The report also reveals that eastern region had the highest prevalence of current alcohol consumption
By Tandin Wangchuk
The Non-communicable Disease Risk Factors: Bhutan STEPS Survey Report, 2019 throws some interesting facets to alcohol production and use in the country.
It reveals that in Bhutan, NCDs are estimated to account for 69.0% of all deaths in 2016. Four main groups of NCDs – CVD (28.0%), cancers (10.0%), chronic respiratory diseases (9.0%), and diabetes mellitus (4.0%) – are responsible for the majority of these NCD related deaths/
“The WHO STEPwise approach to non communicable disease risk factor surveillance facilitates countries to track national NCDs status including the 25 key indicators highlighted in the NCD Global Monitoring Framework which will help Bhutan track progress and guide policy and program planning in NCD prevention and control,” the WHO report states.
Worldwide, 3 million deaths occur every year due to harmful use of alcohol, which represents 5.3 % of all deaths. In the South-East Asia Region, which is home to 1.9 billion people, 1 in 20 deaths were attributed to alcohol consumption.
In Bhutan, the National Policy and Strategic Framework to Reduce Harmful Use of Alcohol (2015-2020), entails strategies to reduce accessibility, availability and affordability of alcohol while there is a total ban on alcohol advertisement, promotions and sponsorships.
The report highlights that to reduce alcohol availability and accessibility, mechanisms such as restricted licensing, sale timing and location, age and restriction on the sale of locally brewed alcohol were instituted. Further, affordability is minimized through heavy taxation in addition to stringent drink driving countermeasures.
“Additionally, community-based interventions to reduce the harmful use of alcohol were implemented in selected priority districts,” it states.
Prevalence of alcohol in Bhutan
The prevalence of current alcohol consumption, in the past 12 months among all respondents, was 42.9% and that of life-time abstainers was 40.7%.
It also stated that, of the respondents, 16.4% were former drinkers and 33.1% reported consuming alcohol in the past 30 days.
Further, among those who drank in the past 12 months, 6.2% drank daily, 13.9% drank 1-4 days/week and 22.9% drank 1-3 days/month or less than a month. Majority of current drinkers (51.7%) were found in the age group of 25-39 years while former drinkers (24.6%) were reported in the older age group of 59-65 years.
Of the total respondents, 19.4% in the age group of 15-24 years were current drinkers (past 30 days) and this proportion increased with increase in age, going up to 41% for the 25-39 years’ age group and decreasing a bit for the age group of 40-69 years (34.5%).
The report also reveals that eastern region had the highest prevalence of current alcohol consumption (49.6%) followed by western region (42.8%) and central region (38.4%) compared to the national average of 42.9%.
There were slightly more men current drinkers (50.1%) than women (34.9%) and urban areas had higher current use of alcohol compared to rural areas (48.7% versus 38.8%). The report revealed.
In addition, there were more current drinkers among 25-39 years, secondary or more education level and those in the lowest and highest wealth quintiles.
“Of the respondent, 17.5% were heavy episodic drinkers and amongst the current drinkers in the last 30 days, 51.3% were engaged in HED. The incidence of HED drinking increased with increasing age and amongst current drinkers; it was the highest for the age group 25-39 years (53.6%),” the WHO report highlights.
It also states that older aged people and men are more heavy episodic drinkers than other population groups. HED was higher in urban areas compared to rural areas (18.7% versus 15.1%).
Additionally, beer is the most common type of alcohol consumed (45.2%) followed by ara (23.5%). While whisky and Ara are more popular among the older age group, beer and wine are more popular among the younger age group. Wine and Ara are the more popular drinks with women than men.
The report states that Ara is more popular in the rural areas (rural 32.2%, urban 13.5%). Similarly, respondents with higher qualification drink more commercial products (beer 59.4%, wine 16.0%, spirit 6.3%, Ara 8.1%, other home-brewed 10.2%.
On a monthly or more frequent basis, 12.3% reported that they are not able to stop drinking once started, 3.8% needed a drink first thing in the morning, and 4.5% of the respondents failed to perform tasks that were expected of them.
Interestingly, an estimated 6.8% of women current drinkers reported they couldn’t stop drinking once started, compared to 16.9% of men. Further, a higher proportion of respondents in rural areas (13.9%) reported not being able to stop drinking, as compared to respondents in urban areas (10.1%).
The study also revealed that current drinkers belonging to the lowest wealth quintile had the highest proportion of respondents (18.3%) reporting their inability to stop drinking once started. This proportion decreased to 6% for respondents in the highest wealth quintile.
Meanwhile, amongst respondents who drove a vehicle in the past six months, 16.3% reported being stopped or checked by traffic police for drink driving and 7.2% of all respondents reported that in the past 30 days they rode in a vehicle where the driver was drunk.
“Respondents aged between 25-39 years with higher educational level and in higher wealth quintiles engage more in drink driving,” it states.
In case of brewing alcohol, of the total respondents, 32.3% of respondents reported that alcohol was brewed in their households.
Of this, 13.5% reported that alcohol was brewed weekly or more frequently, 24.5% reported that alcohol was brewed monthly, and 61.8% reported that alcohol was brewed less than monthly.
In addition 63.4% reported that the brewing was for religious purposes, 43.4% reported that it was for self-consumption, 2.4% reported that it was for a baby shower, and 2.1% reported that it was for commercial purposes.
“With increase in age, the proportion of respondents brewing alcohol at home increases; 27.9% of the age group of 15-24 years brewed alcohol at home and this increased to 45.9% for the age group of 55-69 years,” the study states.
A higher proportion of women brewed alcohol at home compared to men (34.4% versus 29.9%).
The proportion of rural residents brewing alcohol at home was five times higher than the proportion of urban residents (rural 47.8%- urban 9.8%) brewing alcohol at home. Noncommunicable Disease Risk Factors: Bhutan STEPS Survey Report, 2019 36
Home brewing of alcohol decreased with an increase in levels of education. A similar pattern emerged with an increase in household wealth.
With an increase in household wealth home brewing decreased significantly; 65.5% of respondents, belonging to the lowest wealth quintile, brewed alcohol at home and this proportion went down to 8.8% for respondents belonging to the highest wealth quintile.
Meanwhile, the prevalence of use of any tobacco product in the country was 23.9% (32.9% for men, 11.8% for women).
Amongst the current tobacco users, 10.6% used smoked tobacco (15.2% for men, 3.7% for women); 14.7% used smokeless product (20.3% for men, 8.3% for women) and 1.4% used both smoked and smokeless tobacco products.
However, it also revealed that 70.6% of respondents never used smoked tobacco, 18.8% smoked formerly (8.7% daily 10.1% non daily) and 10.6% were current smokers.