Abstract
Bhutan, known as a country of happiness, has experienced rapid social changes and the increasing burden of non-communicable diseases (NCDs) that can impact health and happiness. To inform future NCD prevention programs in Bhutan, this study explores knowledge, perception, and the practices of Bhutanese related to NCDs in the context of the philosophy of happiness. Research was conducted in rural and urban communities of Bhutan in 2017 among 79 inhabitants of both genders, aged ≥18. Participants were recruited through purposive sampling with the data collected by in-depth interviews, participatory observation, and anthropometric measurements. Data were analyzed by thematic analysis. Across participants, health was considered as an important element of "happiness". However, lifestyle-related NCD risk factors prevailed due to the lack of effective education programs on NCDs and thus the lack of practical knowledge for NCD prevention across society. We further found that the value of happiness "finding happiness in any situation is virtue" was universal as well as other traditional values and customs, shaping people's health behaviors. From these observations, it is recommended that more practical NCD education/prevention programs should be urgently introduced in Bhutan that involve multiple generations, religion authorities, educational settings, and medical services. This is the first comprehensive qualitative study on the NCD-related lifestyle risks among Bhutanese concerning the concept of happiness.
Highlights
Lifestyle changes may impact people’s health and happiness [1,2,3,4,5,6]
According to a recent report by the WHO [12], the prevalence of diabetes is increasing in Bhutan in both genders, and 24.8% of the population is above the recommended weight level
To emphasize sustainable development and the happiness of the people, Bhutan sets GNH (Gross National Happiness) as the basic philosophy of the national policy based on the Constitution [11]
Summary
The socioeconomic burden of non-communicable-diseases (NCDs) has been increasing [7,8,9,10,11]. Basic medical services are free and provided for all in Bhutan [13, 14]. Avoiding a future increase in medical expenses and social burdens is, an issue of highest priority, while the country has to simultaneously address unmet needs of infectious diseases, malnutrition, mother and child health, and so forth [15,16,17]. To emphasize sustainable development and the happiness of the people, Bhutan sets GNH (Gross National Happiness) as the basic philosophy of the national policy based on the Constitution [11]. The GNH consists of nine indicators, including living standard, education, cultural diversity, community vitality, time use, psychological wellbeing, ecological diversity, good governance, and health [1]
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