Health: Despite significant progress in reduction and control of pesticide use in agriculture, contaminated imported vegetables could be a threat in view of the increasing cancer cases in the country.

Experts and health officials at a high-level advocacy meeting on carcinogenic chemicals and human health held in Thimphu last week expressed concerns over imported vegetables while also discussing priority carcinogenic chemicals.

Cancer situation

The Bhutan Cancer Report 2015 states that cancer is an important cause of morbidity and mortality in Bhutan. From 211 (all types of cancer) cases in 2008, it increased to 639 in 2014. Among them, stomach, cervical and colo-rectum cancers topped the list followed by the rest.

The annual increase of cancer cases was 86/100,000 population in 2014 from 31/100,000 in 2008.

Although the report doesn’t link cancer cases to consumption of imported vegetables, it states that of the many factors, certain occupations have higher risks for specific types of cancer given the exposure to chemicals and condition of work that poses a risk. The report also expresses the possible link between industrial exposure and air pollution given the increasing number of vehicles in the country and increasing cancer incidences.

According to the World Health Organisation (WHO), cancer is a leading cause of death worldwide accounting for 7.6 million deaths, which is about 13 percent of all deaths in 2008. Seventy percent of all cancer deaths in 2008 occurred in low and middle-income countries.

WHO carried out a global comparative risk assessment of the burden of disease attributable to selected occupational carcinogens in 2004. The results showed that globally at least 241,000 deaths and 1,980,000 disability adjusted life years were attributable to lung cancer, leukemia and mesothelioma, which are strongly associated with exposure to carcinogenic chemicals.

The Annual Health Bulletin 2016 also reported a high number of cases related to occupational and environmental exposures and poisoning from chemicals, and plant and animal toxins treated at health facilities in Bhutan from 2011 to 2015.

This high morbidity indicates a need for greater attention to be given to the sound management of chemicals, states the national profile on chemical management 2016. The profile also focuses on sound management of chemicals, which is essential to achieve a sustainable level of agricultural and industrial development and a high-level of human health and environmental protection.

Health secretary Dr Ugen Dophu said that cancer is caused by many factors such as radiation, infection be it viral, bacterial or parasitic and through chemicals as well.

Dr Ugen Dophu said that people should be cautious of consuming imported vegetables. “At present only three types of vegetables were found contaminated with chemicals so we can assume that other vegetables could be contaminated as well.”

Dr Ugen Dophu said that the imported vegetables could be contaminated with different chemicals. “When we consume these vegetables for a long time, chemicals accumulate in our body and cause diseases especially cancer,” he said.

Imported vegetables 

As an import driven country, Bhutan is highly dependent on imported vegetables especially during winters. Considering the price difference, consumers prefer imported vegetables that are much cheaper.

The agriculture ministry banned the import of chillies, beans and cauliflowers early this year after high levels of pesticide residues were detected in them. However, many people especially those living in the border towns continue to consume these vegetables given its availability in the adjoining Indian border towns not bothered by implications on human health.

The Indian media has reported that indiscriminate and unregulated use of pesticides was poisoning land, water, air and food in India. India spreads out about 90,000 tonnes of pesticides on its fields making it one of the largest users in the world. It has also been reported that farmers use pesticides carelessly. While some use the wrong chemical, others overuse and many harvest immediately after spraying, which is why dangerous levels of pesticide are found in the vegetables. Harmful fungicides are also used to ripen fruits so that it could be rushed to the market.

According to health officials, pesticide residues in vegetables, fruits, pulses, grains and water can cause numerous health complications like cancer, genetic defects and impotency.

Health secretary Dr Ugen Dophu said until there is enough capacity to measure chemicals in the food and water that Bhutanese consume, measures such as not buying flawless vegetables, washing hands after handling the vegetables and washing the vegetables thoroughly under running water before storing them can be taken. “The vegetables should be washed again before cooking and also cooked properly as some chemicals tend to alter from heat,” he said.


While there is no specific legislation to deal with carcinogens, Bhutan is signatory to several international conventions and instruments. Some of the challenges in the current system are lack of awareness, poor monitoring and enforcement, capacity and infrastructure to detect and deal with the ill effects of carcinogens.

Agriculture minister Yeshey Dorji said that the ministry might ban more imported vegetables if a high amount of chemicals are found in them after constant testing. “But we will also look for options to import vegetables that are safe for consumption,” Lyonpo said.

Lyonpo Yeshey Dorji urged people especially those living in the border towns to be responsible and avoid consumption of the banned vegetables. “Given the limited manpower, we can’t frisk every individual,” Lyonpo said. “The vegetables were banned, as they were not fit for consumption.”

Lyonpo said vegetables grown within the country would enter the market from February for which the ministry is developing a strategy that would also look at the pricing, among others.

Other measures are to increase in-country production and subsidies, farm mechanisation to enable large-scale farming, marketing strategies and establishment of cooperatives. “We also encourage people to have their own kitchen gardens,” Lyonpo said. “We are trying hard to substitute import by next year especially chillies and beans.”

WHO’s technical officer for occupational and environmental health Dr Lobzang Dorji, at the sideline of the high-level advocacy meeting, said there were many priorities for a small country like Bhutan. “It’s important for the government and policy makers to come out with proper measures in dealing with carcinogens,” he said.

When it comes to vegetable imports, Dr Lobzang Dorji said we must work together at the country level. “If possible, avoid use and if not, substitute,” he said.

However, to link increasing cancer cases to imported vegetables, he said a proper study should be conducted. “Bhutan may not be at a higher risk like other countries but we could still be at risk considering the size of the country,” Dr Lobzang Dorji said.

Kinga Dema