Alcoholism as Challenge or Issue in Bhutan

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Alcoholism as Challenge or Issue in Bhutan

Alcohol is an important part of Bhutanese culture, especially in the eastern parts of Bhutan, they serve it as a gesture of showing respect, honor and hospitality. Alcohol is served in a number of forms including welcome drink, farewell drink, drink with food and other ceremonial forms. The basic nature of alcohol is underplayed to promote it as a socially acceptable commodity in Bhutan. Due to which it becomes one of the reason for being widely available in country, an easy access to alcohol for every individuals. According to one of the report published by Movendi (Movendi, 2019), there is one alcohol outlet for every 177 Bhutanese. Though there are enforcement of strictly ban of illicit alcohol but cheap industrial alcohol are available in almost every retail stores. Through such availability, it becomes easier for every consumers to indulge in alcohol.

The BLSS (Bhutan Living Standard Survey, 2007) data revealed that about 86% of the total alcohol consumed by the Bhutanese in 2007 was made up of local homebrews, which becomes one of the factors of the easy access to alcohol in Bhutan for the consumers. Public consumption of alcohol is high. Alcohol abstention rate among the Bhutanese population 15 years and older is 64.7%, notably lower than the South East Asian rate of 80.4% (World Health Organization, 2011). A survey conducted in 2001 in eastern Bhutan found that more than 58 percent of the respondents were alcoholics; of which 50 percent of the males were the sole bread earners in their families (Report on IECH survey 2001, 2001). In urban Thimphu, of the 36.4 % of the adults who had consumed alcoholic beverages in the past year, 10.5% engaged in binge drinking (Royal Government of Bhutan, 2009). High school surveys showed that 37.3% among Grade 7-8 and 48.3% among Grade 9-10 and 59.1% consumed alcohol (Bhutan Narcotic Control Agency and United Nations Office on Drugs and Crime, 2009), indicating that underage drinking may be common.

The usual main for such factor is due to availability of alcohol and easy access of it, which will somehow lead to more alcohol abuse and cause domestic violence as well. Hundreds of families throughout Bhutan are victims of domestic violence. It not only affects adults but has a more adverse impact on children as well. RENEW (Respects, Empower, Nurture and Educate Women) sees such cases of domestic violence every month, where the main factor for such issue is due to alcohol abuse. As Bhutan views alcohol and traditional games as a good mixture in Bhutanese society, such events lead up to consuming alcohol and affecting the living environment after consumption of alcohol in their home environment.

The 7th session of the first parliament held on 2011 directed relevant agencies to strengthen alcohol use prevention programs focusing on demand and supply reduction policies to improve the wellbeing of the people aspiring to GNH and free from alcohol related harm (Royal Government of Bhutan, 2015). Following Parliaments directions, stakeholders coordinated by the Ministry of Health conducted a series of consultations to develop alcohol control strategies outlined in this document. After passing the GNH Policy Screening Test, the document was reviewed and approved after deliberations by the Cabinet Members in the three sessions of the Lhengye Zhungtshog: the 63rd (January 20, 2015), 82nd session (28 July, 2015) and 90th (December2,2015) (Royal Government of Bhutan, 2015).

The strategy focuses on alcohol control through a holistic public policy approach. In addition to public health interventions, the strategy includes strengthening the enforcement of existing policies pertaining to the sale of alcohol to minors, hours of operation, places of sale, and advertisement and promotion of alcohol products. Though such implementation are done by the government which addresses the issues or challenges related to alcohol, there are no monitoring or any follow-ups done for the implementation, which result to another factor of retailer to sell it in more ambiguous manner and not biding the law.

Studies in Thimphu (2013) and Trashigang (2014) revealed a very low compliance with alcohol rules among sellers (Dorji, 2014). Alcohol service policies were violated 90% of the time in licensed outlets in Thimphu. Even on Tuesdays when compliance was greatest (43%), it is far below acceptable levels. Similarly, compliance was poor in all 35 outlets in Trashigang town. However, the studies illustrated that a single information session on alcohol control policies with a follow up implementation check visit to outlet owners/managers significantly improved practices from a low base.

Go Youth Go (GYG), a youth based organization, during the implementation of an education program among 437 alcohol outlets in Thimphu city in January 2015, noted many unlicensed outlets selling alcohol (Royal Government of Bhutan, 2015). Poor practices are expected to be an issue in the country due to minimal enforcement of existing alcohol control legislation and policies. Even though, there is enforcement, the consumer who are dependent on alcohol will find means to consume alcohol, therefore for such issue, there is a need for proper treatment plans for them. Included implementation of an education program for alcohol was done only in Thimphu sub-regions and based on it only, it was given as a report with the perspective of the whole country when the survey hadnt been done in other parts too. Therefore such implementation need to be conducted in other parts of Bhutan included it will also help to motivate young youths to advocate themselves which doing the survey.

Royal Government of Bhutan incorporation with Ministry of Health and RSTA (Road Safety and Transport Authority) implemented integrative well-funded, time bound comprehensive national and sub-national action plans to reduce the harmful use of alcohol, enhanced inter-sectoral coordination to implement alcohol policies at all levels by establishing a National Alcohol Control Committee (NACC) at the national level, Dzongkhag committee, Thromdey committee and Gewog Committee chaired by Prime Minister, Dzongda, Thrompon and Gup respectively and lastly they built partnership with mass media organizations to raise awareness on harms associated with alcohol use where they allocate adequate funds to implement alcohol policies (Royal Government of Bhutan, 2018). There are limitations to advocacy and implementation of such practices, where one of the downfall could be people would not to adequate enough to listen to the whole advocacy program instead there will be littering (advocacy brochures and pamphlets) of the surrounding only.

One of the actions mandated for Bhutan InfoComm and Media Authority (BICMA) is to ensure that minors (below 18 years) are restricted from entering entertainment venues such as drayangs and discotheques that exclusively promote alcohol consumption (Pelden, 2016). The policy also mandates the authority to notify drayangs, nightclubs and other places of entertainment where alcohol is sold to conduct age identification checks to restrict underage entry. The authority will also develop a joint enforcement implementation plan with the economic affairs ministry to enforce the prohibition of sale of alcohol in entertainment venues after 10 PM (Pelden, 2016). Though such implementation are done, there is need for close monitoring in the entertainment venues, they could either monitor through letting a stakeholder (RSTA) to regulate the policies and patrol the venues or the government can implement like other countries to check individuals citizenship card for minors to not enter freely and have easy access to the entertainment venues.

In one of the report, bylaw there was reduction of home brewing of alcohol was discouraged in the communities, where alcohol use during religious rituals was replaced by soft drinks, disallowing sell of alcohol in grocery shops and communities started contributing a fixed amount instead of alcohol during bereavement in the communities (Dil K. Subba, 2018). A group was identified in the chiwog to monitor the bylaws and the group have been continuously monitoring the compliance of the bylaws agreed in the communities. All community events like tshechus, religious rituals and bereavements were monitored to reduce alcohol use. Gewog administration restricted unlicensed sale of industrial alcohol in the communities (Dil K. Subba, 2018). There has been good cooperation from the community as well as the group who are responsible for monitoring. The Mental Health Programme of the Ministry of Health has been periodically following-up with the monitoring group to ensure compliance ever since the start of the study project.

Bhutan has an alcohol control policy in place, the National Policy and Strategic Framework to Reduce Harmful use of Alcohol was adopted in 2015 (Royal Government of Bhutan,2015). The policy contains measures which can reduce alcohol consumption and harm if implemented correctly. Nevertheless, there are weak enforcement of laws, weak coordination among implementing agencies, and lack of clarity among local governments on their enforcement authority have been recognized as major barriers to effective implementation of the law. By strengthening the implementation of these laws the country can reduce the growing alcohol abuse and harms.

The report, the National Policy and Strategic Framework to Reduce Harmful use of Alcohol was adopted in 2018 (Royal Governement of Bhutan, 2018), added that laws are not implemented properly due to lack of human capacities and inadequate financial resources. Due to one of factors for increase in youth alcohol use were lack of communication with parents and lack of recreational activities for youth. There is a lack of adequate support for rehabilitation services, necessary aftercare services and social stigma surrounding the issue alcohol use disorders for the youths and the alcohol dependents. Currently centers only cater to about 20% of the substance use disorder cases. The recommendation for the report and implementation is that government focus on addressing the issues, affirmative actions to ensure responsible parenting, affordable recreational facilities, and rehabilitation services and to explore taxation and pricing policy.

Non-governmental organizations are essential partners for alcohol policy; they are a vital component of a modern civil society, raising peoples awareness of issues and their concerns, advocating change, creating a dialogue on policy and exposing harmful actions of the alcohol industry. They should be one of the stakeholder for the implementation of policy related to alcohol, NGOs in particular, those organizations which deal with families, civil, cultural, economic, political, and social rights, including those that deal with the rights of children and young people would be the most prominent stakeholder for it.

Agencies such as Royal Bhutan Police and Dessungs, should be one the stakeholder for the implementation as they will be more aware of minors who are abusing alcohol, where they wont be focusing only on the general age group. The perception from these agencies group will make it more prominent on how to go on and which policies or implementation needs more focus to make it more effective.

Consumption of alcohol is widely accepted and ingrained in the Bhutanese society and culture; alcohol is served during the religious rituals and festivals. Alcohol is an addictive drug; it alters cognitive and physiological motor, and causes behavioral disinhibition causing severe risks to individuals and society. In Bhutan and also globally, the basic nature of alcohol is underplayed to promote it as a socially acceptable commodity. Excessive use of alcohol can result in serious health problems; affect interpersonal relationships, increase violence, accidents and road crashes. Alcohol use also has adverse socio-economic consequences due to loss of productivity, premature deaths and disabilities. Therefore, to adverse those issues and challenges, there is a need for more effective and efficient implementation of policies with the joint multistakeholder to make it more prominent.

References

Bhutan, R. G. (2009). Report on 2007 STEPS survey for risk factors and prevalence of noncommunicable diseases in Thimphu. Ministry of Health.
Bhutan, R. G. (2015). National Policy and Strategic Framework To Reduce Harmful Use of Alcohol 2015-2020. Lhengye Zhungtshog.
Bhutan, R. G. (2018). The National Policy and Strategic Framework to Reduce Harmful Use of Alcohol (2013-2018). Royal Government of Bhutan.
Crime, B. N. (2009). Drug and Controlled Substance Use in Bhutan- at a glance. Bhutan Narcotic Control Agency and United Nations Office on Drugs and Crime.
Dorji, G. (2014). Promoting Responsible Alcohol Service Practices Among Licensed Establishments in Thimphu, Bhutan: A Pilot Intervention. Thimphu: RASP.
Movendi. (2019). Bhutan: Easy Alcohol Availability Major Issue. Retrieved from https://movendi.ngo/news/2019/06/05/__trashed-2/
Organization, W. H. (2011). Global Status Report on Alcohol 2011. Geneva: World Health Organization.
Pelden, S. (2016, January 1). Cabinet endorses strong alcohol policy. Retrieved from Kuensel : https://kuenselonline.com/cabinet-endorses-strong-alcohol-policy/
(2001). Report on IECH survey 2001. Bhutan: Department of Public Health, Ministry of Health.
Subba, D. K. (2018). Community action to reduce harmful use of alcohol: a pilot study in the remote villages of eastern Bhutan. Bhutan Health Journal.

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