Health: With one death in every two days, alcohol liver disease (ALD) continues to be the top killer disease in the country.

From 1,217 ALD cases in 2005, health centres across the country recorded 3,140 cases in 2014.

Records indicate a steady increase in both ALD cases and deaths since 2005.

In 2005, about 92 deaths were recorded which increased to 176 in 2014. Since 2005, the highest deaths from ALD were recorded in 2011 and 2014 with 169 and 176 deaths respectively.

The Cabinet on December 2 endorsed the National Policy and Strategic Framework To Reduce Harmful Use of Alcohol (2015-2020), four years after work to frame one began in June 2011.

Health officials are optimistic that the comprehensive policy would help reduce alcohol availability, accessibility and affordability.

The policy states that the per capita adult pure alcohol consumption among Bhutanese above 15 years is 8.47 litres higher than the global consumption of 6.2 liters. Drinking among the Bhutanese was not only pervasive but that those who drink consumed alcohol in a hazardous manner.

Although a proper economic analysis of the alcoholic disease and injury burden has not been conducted so far, the cost may be hundreds of millions of ngultrum, the policy states.

The annual hospital treatment cost of alcoholism alone, which represents a fraction of the total burden, was estimated at Nu 29 to 30 million from 2005 to 2009. The policy also states that alcohol consumption and poverty is a reinforcing loop.

Citing the examples of the communities of Lhuentse and Mongar, it states that staple grains are used for producing home-brewed alcohol and problems are compounded by the poor spending their meager cash income on commercially produced alcohol which is becoming popular in the rural areas.

While revenue from the sale of alcohol is substantial, the policy states that alcohol revenues do not compensate for the economic losses incurred as a result of alcohol-related harm, loss of productivity, and premature deaths occurring in our society.

Health ministry’s public health director Dr Pandup Tshering said that the strategies to reduce harmful use of alcohol would focus more on the youth.

While alcoholics will continue to receive treatment from health centres through the existing programmes, Dr Pandup Tshering said that advocacy would be continued to reduce harmful use of alcohol among the population.

“The cost implication on health from ALD is huge,” Dr Pandup Tshering said.

Alcoholic-linked problems

The policy states that the two common sources of alcohol products in Bhutan are homebrewed and industrial distilled alcohol. Among rural people, ara is widely consumed while industrial alcohol is quickly penetrating the rural areas as a consequence of the alcohol industry’s effective marketing and distribution system. While in urban areas, industrial alcohol is the main source, the policy also highlights that alcohol is cheap in Bhutan compared to neighboring countries.

“Over the years domestic production of alcohol has increased along with the alcohol outlets such as wholesale, retail and bars,” the policy states.

There are 5,407 alcohol outlets in the country today or one outlet per 98 Bhutanese (aged 15 and above). “As unlicensed outlets are believed to be ubiquitous in the country, the population per outlet is considerably higher with illegal outlets included in the numerator.”

Thimphu referral hospital has recorded a fourfold increase in admissions for alcohol dependence.

About seven percent of the road accidents in the country are attributed to drink-driving while police records and Thimphu referral hospital’s forensic unit reported an increase of domestic violence cases related to alcohol. However, the police recorded a drop in alcohol related crime in the country by about five percent from 2012 to 2014.

Alcohol is also reported as a contributory factor to homicides in the country. Police report indicates an increasing trend in crime committed by adolescents, mostly under the influence of alcohol in urban areas.

RENEW reports also indicate that 70 percent of perpetrators of domestic violence were committed under the influence of alcohol. Alcoholism, adultery, and domestic violence are also noted as the main reasons for the increasing trend of matrimonial court cases. “A 2014 assessment of a five-year suicide rates from 2009-2013 revealed its association to alcohol use,” states the policy.

The policy also linked alcohol use to teenage pregnancy given the negative effect on negotiation skills and use of contraception. Teenage pregnancy, which is more prevalent among rural women, accounts for 11 percent of all births in Bhutan. About 58 percent of high school students aged 15-20 were sexually active in 2000.

“Alcohol can also aggravate HIV/AIDS epidemic by its negative influence on ability to have safe sex,” states the policy. “The continuing spread of HIV/AIDS can present a serious obstacle to Bhutan’s development as more than 60 percent of the country’s population is less than 25 years of age.”

Kinga Dema