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Buckling under the burden of NCDs

Non-communicable diseases (NCDs) are estimated to account for 69 percent of all deaths in Bhutan making it the leading cause of all preventable deaths, according to WHO NCD country profile, 2018.

This was shared at a high-level advocacy for parliamentarians and key stakeholders for accelerating prevention and control of NCDs in Bhutan in Thimphu yesterday.

The event, organised by WHO and the health ministry was held to appraise the members on the political, policy and programmatic opportunities and challenges in securing the health of the nation through NCD prevention and control response and dwell on the theme “time to deliver.”

Deaths from NCDs in the country increased to 69 percent in 2018 from 53 percent in 2011. Among them, 53 percent died before 70 years.

Cardiovascular diseases were the major cause of death in the country at 28 percent, followed by cancer and chronic respiratory disease at 10 and nine percent . Diabetes accounts for four percent of the deaths in the country.

Morbidity trend of NCD in the country has seen an upward trend from 2008 to 2012.

Deputy chief programme officer with the ministry’s lifestyle related disease programme, Pemba Yangchen, said that to address the rising trend, the health ministry has introduced the package of essential NCDs (PEN), a disease algorithm that helps in preventing and detecting NCDs at earlier.

The PEN was piloted in Paro and Bumthang. In 2012, it went nationwide.

“In order to see the compliance of PEN, the PEN clinical Audit was carried out in 2016,” Pemba Yangchen said.

The findings showed that there was a reduction is cardiovascular risk. The findings also revealed that there was a decline in the proportion of people with hypertension by 21 percent and diabetes by 17 percent.

Recognising that NCDs risk factors lie beyond the health sector, Pemba Yangchen said that a multi-sectoral national action plan (2015 -2020) was endorsed by the 80thLhengye Zhungtshog in July 2015.

“The action plan endorses the principles and recommendations that are outlined in the South-East Asia Regional document. Besides it also endorses the ten voluntarily targets that are to be achieved by 2020 and 2025,” she said. “Bhutan is on track. We have achieved almost all targets and almost all indicators are on track.”

This would be verified in a survey that would be carried out next year.

To provide thrust to the national action plan, a National Steering Committee of 12-member team chaired by the health minister was instituted, she said.

Low harmonisation with sectoral plans, budget, and no active engagement of local governments and inadequate ownership to NCD response were some of the challenges faced in the last three years.

Increasing fiscal space for integrating NCD prevention and control in sectoral budget through annual work plans, empowering LG on public health and social issues, making unhealthy products less affordable and available, and creating an enabling environment for comprehensive healthy lifestyles in schools, institutions, and workplaces and urban setting are some of the way forward.

Director of public health department, Dr Karma Lhazeen, said that over the years behaviour and lifestyle of the population have gradually changed. “Our population are less active now than ever before. Age old poor dietary or feeding practices have not changed much but to add to that we have access to unhealthy junk food that is available at affordable price in every shop.”

She pointed out that items grown in the country like fruits, vegetables and cereals are available but unaffordable to many. “It is time to address irresponsible marketing and trade as well as regulate the import of food items that are harmful to the health of the populations.”

Dr Karma Lhazeen said NCDs are fundamentally a development and socio-economic issue, striking both rich and poor people but inflicting more ill-health and other consequences on the poor in all countries. “Without targeted and sustained interventions, these health inequities are likely to widen, causing an even greater individual, social and economic consequences.”

“It is time to deliver on the political commitments and also request our members here in taking forward the agenda of responding to the world’s biggest killer,” she said.

The chief guest, Speaker Wangchuk Namgyel, said that the burden of NCDs consumes a huge proportion of the national health budget. “If prevention efforts are not strengthened, our constitutional mandate of free public health care will be hugely compromised.”

Deputy chairperson of the national council’s social and cultural affairs and eminent member Kesang Chuki Dorjee, said every life is precious and people dying young from heart attacks and strokes is a preventable tragedy. “There is no excuse for any inaction since no preventable death is acceptable.”

The government and the society, she said must work together to achieve a healthy lifestyle. “Given the critical challenge the NCD poses to the nation and society, we need to engage political leaders at forums like this so that they will make well-informed decisions during parliamentary discussions as well as educate their constitutes back at home.”

Acknowledging the importance of adequate budget to achieve visible outcomes, she said Bhutan is grateful for the support of international donors to accelerate the NCD response in the country thus far. “But, in order to sustain the effort of combating NCDs, the government will need to prioritise and allocate funds accordingly since this is an urgent national priority.”

The eminent member said that the council is reviewing the harmful effects of alcohol. “We have strengthened the legislation wherever necessary to promote healthy living,” she said. “We will continue to support the promotion and protection of public health.”

Dechen Tshomo

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