There is growing global interest in Gross National Happiness (GNH) as a metric to capture population well-being and economic development. Empirical evidence suggests that health is necessary for achievement of happiness. The growing epidemic of non-communicable diseases (NCDs) threatens to undermine the achievement of GNH. We analyze synergies between current policy priorities and the institutional mechanism for GNH and the Global NCD Action Plan 2013-2020 that has informed Bhutan's approach to NCDs. We identify strategic policy opportunities to strengthen outcomes for both policy areas. Lessons from Bhutan also suggest strategic opportunities to address NCDs in other countries where happiness is on the national agenda, or where action on NCDs could be improved through engagement between health and other sectors, especially where ways to promote and measure GNH (population well-being) already exist.

ObjectiveCommon mental disorders (CMDs) are a major cause of the global burden of disease. Bhutan was the first country in the world to focus on happiness as a state policy; however, little is known about the prevalence and risk factors of CMDs in this setting. We aim to identify socioeconomic, religious, spiritual and health factors associated with symptoms of CMDs.Design and settingWe used data from Bhutan’s 2015 Gross National Happiness (GNH) Survey, a multistage, cross-sectional nationwide household survey. Data were analysed using a hierarchical analytical framework and generalised estimating equations.ParticipantsThe GNH Survey included 7041 male and female respondents aged 15 years and above.MeasuresThe 12-item General Health Questionnaire was used to measure symptoms of CMDs. We estimated the prevalence of CMDs using a threshold score of ≥12.ResultsThe prevalence of CMDs was 29.3% (95% CI 26.8% to 31.8%). Factors associated with symptoms of CMDs were: older age (65+) (β=1.29, 95% CI 0.57 to 2.00), being female (β=0.70, 95% CI 0.45 to 0.95), being divorced or widowed (β=1.55, 95% CI 1.08 to 2.02), illiteracy (β=0.48, 95% CI 0.21 to 0.74), low income (β=0.37, 95% CI 0.15 to 0.59), being moderately spiritual (β=0.61, 95% CI 0.34 to 0.88) or somewhat or not spiritual (β=0.76, 95% CI 0.28 to 1.23), occasionally considering karma in daily life (β=0.53, 95% CI 0.29 to 0.77) or never considering karma (β=0.80, 95% CI 0.26 to 1.34), having poor self-reported health (β=2.59, 95% CI 2.13 to 3.06) and having a disability (β=1.01, 95% CI 0.63 to 1.40).ConclusionsCMDs affect a substantial proportion of the Bhutanese population. Our findings confirm the importance of established socioeconomic risk factors for CMDs, and suggest a potential link between spiritualism and mental health in this setting.

Study Objectives: Short and long sleep durations have been found to be associated with chronic conditions like diabetes mellitus, hypertension and cardiovascular disease. However, most studies were conducted in developed countries and the results were inconsistent. The aim of this study is to investigate the association between sleep duration and self-reported health status in a developing country setting. Methods: We conducted secondary data analysis of the 2010 Gross National Happiness study of Bhutan, which was a nationwide cross sectional study with representative samples from rural and urban areas. The study included 6476 participants aged 15-98 y. The main outcome variable of interest was selfreported health status. Sleep duration was categorized as ≤ 6 h, 7 h, 8 h, 9 h, 10 h, and ≥ 11 h. Multiple logistic regressions were conducted to investigate the association between sleep duration and self-reported health status. Results: The mean sleep duration was 8.5 (± 1.65) h. Only 9% of the respondents slept for 7 h; 6% were short sleepers (≤ 6 h) and 84% were long sleepers (21%, 8 h; 28%, 9 h; 22%, 10 h; 13%, ≥ 11 h). We found that both short (≤ 6 h) and long sleep duration (≥ 11 h) were independently associated with poor selfreported health status. Conclusions: This study found that people with shorter and longer sleep durations were more likely to report poorer health status.

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Background Bhutan is facing an epidemic of noncommunicable diseases; they are responsible for 53% of all deaths. Four main modifiable risk factors, including tobacco use, harmful use of alcohol, physical inactivity, and unhealthy diet, are the causes of most noncommunicable diseases (NCDs). This study aimed to assess 1) the prevalence of NCDs modifiable risk factors in Bhutan’s adult population and 2) associations between the sociodemographic factors and the NCDs modifiable risk factors with overweight or obesity, hypertension, and diabetes. Methods We used the 2014 Bhutan WHO Stepwise Approach to NCD Risk Factor Surveillance (STEPS) Survey dataset in this study. Data were analyzed using multiple logistic regressions, constructed with overweight or obesity, hypertension, and diabetes as outcome variables and modifiable risk factors as independent variables. Results The prevalence of tobacco use, harmful use of alcohol, unhealthy diet (low fruits and vegetables intake) and physically inactive was 24.8% (95% CI: 21.5, 28.5), 42.4% (95% CI: 39.4, 45.5), 66.9% (95% CI: 61.5, 71.8), and 6.2% (95% CI: 4.9, 7.8), respectively. The prevalence of overweight or obesity, hypertension and diabetes was 32.9% (95%CI: 30.0, 36.0), 35.7% (95% CI: 32.8, 38.7) and 6.4% (95% CI: 5.1, 7.9), respectively. Multiple logistic regression showed that older age groups were more likely to be overweight or obese, hypertensive, and diabetic. Our analysis also found that tobacco users were less likely to be overweight or obese (aOR 0.71, 95% CI 0.52, 0.96), and to be hypertensive (aOR 0.74, 95% CI 0.56, 0.97); but they were more likely to be diabetic (aOR 1.64, 95% CI 1.05, 2.56). Alcohol users were more likely to be hypertensive aOR 1.41 (95% CI 1.15, 1.74). Furthermore, vigorous physical activity could protect people from being overweight or obese, aOR 0.47 (95% CI 0.31, 0.70), and those consuming more than five serves of fruits and vegetables per day were more likely to be overweight or obese, aOR 1.46 (95% CI 1.17, 1.82). Conclusion The prevalence of NCDs modifiable risk factors and overweight or obesity and hypertension was high in Bhutan. We found strong associations between tobacco use and diabetes, alcohol use, hypertension, physically inactive, and overweight or obesity. The results suggest that the government should prioritize NCDs prevention and control programs, focusing on reducing modifiable risk factors. The health sector alone cannot address the NCDs epidemic in Bhutan, and we recommend the whole of government approach to tackle NCDs through the Bhutan Gross National Happiness framework.