Joint UN Mission supports Bhutan efforts to prevent and control noncommunicable diseases

Feb 17, 2017

Joint UN Mission meets Tshering Tobgay, Prime Minster of Bhutan. Photo: PM/Bhutan Office

Thimphu – Reducing harmful alcohol use, and improving diet and nutrition in Bhutan were among key areas focused on by the first joint mission to the country by the United Nations Interagency Task Force on the Prevention and Control of Noncommunicable diseases (NCDs).

The task force visited Bhutan from 6-10 February to support the government in tackling NCDs - principally cardiovascular diseases, diabetes, cancers, and chronic respiratory diseases and NCD-related conditions.

Noncommunicable diseases a growing concern

In Bhutan, NCDs cause more than half of all deaths, and the probability of dying prematurely from NCDs is 21%. Also more than a quarter of the adult population has hypertension.

“Non-communicable diseases is a growing concern in Bhutan;” said the country’s prime minister, Tshering Tobgay. “As we live longer and enjoy greater prosperity, we are also succumbing to lifestyle diseases.”

While Bhutan is a development success story with decreasing poverty and improvement in human development, the forces of globalization and urbanization are causing an increase in NCDs in Bhutan.

UN Joint Mission meeting with UN Country Team. Photo: WHO.


United Nations Interagency Task Force joint mission

Bhutan is the third country in WHO’s South-East Asia Region to host such a mission, which included representatives from the United Nations Development Programme (UNDP), United Nations Population Fund (UNFPA), United Nations Children's Fund (UNICEF), World Food Programme (WFP), the World Bank and the World Health Organization (WHO), which led the initiative.

During the visit, the Joint Mission met with Bhutan’s Prime Minister, government ministers, parliamentarians and high-level officials from central and local government. Meetings with non-governmental and civil society organisations, academicians and the Bhutan Chamber of Commerce also took place.

The Mission was particular concerned about the use of tobacco, especially among adolescents. Despite a ban on the sale of tobacco, statistics suggest that around one third of men use tobacco in smoked and smokeless forms, while 60% of the adult population chews doma (areca nut, beetle leaves, and lime), the practice associated with increased risk of cancer.

More than two-thirds of adults do not consume enough fruits and vegetables, and the average intake of salt is around twice the amount recommended by WHO. Obesity is also becoming an increasing issue for the country, while one in five children are stunted.

Behavioural change needed

But all this is set to change. During the last five years, rates of childhood stunting have shown a sharp decrease and the government has developed a comprehensive set of strategies and plans to tackle NCDs. The mission reviewed these with government and other partners in order to agree on a small set of priorities that would be most cost effective in reducing NCDs and which could be taken forward over the next 12 months.

“Like in many countries, people in Bhutan are increasingly consuming pre-packaged foods and beverages which are high in fats, sugars and salt and these foods and beverages have now started to be sold at some schools as well,” says Dr Chizuru Nishida, Coordinator for Nutrition Policy and Scientific Advice unit from WHO Headquarters in Geneva who participated in the mission.

She adds: “Providing information to facilitate people’s behavioural change is important. But such behavioural change cannot be achieved if the food environment is not conducive for people to implement healthy dietary practices, in particular in schools.”

In 2016, the Bhutanese government spent approximately USD 2.8 million referring almost 1300 people for medical treatment to India, mostly to treat cancers, and kidney and heart disease, Mr Tobgay said. “This underscores the urgency to take preventive measures,” he adds.

rbap-hhd-2017-bhutan-4UN Joint Mission meets with Members of Parliament of Bhutan. Photo: UNDP.


A five-year NCD action plan to promote healthy lifestyles

Bhutan’s government has approved a five-year NCD action plan to promote healthy lifestyles and reduce preventable illnesses in the country. ”I seek the support of all fellow-citizens to fight the growing scourge of noncommunicable diseases,” Tobgay adds.

The UN Mission held detailed discussions with several government ministries, including the Gross National Happiness Commission, on how NCDs are reflected in the upcoming National Five Year Plan. The Mission also had in depth meetings with the UN agencies in Bhutan to identify how its new SDG Plan will support government development and NCDs strategies. Attention was also given to how the UN Country Team can help catalyse government action during the remaining lifetime of the current UN Development Assistance Framework, which ends 2018.

To respond to the challenges of the harmful use of alcohol, Bhutan has developed a comprehensive national alcohol policy framework, highlighting the need to implement regulatory measures to respond to the threat. Also active is a strong grassroots community network aiming to tackle harmful alcohol use.

“The harmful use of alcohol is considered an important risk factor for NCDs, which also contributes significantly to premature mortality due to liver cirrhosis as well as family problems and traffic injuries,” says Dr Vladimir Poznyak, Coordinator for the Management of Substance Abuse Team from WHO Headquarters in Geneva who was also part of the mission in Bhutan. “Due to rapid social changes more attention should be paid to the regulation of commercial alcohol that will gradually replace traditional alcohol beverages in the country, particularly among young people.”

UN Joint Mission meets with Gross National Happiness Commission. Photo: UNDP.


Strong UN-system support

The Mission demonstrated that strong UN-system wide support exists to support action on NCDs in Bhutan and around the world. Mr Piet Vochten, UN Resident Coordinator a.i. and WFP Resident Representative in Bhutan, outlined the central role of UN system as a whole in supporting Bhutan tackle NCDs.

“We are now seeing how NCDs impact the wellbeing of Bhutan at both individual and community levels, and furthermore is also now a significant drag on the national economy. Combined, NCDs are a real challenges to Bhutan’s sustainable development,” he says.

The health sector alone cannot address issues such as pricing, regulation and enforcement of products that are harmful to people’s health, Mr Vochten says, concluding that all parts of Government must work together to tackle the root causes of NCDs. “Although we are a small team with limited resources, the UN team in Bhutan is committed to step up its action to support Government action against NCDs,” he adds.

A report with a set of recommendations for action in Bhutan is currently being finalized by Dr Nick Banatvala, the team leader, and the rest of the Joint Mission, in close collaboration with the Government and the UN team on the ground, to ensure that Bhutan is well placed to report at the Third High-level Meeting on NCDs in 2018 and continue its progress in meeting the NCD-related Sustainable Development Goals.


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