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Common Diseases in BhutanIn recent years Bhutan, a small, predominately mountainous country landlocked between China and India, has noticed an epidemiological shift in the disease pattern. The incidence of communicable diseases has significantly decreased, and the Bhutanese now suffer from high rates of noncommunicable diseases (NCD).

In 2008, Bhutan’s age-standardized rates for NCDs per 100,000 population were the highest among males and females in the South East Asia Region (SEAR). Currently, NCDs are the leading cause of morbidity in Bhutan, accounting for 62 percent of the country’s disease burden.

Below is a list of the top four most common diseases in Bhutan:

1. Diabetes

Diabetes are a set of chronic diseases resulting from elevated blood glucose. In Bhutan, there was a 63 percent increase in diabetes from 944 cases in 2004 to 2,605 cases in 2009.

A healthy diet and body weight, exercise and avoiding tobacco use are all preventative measures for type 2 diabetes, which results from the body’s ineffective use or production of insulin. In Bhutan, survey data indicated that one in three Bhutanese are overweight, 42.4 percent consume alcohol and the average daily salt consumption is nearly two times the World Health Organization’s (WHO) recommended limit.

2. Cardiovascular Diseases (CVD)

The same preventative measures are suggested for maintaining heart health. In 2008, mortality due to CVDs in SEAR was the highest in Bhutan, accounting for 53 percent of Bhutanese deaths.

3. Chronic Respiratory Diseases

Chronic respiratory diseases are diseases of the lung that narrow air passages and obstruct breathing. Common chronic respiratory diseases include chronic obstructive pulmonary disease (COPD), asthma and occupational lung disease.

Tobacco use increases risk for chronic respiratory diseases. Even with the ban on the sale of tobacco in Bhutan, tobacco use is widespread, as 34 percent of men and 14 percent of women reported using tobacco in 2011.

4. Cancers

In 2008, the age-standardized death rate due to cancers in Bhutan was 124.8 per 100,000 population. Of all cancers, lung and cervical cancers have the highest incidences among Bhutanese men and women, respectively.

So far, the government has initiated health-related behavioral interventions addressing the social determinants of NCDs; these include bans on tobacco sales and advertisements, laws prohibiting smoking in public and the establishment of outdoor gyms in every district.

“The government’s response to NCDs has been very encouraging,” says WHO’s Tshering Dhendup, “There is high-level political commitment.”

Included in the country’s upcoming five-year socioeconomic plan (2018–2023) is a multi-sectoral framework for the prevention and reduction of common diseases in Bhutan. This much-needed plan is expected to result in widely shared improvements in health status for the Bhutanese population.

Gabrielle Doran

Why Is Bhutan Poor
Why is Bhutan poor? The landlocked country, located in the eastern region of the Himalayan Mountains, is one of rich culture and strong national pride. Despite the lack of infrastructure and small economy, Bhutan is considered to be the happiest country in Asia. It is also one of the poorest, with a striking poverty rate of 12%. Factors such as rugged landscape, lack of education and intangible government goals all contribute to answering this question: Why is Bhutan poor?

Difficult Landscape

Due to its location in the Himalayas, Bhutan’s terrain is extremely hilly and rugged. It also has no contact with any body of water. This makes movement throughout and beyond the country extremely difficult. The lack of mobility further impacts the ability of the Bhutanese government to make health care and education readily available throughout the country.

Lack of Education

Most children have to walk two to three hours to find a primary school. Consequently, 47% of the population above the age of six is uneducated. Without an education, finding a job becomes extremely difficult. Most jobs require specialized skills, so the impoverished Bhutanese population is often limited to either subsistence farming, trading or laboring.

Farmers, especially in rural regions, are severely limited in capital and resources and often work for the bare necessities. Given that 96% of the poor live in rural areas, most of them get stuck in a vicious cycle of poverty. Even if they were to get enough capital to produce more, due to inadequate access to markets, they would not be able to take part in much trade. Consequently, education certainly plays a big factor in answering the question, why is Bhutan poor?

Natural Disasters

Bhutan is often struck by natural calamities due to its mountainous landscape. Floods and landslides make it impossible for any major infrastructural development to take place. This also increases the cost of goods and services. These natural disasters also affect residents’ health by causing an increase in diseases such as malaria and tuberculosis. This can prevent already poor families from going to work and increase medical costs.

Despite these sub-par living conditions, the government continues to focus on Gross National Happiness instead of improving the economy. With such a large proportion of the population living under the poverty line, Bhutan must rise up and focus on tangible objectives.

Recently, the government has implemented legislation, such as the National Rehabilitation Programs and the Rural Economic Advancement Program, that aim to help needy individuals by giving them land and better socioeconomic opportunities. Bhutan may have a long way to go, but these programs have certainly propelled them in the right direction and away from the question: why is Bhutan poor?

Tanvi Wattal

Photo: Flickr

Water Quality in BhutanBhutan, a country among the Himalayan Mountains, has been making remarkable strides to provide safe drinking water for citizens. These efforts are apparent in the adoption of the Bhutan Drinking Water Quality Standard and the recent National Water Symposium.

The Bhutan Drinking Water Quality Standard was adopted in 2016 by the National Environment Commission to protect public health and improve water quality. Unclean water has been traced to numerous diseases, such as cholera, fluorosis and typhoid fever. Before the standard was adopted, water providers had no obligations to conduct water testing and treatment. This left the 745,000 Bhutanese citizens with potentially hazardous water.

According to the standards document, the objectives are:

  1. To set safe concentrations of nationally relevant drinking water parameters.
  2. To contribute towards a progressive improvement of drinking-water quality management (e.g. sampling, testing, reporting and documentation) by all service providers.
  3. To strengthen the application of water safety planning in all drinking-water systems.
  4. To contribute towards increased public awareness of drinking-water safety.
  5. To build a national drinking-water quality database.
  6. To improve accountability of all stakeholders in the provision of a safe-for-drinking water supply.

To further ensure better water quality, Bhutan hosted a National Water Symposium (NWS) on May 9, 2017. The NWS will improve water quality in Bhutan by devising a system of water management and sustainability. Organizers of the Symposium gathered 60 water sanitation professionals to decide priority focus areas for the twelfth Five Year Plan (FYP), a series of five-year economic goals.

One of these focus areas is supplying and conserving safe drinking water for families. Climate change’s effects in the region have made water conservation a significant concern. While Bhutan has one of the highest per capita water availabilities in the world, the rapidly melting glaciers and snow in the country’s often cold region pose a threat to future water availability. The Symposium will identify ways to manage and conserve natural water resources to improve water quality in Bhutan.

According to the Bhutan Times article, “National Water Symposium Brings Experts Together,” event organizer Lyoncchen Tobgay said that “managing water resources and providing continuous safe drinking water to every household is one of the flagship projects prioritized in the twelfth FYP.”

With the new standards and efforts from participating agencies from the National Water Symposium, Bhutan’s water quality should vastly improve over the next few years.

Marie Adigwe

Photo: Google

Bhutan Refugees
Situated between India and China, Bhutan is an isolated Buddhist kingdom that had generated one of the highest numbers of refugees in the world compared to its population. Since 1991, one sixth of Bhutan’s people have resettled in Nepal, India and other countries.

  1. Bhutan refugees are called Lhotshampas, or ‘southerners.’ Lhotshampa people are Bhutanese people of Nepalese ancestry. In the 1980s, Lhotshampas were seen as a threat to political order and were evicted from Bhutan in the 1990s to settle in Nepal.
  2. The government of Nepal and UNHCR has managed seven refugee camps since the 1990s. In 2008, the International Organization for Migration and UNHCR jointly started refugee resettlement programs throughout the world.
  3. In 2007, more then 100,000 refugees from Bhutan lived in the seven camps of the Jhapa and Morang districts in eastern Nepal. Now, just two camps remain and the refugee population is less than 18,000 people.
  4. A group of eight countries — Australia, Canada, Denmark, New Zealand, the Netherlands, Norway, the United Kingdom and the United States of America — came together in 2007 to create new life opportunities for Bhutan refugees.
  5. Bhutan refugees have to go through an interview and selection process. The first refugees settled included women at risk, survivors of violence and torture and refugees with medical needs such as speech and hearing impairments.
  6. Some Bhutan refugees requested that the Nepal government send them back home. These refugees are unwilling to settle in a third country; however, the Secretary of Beldangi Camp Sanchahang Limbu said that he fears there would be no one to care for the refugees once they returned home.
  7. As of November 2015, 5,554 Bhutan refugees were resettled in Australia, 6,500 in Canada, 874 in Denmark, 1,002 in New Zealand, 327 in the Netherlands, 566 in Norway, 358 in the United Kingdom and 84,819 in the U.S.

These migrating people hope for a final destination to their journey, and countries across the world strive to help them attain this goal.

Jacqueline Venuti

Photo: Flickr

bhutan
Since the 1990s, there has been great progress in Bhutan’s small, agricultural based economy. With this economic progress, the citizens of Bhutan have seen a decline in poverty, a decentralized government and better access to health care.

In 2007, poverty in Bhutan was well over 40 percent. As of 2014, Bhutan’s National Statistics Bureau reports that poverty is at 12 percent nationally. Dietary diversity has improved greatly since 2007 among poor and non-poor, with households consuming higher amounts of nuts, fruits, oils and fats and sweeteners like sugar and honey.

Still, as more and more of Bhutan’s small population of 761,019 mobilizes out of extreme instances of poverty, there are indications that proper nutrition is a problem for many, especially children. It is estimated that 34 percent of children in Bhutan are stunted as a result of malnutrition and 11 percent show signs of wasting. While malnutrition and stunting is found to be slightly higher in rural regions of western and eastern Bhutan, national statistics from Bhutan show that at least 15 percent of children under five are undernourished.

There are a number of reasons as to why malnutrition and the stunting of children is prevalent in Bhutan. One significant factor is the health and nutrition of mothers who are pregnant or nursing. According to UNICEF, poor practices of infant feeding and a 50 percent rate of anemia among young mothers contributes to the vicious cycle of malnutrition among young children in Bhutan. As a result, one of every 10 mothers gives birth to a low-weight baby. The Bhutan Poverty Assessment said, “the under nutrition problem is prevalent in the eastern part of the country and among children of mothers with no education.”

There is an overall lack of use of antenatal and prenatal care amongst mothers in Bhutan. Few women in rural areas have their births attended by skilled professionals, even though Bhutan offers a system of universal health care to its citizens.

Others point to Bhutan’s reliance on foreign imports of food as being the main cause. This reliance causes the population to depend on foreign sources of food, which sometimes leads to a degree of neglect in subsistence farming and agriculture. Also, imports of certain Western foods, high in sugar content and offering little nutritional value, have led to a disparity in adequate nutrition in Bhutan.

The Kingdom of Bhutan is on track to meet the Millennium Development Goals; however, malnutrition remains the main impediment to Bhutan’s development. Though Bhutan fares far better than other nations in Southern Asia, it has recognized that in order to improve the overall well-being of the nation, something must be done to improve the health and nutrition of its young mothers and children.

– Candice Hughes

Sources: Bio Med Central, Global Nutrition Report, National Statistics Bureau, Unicef, World Bank
Photo: Asia News

hunger in bhutan

Malnutrition and hunger in Bhutan is nothing new for the country or its policy makers. Although there has been a dramatic decrease in underweight children at the national level, many rural-urban disparities still exist. The Bhutan Living Standards Survey demonstrated that the eastern and southern regions face a higher degree of seasonal food deficit than the westernmost parts of the region. An estimated 37 percent of children showed signs of stunted growth, while almost 5 percent were deemed too thin for their age group.

Starting in 1974, the World Food Programme (WFP) has been helping alleviate hunger and poverty by implementing feeding projects specifically aimed at school children. Currently, the level of assistance has increased and more focus has been directed toward health, agriculture, dietary development and irrigation.

According to the WFP, roughly one-third of the Bhutanese population suffers from food insecurity. High rates of malnutrition are often seen in remote villages, where poverty is overwhelming. An estimated 12 percent of the population is considered poor. In addition, lack of access to markets and essential health services proves detrimental to the welfare of Bhutanese living in the countryside. This common occurrence is due to the high amount of natural disasters in the country. Floods and storms remain a hindrance to receiving adequate food supply, and since the Bhutanese rely heavily on agriculture, it produces a cycle of poverty and starvation.

To combat the ongoing crisis, the United Nations Development Programme has established multiple school interventions to address the problems associated with hunger in Bhutan. In collaboration with the Royal Government of Bhutan, the school feeding projects provide over 41,000 students in rural boarding schools with two meals a day. UNDP also lends assistance to raise agricultural productivity for rural farmers, as well as find jobs off the farm as a poverty reduction strategy.

With all these programs, Bhutan has seen a 24 percent decrease in poverty since 2000. Although rural areas still have a much higher percentage of the population living with food insecurity and malnutrition, the rates are much lower than in 2000. Thus the first Millenium Development Goal of halving extreme poverty and hunger by 2015 is looking like a more realistic goal for Bhutan.

Leeda Jewayni

Sources: UN, UNDP, The Examiner, World Food Programme, World Food Programme 2
Photo: Flickr

bhutan
The Southeast Asian country of Bhutan reported 34 HIV cases between December 2013 and June 2014, according to the nation’s Ministry of Health.

The number of cases breaks down as 18 males and 16 females. Two of the cases involve minors aged 2 years old and 3 years old, respectively.

Among the same time period four years prior, the country saw 32 cases of the disease, equally split among males and females.

A 2008 report published by the nation’s Ministry of Health stated that the first case of HIV appeared in the country in 1993. Though Bhutan continues to enact measures to stop the spread of the disease, the “number of cases continues to rise steadily.”

On average, Bhutan reports five new HIV cases each month.

While other countries typically see a higher proportion of males with the virus than females, the distribution among genders is nearly equal in Bhutan.

Bhutan is a small Southeast Asian country with a population of over 750,000 people. Roughly the size of Switzerland, Bhutan has experienced strong economic growth since the beginning of the century. The nation’s per capita gross national income (GNI) has risen from $730 in 2000 to $2,070 in 2011, making it one of the highest in South Asia.

However, despite sizable drops in poverty, Bhutanese citizens suffering from severe poverty continue to become victims.

According to the World Health Organization, HIV attacks the body’s immune system. It is spread by unprotected sexual intercourse or through contaminated blood or instruments including needles and syringes. The more advanced stage of the virus, AIDS, often occurs within 10 years to 15 years of the first signs of the virus.

While there are treatments and medication that can slow the progression of the disease, there is currently no cure for either HIV or AIDS.

– Ethan Safran

Sources: Zee News, The Health Site, The World Bank, The Bhutanese, World Health Organization 1, World Health Organization 2
Photo: Authint Mail

Bhutan: First Country with Completely Organic Farming
Bhutan is set to become the world’s first entirely organic country in terms of farming and agricultural practices, as all synthetic fertilizers and pesticides have been banned by the government. Farmers will have to rely on all-natural forms of fertilizers, mainly animal waste and other farm waste by-products.

The government of Bhutan hopes that instead of limiting the country’s agriculture, the ban on pesticides will increase farming and enable more food to be produced, including specialty foods with demand from neighboring countries such as China and India.

Bhutan’s minister of agriculture and forests, Pema Gyamtsho, asserted that the topography of the country played a large role in the decision, citing terrain issues with using synthetic pesticides, including uncontrollable run-off that has a negative effect on plants and animals in the vicinity.

Although Bhutan has only recently seen a boom in development and current technologies reaching citizens, the government is confident that going organic will not only protect the country from future climate change implications but also from an economic standpoint in hopes that the amount of food they will have to import will remain minimal.

Some farmers in Bhutan have expressed their doubts about the plan, citing recent low crop yields due to nontraditional high temperatures and an increase in invasive pests, creating a need for more synthetic fertilizers.

Although the use of pesticides and synthetic fertilizers are mostly widespread currently, Bhutan as a whole is an extremely sustainable nation: over 95% of the country “has clean water and electricity, 80% of the country is forested and, to the envy of many countries, it is carbon neutral and food secure.”

Christina Kindlon

Source: Guardian

Bhutan: World Leader in Organic Farming

Bhutan, a small country located in the Himalayan Mountains between China and India, has announced its plan to become the first country to use entirely organic agricultural methods. The country has demonstrated its commitment to sustainability in many of its policies and practices, and now Bhutan is a world leader in organic farming practices.

The country has not set a date for when the change will be complete. Minister of Agriculture and Forests Pema Gyamtsho stated, “Going organic will take time… We cannot do it tomorrow. Instead we will achieve it region by region and crop by crop.” Organic agriculture is a method of growing crops that uses no chemical fertilizers, pesticides, or herbicides.

Agrarian culture and lifestyle dominate Bhutan, where many politicians are also farmers, and most farmers already utilize organic growing methods. Minister Gyamtsho cited several reasons for the country’s push to go entirely organic, including increased food production. He hopes that Bhutan will increase its high quality food exports to neighboring India and China, while retaining food security for its citizens. Other reasons for the complete organic transition include the country’s strong Buddhist beliefs, and the negative effects of chemicals on the natural environment.

Like the rest of the world, Bhutan’s future depends on how it reacts to global issues such as climate change, population growth, and food security. While Bhutanese farmers who already practice organic methods surely support the government’s decision, other famers are unsure about growing crops without chemicals. In some regions, the last few years of warm temperatures and unpredictable weather have yielded smaller harvests and more pests. Some family farmers whose children have moved into the city are forced to use chemicals to maintain sufficient levels of productivity.

Nevertheless, the nutritious products of organic agriculture continue to be in high demand around the world. Organic farmers use natural methods to control pests and practice soil-building techniques, such as composting. Building and maintaining healthy soil is necessary for long-term sustainable agricultural systems. While there is debate over whether organic farming practices produce a lower yield per acre than conventional practices, there is no question that chemically based farming is detrimental to natural ecosystems.

With a population of around one million people, Bhutan is a unique country in many ways. Rather than using Gross Domestic Product (GDP) to measure prosperity and growth, Bhutan gauges its citizens’ productivity and health according to Gross National Happiness (GNH). As a world leader in organic farming practices, Bhutan will continue its track record of setting a standard for sustainable development that other countries can model.

Kat Henrichs

Source: Guardian

Photo: NPR