The health ministry has proposed that 53 percent of the finance and materials to address non-communicable diseases (NCDs) would be at the district level in the 12th Plan.

During the inaugural session of the third international conference on medical and health sciences at the Royal University of Bhutan’s convention hall in Thimphu yesterday, chief guest Economic Affairs Minister Lekey Dorji, said this would mean more power for local decision-making.

According to the World Bank’s NCD policy brief, Bhutan is in the early stage of demographic transition. It is estimated that by 2025, the proportion of ageing population (65 years and above) will increase from 4.4 to 7.3 percent.

Lyonpo Lekey Dorji said that prevalence of NCDs would also rise. About 62 percent of disease burden is attributed to NCDs, including injuries and 38 percent to communicable diseases, maternal, and child health and nutrition.

He said that with increasing NCDs in Bhutan, healthcare cost is escalating rapidly and that with increasing number of patients being referred abroad, a major challenge in the coming years would be to sustain free basic healthcare system.

In order to meet sustainable development goal target three (Good health and well-being), Lyonpo said it was important to integrate early detection, screening and treatment of NCDs at the primary care level by developing surveillance systems and building capacity of health professionals. “This should also include palliative care.”

NCDs prevention and control is central to Bhutan’s plans for a sustainable future.

“This is in line with the 2030 agenda for sustainable development, aimed at eradicating poverty, promoting peace, and leaving no one behind,” Lyonpo said. “The agenda also targets a one-third reduction in premature deaths from NCDs by 2030.”

The president of Khesar Gyalpo University of Medical Sciences of Bhutan (KGUMBS), Dr Kinzang P Tshering, said that this year’s conference theme, ‘Lifestyle-related diseases: opportunities and challenges,’ was chosen considering rising epidemics of non-communicable diseases, globally and nationally.

Dr Kinzang P Tshering said the conference provided an opportunity to health professionals to update on different fields of medicine and also to get credits for the continuing medical education, which is a prerequisite for renewing their licenses to practice.

“We are hopeful that the conference will provide an opportunity to discuss the various aspects of lifestyle-related diseases, challenges and opportunities and stimulate young minds to carry out researches and outcome with some good solutions to tackle NCDs,” he said.

Director of Department of Public Health, Dr Karma Lhazeen, said with rapid socioeconomic and demographic transition, more Bhutanese were exposed to NCD risk factors.

According to the STEPs survey, 2014, more than two-thirds of adults do not consume enough fruits and vegetables and average intake of salt among the population was twice the amount recommended by the WHO.

It also revealed that half of the population did not engage in a vigorous physical activity, while 39 percent of the population was overweight or obese, and 36 percent had raised blood pressure. One in three people with high blood pressure did not receive treatment.

Dr Karma Lhazeen said that once thought of as diseases of the rich, NCDs are now the leading cause of death in low-and-middle-income countries.

About 30 percent of NCD-related deaths in low-income countries occur under the age of 60, as compared to 13 percent in high-income countries.

She said that without targeted and sustained interventions, these health inequalities are likely to widen, causing even greater individual, social and economic consequences. “NCDs are aggravated in urban areas by changes in diet and physical inactivity, exposure to air pollutants that include tobacco smoke and harmful use of alcohol.”

Negative effects of globalisation, rapid and unplanned urbanisation, increasingly sedentary lives, and marketing of foods high in salt, fat and sugar are some of the factors that accelerate the growing burden of NCDs in developing countries.

Dr Karma Lhazeen said that although morbidity and mortality from NCDs mainly occur in adulthood, exposure to risk factors begins in early life. “Children can die from treatable NCD’s such as rheumatic heart diseases, type one diabetes, and leukaemia if health promotion, disease prevention and comprehensive care are not provided.”

She said challenges related to NCDs are that many determinants of behavioural risk factors are outside the health domain and have strong root social causes, such as poverty and illiteracy.

Policy action and structural interventions are needed to address these root social causes so that the exposure and vulnerability of disadvantaged groups and inequitable outcomes are reduced, she added.

“The cost of inaction far outweighs the cost of taking action on NCDs. There are interventions for prevention and control of NCDs that are affordable and give a good return on investments,” she said.

The second issue of the Bhutan Health Journal and the conference abstract was also released at the event.

Mother and child health, healthcare system, clinical management and public health are some of the issues that will be covered during the two-day conference.

To encourage participation and to recognise their hard work, prizes for the two best oral and poster presentations each will be awarded on the last day of the conference on November 5.

Dechen Tshomo