Non-Communicable Diseases 15 December, 2009 - More than half the urban Bhutanese population is overweight and about 12 percent obese, according to a health ministry survey report on the risks and prevalence of non-communicable diseases (NCD).

It is the first survey ever done after Bhutan started seeing a rise in NCDs or lifestyle-related diseases in the mid 90s. The survey of 2,484 Thimphu residents, between 25-74 years, found that females are more inactive than men and that half the population is getting, on an average, only 17 minutes of physical activity a day.

The survey, which was carried out in 2007 and launched yesterday in Thimphu, along with the national policy and strategic framework on the prevention of NCDs, was done to assess the exposure of Bhutanese population to risk factors such as tobacco, alcohol, physical inactivity and diet.

It was found that 93.1 percent of the total 204,255 urban population are exposed to at least one of the risk factors, 56.5 percent to two risk factors and 38.4 percent exposed to 3-5 risk factors.

Although the overall prevalence of smokers was low, it was found that 82.2 percent of urbanites smoked daily, the average age to start smoking was 20.9 years and that, overall, about 20 percent of the Bhutanese population is exposed to health risks through tobacco use.

According to the report, about 66.6 percent of the urbanites consumed less vegetables and even lesser fruits. An urban adult Bhutanese consumed 1.6 litres of vegetable oil in a month and 55.5 percent of them consumed suja at least once a week.

“When we’re talking about NCDs, we’re talking about a group of diseases, which has the potential to bankrupt the health finances if we don’t take preventive steps,” said the medical specialist and NCD advisor at the Thimphu referral hospital, Dr Tashi Wangdi. “If risk factors are eliminated, 80 percent of heart diseases, stroke and type 2 diabetes and 40 percent of cancer diseases can be prevented.”

Using a “mantra” of 3-Four-50, Dr Tashi Wangdi said that there are three risk factors that are responsible for four chronic diseases - cardio vascular diseases, respiratory diseases, cancers and diabetes, which contribute to more than 50 percent of the disease burden. “If you remember this, you’d know what to do, and where what needs to be tackled.”

While men were heavier drinkers than women, at 34.9 percent as compared to women at 25.5 percent, it was found that almost one third (30.8 percent) of Thimphu’s adult population were regular drinkers, and about 10 percent of them are into binge drinking.

The study also found that nine percent of the urban adults in Thimphu were taking treatment for hypertension, 22.1 percent had raised blood pressure and 2.5 percent were diabetic.

Although the survey is Thimphu centric, health officials said that it’s representative of the country’s urban population but not the rural populace. Thimphu was chosen as the survey site as it has the largest urban population and consists of individuals from across the country.

To prevent and control NCDs in Bhutan, the study strongly recommends to invest in preventing NCDs with intensive health promotions and to minimise exposure of population risks. “Bhutan must pay attention to implement evidence-based public health interventions urgently,” recommends the report.

It also recommends framing policies to create walkability like pedestrian paths, sidewalks and sporting facilities that would encourage people to promote physical activity, improve food security and access to healthy diet and intensify safer use of alcohol and tobacco cessation in communities.

“It goes beyond the health’s ministry’s responsibility if the roadsides are still dirty and there are no facilities for people to walk,” said the head of the NCD division, Dr Gampo Dorji. “Therefore a multi-sectoral strategy is important because, if we have very less enforcing mechanisms, it fails. Issues, such as the demand and supply of alcohol and tobacco and enforcement of certain policies, have to be taken care of.”

Hospital records show that NCDs account for more than 50 percent of inpatient deaths. From 25,835 cases in 2003, NCD cases rose to 35,875 in 2007 in Bhutan.

The WHO projects that by 2015, there will be 21 percent increase in deaths from NCDs, while communicable diseases will decrease by 16 percent in South East Asia.