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Climate and Health in Bhutan

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Climate and Health in Bhutan Climate and health in Bhutan Dago Tschering and Gyambo Sithey identify the main areas in which Bhutan is at risk from adverse climate change effects on health he Kingdom of Bhutan is sandwiched Modern medical care in Bhutan began in on primary healthcare, the Royal Government between the world’s most populous the early 1960s. Since then the Royal Gov- chose to use primary healthcare as its core countries, India and China. The ernment has been providing free healthcare thrust to reach the rural population scat- terrain is among the most rugged services and it has been the national health tered over the rugged mountainous terrain and mountainous in the world. The policy to provide an integrated, equitable, of Bhutan. Bhutan has, therefore, committed Himalayas form a formidable natu- cost-effective and well-balanced health serv- itself to the ideals of ‘Health For All’. Currently, ral boundary in the north and the ices to all Bhutanese. Following the World there are 1.8 doctors per 10,000 people and 14 T plains of India border the southern part of Health Organization’s Alma-Ata Declaration hospital beds per 10,000 people. the country. Bhutan’s resident population is 634,982 Bhutan’s climate is influenced mainly by MAIN POINTS with 69.1 per cent of the population still re- the monsoon, which blows in from the Bay The authors iden- They consider siding in rural areas. The Total Fertility Rate of Bengal, local topography and the variation tify the main impacts that the health sec- has reduced from 5.6 in 1994 to 2.6 in 2005. in elevation as one moves from south to the of climate change on tor’s primary role lies The rate of growth (the difference between north. In general, Bhutan has three distinct the health of the pop- in emergency prepar- the number of births and deaths in a popula- ulation of Bhutan. edness for damage climatic zones: the southern foothills, the in- tion) is 1.3 per 1000 population, compared to Higher morbidity control and that the ner Himalayas, and higher Himalayas. While and mortality from health sector’s par- 3.1 in 1994. The infant mortality rate has been southern Bhutan is generally hot and humid, extreme weather and ticipation in all areas reduced to 40 per 1000 live birth from 70.7 per the central inner Himalayas have a cool cli- climate events and an identified as vulnera- 1000 live births in 1994. mate. The inner Himalayan Mountains in the expansion of vector- ble to the adverse ef- Access to safe drinking water in the com- northern borders of the country experience borne and water-re- fects of climate munity is an important parameter as there is a severe alpine climate conditions and are un- lated diseases are ex- change must be rec- high association between safe drinking water, der perpetual snow. pected. ognized. hygiene, sanitation and morbidity. Currently, 24 Tiempo Issue 71 April 2009 Climate change health impacts Changes in world climate would impact human health. While some health impacts would be beneficial, most of the impacts will probably be adverse. In Bhutan, there are three major areas of concern. First, there would be higher morbidity and mortality from extreme weather and climate events. Four types of floods are common in tropical Asia: riverine floods, flash floods, glacial lake outburst floods and breached landslide-dam floods. Flash floods are common in the foothills, moun- tain borderlands and steep coastal catch- ments. Second, there could be an expansion of A mountainous region in Bhutan Photo: © Kevin Hicks vector-borne diseases. Many vector-borne diseases are sensitive to ambient tempera- 84 per cent of households drink from piped diseases alone contribute to 40-50 per cent of ture and precipitation. Even small changes water either within the house (22.7 per cent) or the overall morbidity cases in Bhutan. in temperature and precipitation, or in veg- from outside the house (61.5 per cent). In terms Mortality data for Bhutan are still very lim- etation, host populations or water avail- of sanitation, only 10 per cent of the houses ited. Although routine collection of annual ability, may increase or decrease the distri- do not have toilet facilities; 90 per cent have vital statistics has been a regular activity of bution and abundance of vectors, especially either an independent flush toilet or pit. health centres, data quality and coverage re- at the margins of their distribution, thus Acute respiratory infection and diarrhoeal mains highly questionable due to various potentially changing their range. diseases lead in the ten most common dis- reasons like under-reporting. The accuracy of Finally, there would be an increase in wa- eases in the country. Following these, skin the diagnosis of a disease for the underlying ter-related diseases. As noted earlier, diar- infection, viral and/or bacterial intestinal in- cause of deaths is another weak area in the rhoeal diseases are one of the major causes fections, gastritis and peptic ulcer, conjuncti- mortality data. Cardiovascular disease, cir- of morbidity and mortality in a developing vitis, malaria and other infectious diseases are rhosis of liver and accidental injuries are the country such as Bhutan. most prevalent. Acute respiratory infection most common causes of mortality. Malignan- alone contributes to an average 20-25 per cy is another emerging cause of death, though Current public health concerns cent of the morbidity cases, followed by diar- the incidence of communicable diseases like Dengue, encephalitis, airborne environ- rhoeal diseases contributing to another 10-15 acute respiratory infection, diarrhoeal/dys- mental pollutants/asthma, diarrhoeal dis- per cent of the morbidity cases. The top three entery and tuberculosis remains high. eases (cholera) and malaria are all sensitive www.tiempocyberclimate.org 25 ABOUT THE AUTHORS to climate change and are of particular Priorities for action public health concern in Bhutan today. We consider that, as far as adverse climate Dago Tshering is environ- In Bhutan, dengue fever was first diag- change is concerned, the health sector’s pri- ment education officer for the Royal Society for Protection of nosed and reported in July 2004 when an mary role lies in emergency preparedness for Nature inThimphu, Bhutan. alarming number of people reported to damage control. In this respect, it is imperative Phuntsholing hospital with fever and rashes. to recognize the health sector’s participation Although the mosquito vectors Aedes aegypti in all areas identified as vulnerable to the Gyambo Sithey is a con- and Aedes albopictus were known to exist in adverse effects of climate change. In this re- sultant with the Centre for Re- the southern regions, this was the first time gard, we recommend revisiting the Bhutan search inThimphu, Bhutan. that the disease was suspected and investi- National Adaptation Programme of Action gated. in the context of health. Currently, the health A significant number of encephalitis cases area is confined to emergency medicine and CONTACT have been reported from various hospitals this needs to be extended to cover health around the country. The majority of them information and management for climate- Dago Tshering, Royal Society for are caused by viruses and it is suspected sensitive infectious diseases. Protection of Nature, Post Box 325, Drimen Lam, Thimphu, Bhutan. that Japanese Encephalitis might be one of There is a need to sensitize and become Fax: +975-2-323189 significant ones. Frequent outbreaks occur aware of the effects of climate change on hu- Email: [email protected] in neighbouring states of India. man health among stakeholders. It would be Web: www.rspnbhutan.org Anecdotal data from medical doctors’ in- beneficial to integrate meteorological data Gyambo Sithey, Centre for Research In- dicate an increased number of asthmatic into the Health Information Management itiative Post Box 1358, Changangkha, cases every year. It is suspected that changes System for statistical analysis in respect to cli- Thimphu, Bhutan. in the environment due to rapid urbaniza- mate/seasonal diseases and gear towards de- Te l e p hon e : +975-17708497 tion and climatic changes could be relevant veloping an early warning system for probable Email: [email protected] factors. outbreaks. Installation of weather stations FURTHER INFORMATION Diarrhoeal disease continues to be a major in all of Bhutan’s malaria-endemic districts problem affecting the survival of the chil- would ensure accurate meteorological data. On the Web: The report on which this ar- dren in this country and remains one of the It is also necessary to develop guidelines ticle is based is available at www.clacc.net/ HumanHealth/index.html, along with other top causes of morbidity. Finally, malaria is and indicators for assessing morbidity, mor- national studies on climate change and hu- the second most fatal communicable disease tality and other health information (hy- man health. in Bhutan and has been claiming about 18 giene, sanitation, mental state and so on) lives (average) annually since 1995. Although of the population suffering from natural there has been a significant reduction in the calamities. These key health statistics are malaria case load, the case fatality ratio is required for immediate intervention as well still high. as for surveillance and evaluation of affected communities. ‡ 26 Tiempo Issue 71 April 2009 A GAUNT VIEW © 2009 Lawrence Moore Issue 71 April 2009 ISSN 0962-7030 Editorial team: Saleemul Huq, Hannah Reid, Sarah Granich, Mick Kelly, Johan Kuylenstierna Editorial liaison: Richard Klein Editorial office: Tiempo, International Institute for Environment and Develop- ment, 3 Endsleigh St, London WC1H 0DD, UK. Fax: +44-20-73882826 Email: [email protected] and [email protected] Distribution: Tiempo is availa- ble free on request. Write to: Tiempo Editorial, PO Box 4260, Kamo, Whangarei 0141, New Zealand.
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