseases make a majority of cases at 28 percent, cancer at nine percent, respiratory diseases at six percent and diabetes at two percent.

To address the growing threats of NCDs, which has been evolving as a public health concern since 2009, Bhutan released a five-year multi sectorial action plan yesterday in Thimphu.

The action plan focuses on four types of NCDs- cardiovascular diseases, cancer, chronic respiratory diseases and diabetes while bringing attention to risk factors such as tobacco use, unhealthy diet, physical inactivity, harmful use of alcohol and indoor air pollution.

“We admit there is work to do,” health secretary Dr Dorji Wangchuk said. “Among our people, physical inactivity is still high, alcohol abuse is a huge concern and consumption of salt at 9 grams is much higher than WHO recommended 3-5 gram per day per head.”

Health officials point out that the numbers of referral cases and costs, mostly for advanced NCDs, have almost doubled from 529 patients with a referral cost of Nu 81 million in 2006-2007 to 1,047 patients in 2012-2013, which cost Nu 180 million.

One of the 10 targets set in the action plan is to reduce harmful use of alcohol by five percent by 2020, a percent each year, and by 10 percent by 2025.  The targets are in line with the WHO South East Asia Regional NCD Action Plan that is to be met by 2025.

“The per capita consumption of alcohol is eight liters as compared to the global consumption of 6.2 percent of pure alcohol per person 15 years and older,” the action plan states.

The economic affairs ministry is the lead agency in implementing the activity to review and introduce increase steps in alcohol taxation, among others.

Relative reduction in prevalence of current tobacco use in persons over 15 years, by 15 percent in the next five years is another target the action plan has set.  By 2025, it plans to double the rate to 30 percent.

A Global Youth Tobacco Survey, 2013 found that Bhutan has the highest prevalence of tobacco users among students, both at the regional and global level.

Among others, the Bhutan Narcotics Control Agency with police and customs is to increase border control and in country spot-checks, review and amend the existing tobacco control Act and related regulations to include chewed tobacco and doma, and to develop tobacco cessation guidelines and services together with the health ministry.

The action plan targets a five percent reduction in prevalence of insufficient physical activity among urban population by 2020 and 10 percent by 2025. The national health survey, 2012, found about 26 percent of the population aged 10-75 years indulge in sports/fitness or recreational activities on an average of three days a week.

Besides plans to set up more parks and biking lanes in thromdes, health officials said work is already underway to install an outdoor gym each in the thromdes of Phuentsholing, Gelephu and Samdrupjongkhar to be opened for use on November 11.

“We are planning to have one outdoor gym set in every dzongkhag headquarters,” Dr Dorji Wangchuk said. “We see that however robust these equipment are, people are not using it the way it’s intended for and we request the local government to take full ownership of these equipment.”

Coinciding with the action plan, the WHO representative to Bhutan Dr Ornella Lincetto and Dr Dorji Wangchuk also opened the WHO supported outdoor gyms in Thimphu. The gym equipment installed in eight areas in the capital is worth about USD 90,000, said health officials.

Dr Ornella Lincetto said NCDs constitute one of the major public health challenges globally and according to WHO estimates, 80 percent of global burden falls on developing countries where economic growth and modernization has opened many doors for the spread of unhealthy lifestyles.

“To my knowledge, Bhutan is the first country in the region to make open air gym facilities available as an initiative of the health ministry in collaboration with other sectors and WHO and also the first country to have already finalized their national NCD action plan,” Dr Ornella Lincetto said. “I am optimistic that this action plan will provide the much-needed roadmap to take a coordinated and coherent actions to attain national and international NCD target.”

During the event, the WHO country representative also handed over a volume of Kanjur, Sung bums and texts on Sowa Rigpa to the Faculty of Traditional Medicine.

A major risk factor that has concerned health officials is the unhealthy diet among the Bhutanese, which comprise low consumption of fruits and vegetables, high intake of salt and high consumption of saturated and trans fats. At least 67 percent of Bhutanese do not consume sufficient fruits and vegetables.

The action plan targets reduction in mean population intake of salt by 15 percent in the net five years.

One of the core authors of the action plan from the health ministry’ NCD division’s Dr Gampo Dorji said that while diabetes and cancer had always been a part of the health care, the momentum towards addressing it began in 2009.

“Bhutan became more aggressive in addressing NCDs after a global commitment was made to achieve the targets by 2025 and this action plan will be looking at achieving the global targets,” he said.

With a national steering committee chaired by the health minister already formed, the way forward, Dr Gampo Dorji said, “is to sign a memorandum of understanding with the key stakeholders to implement the activities they have agreed to do.”

Sonam Pelden