Looking beyond policy actions

Burden of non-communicable diseases (NCDs) on health facilities is growing in Bhutan. According to health officials, deaths from NCDs increased to 69 percent in 2018 from 53 percent in 2011.

Even as the national NCD action plan identified strategic action areas and implementation mechanisms, there has been lack of sustainable policy approach to integrate the action plan into policies across all sectors.

Although NCDs have been growing at an alarming rate, all’s not lost. We have the opportunity still to intervene with approaches that will lend themselves to tackling the problem effectively. Fighting NCDs should be made a top public health priority because deaths due to NCDs are preventable.

We are in the early stages of demographic transition. World Bank’s Bhutan NCD policy brief estimates that by 2025, Bhutan’s proportion of ageing population (65 years and above) is expected to increase from 4.4 to 7.3 percent. What this means is that prevalence of NCDs will also increase, putting pressure on the country’s healthcare cost and system significantly. Referral cases and costs, mostly for advanced NCDs, have been doubling over the years. As economic growth and modernisation continue to open doors for unhealthy lifestyles, sustaining free basic healthcare system will be a major challenge in the near future.

Because the cost of inaction far outweighs the cost of taking action on NCDs, our policy actions and structural interventions have to be aligned with specific targets to reduce NCD cases. Strengthening NCD surveillance for actionable evidence, advocating the information to policy makers, and promoting the shared agenda and determinants are seen as not only viable but also effective ways of addressing the problem of growing cases of NCDs in the country. Critically important, however, is an integrated effort which seems to be lacking today.

Recognising the enormity of the challenges facing us today, the health ministry proposed that more than 50 percent of the finance and materials to address NCDs would be at the district level in the 12th Plan. We already have action plan and targets to reduce incidences of NCDs. For example, we have a target to reduce harmful use of alcohol by five percent by 2020, a percent each year, and by 10 percent by 2025.

Our effort to reduce NCD cases, however, should focus beyond policy action and targets. How well we advocate change in the way our people live and what they eat will make a significant difference. Physical inactivity is very high among our population. Unhealthy diet like low consumption of fruits and vegetables, high intake of salt, and high consumption of saturated and trans fats are the major contributors that give rise to NCDs.

There is, so, an urgent need to adopt lifestyle change to reduce exposure to risk factors that contribute to NCDs. What we can ill afford is to not take actions now.

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