Bhutan: Is Bhutan’s GNH going up in smoke?

Sonam Ongmo, January 12,2011

Off with your head

A few years ago, before Bhutan’s first ever Democratic elections, I was invited to dinner at the house of an aspiring politician who joked that if he were elected to office he would make it his personal task to ensure that the policy of GNH (Gross National Happiness) was implemented. And just how would he do this?

He put his hands behind his back and strode around the room with a serious face. Suddenly he stopped, “Why is that man not smiling?” he bellowed. “Where is your smile? Not happy?” he asked of imaginary people. “Off with his head!” he said, sending us, his guests, into peals of laughter. He continued striding around the room until he stopped abruptly again upon another imaginary person. “And you! Are you happy? No? Why not? Why aren’t you happy? Off with his head!” he said swinging his arm across in a flourish, as we cracked up again.

While we may have been laughing then, it’s no laughing matter now.  The person never made it to office, but it looks like he was not wrong about how misguided Bhutanese officials have become in implementing policies while trying to achieve GNH.

It may not be a literal “Off with his head,” but it is as good as that when, in trying to crack down on Tobacco, proselytizing etc. Bhutanese officials have become ever ready and eager to send people packing off to prison.  Perhaps they don’t realize what it means to send a person to prison; never having been in the shoes of someone who is going to prison; or never having had their relatives being sent off to prison. Then it would be a different story, wouldn’t it?

Ill-thought policies like the TOBACCO CONTROL ACT, to prove what?

Government actions/policies/legislations like these, in many countries would have taken people out on the streets in protest, but in Bhutan people have simply taken to the Internet to let it be known how they feel. The media has also asked some hard questions. Business Bhutan correctly pointed out how equating the lack of “the receipt” to smuggling and making it a crime and felony of the fourth degree –  punishable with 5- 9 years in prison –  and placing them in the same category as a human trafficker, abductor, rapist, arsonist, robber etc. can be justified.

I do bear some guilt on this issue. In 2004, I wrote an article for Kuensel, and although it was not about smoking, I mentioned how in New York, Mayor Bloomberg was banning smoking from bars and nightclubs.  I also mentioned how that, while the west “pumped millions of dollars into ads and campaigns to discourage American’s, especially their youth from smoking, it caused American consumption to dwindle and overseas markets to proliferate.”

Call it coincidence, but in 2005 Bhutan came up with its smoking ban. While I can hardly be reassured that my article was its doing, I can take consolation in the fact that I was not the policy maker. Fast forward to 2011. If anything today, the officials should have learnt that enforcing a law like that didn’t do much for smokers. So, instead of learning how this could be implemented practically, it seems they’ve gone the other extreme – throw them in prison.

“No smoking” in public places/offices etc. is now the norm the world over. Why does Bhutan have to go the extra mile? What are we trying to prove? That yet again, we can be an example to be upheld? Not at this rate.

Policies based on extensive research according to the needs of our society

Even if other countries are putting a ban on cigarettes, it is because they can afford to. Their laws are coming at the helm of well-researched and scientific investigation, and how they can cope with it. Everyone knows smoking is bad.  Most, if not all, also know of the social costs incurred by this habit especially in poorer countries.

But their laws are coming in context to their social situations. In our social context alcoholism and drug abuse kills more people than cigarettes; it is no secret that the social cost from alcoholism and drugs on the work, home, hospitals, and society is far greater. Yet what is being done to curb the distribution of alcohol? Not much.

Bhutan’s army welfare project is one of the highest income grossing industries for the government through the sales of its hard liquor, but none of the money from those sales goes into public health education, establishment of rehabs, or even in compensations for the deaths of alcoholics. There are 6529 bars according to the Bhutan Observer, which means one bar for every 100 Bhutanese, and the average deaths resulting from alcoholism at the hospitals is said to be over 50 percent. Yet nothing has been done to curb the production or sales of alcohol.

And in our social/public health context where we do not have enough facilities or psychologists to treat depression, you may be surprised to learn, as I was, that smoking cigarettes, in fact, has its benefits.

Cigarette smoking can have benefits to some – believe it or not.  The search for the Un-sticky Cigarette

Malcolm Gladwell is a renowned best-selling writer and having read his well-researched book, “The Tipping Point,” I have become convinced that at least in Bhutan, where our youth are suffering from depression and drug abuse, cigarette smoking has benefits.

In a chapter called “Case Study” Gladwell discusses Suicide, Smoking, and the Search for the Unsticky Cigarette.

“…I think there are two possibilities. The first can be found in the correlation between smoking and depression, a link discovered only recently…

There are a number of theories as to why smoking matches up so strongly with emotional problems. The first is that the same kind of things that would make someone susceptible to the contagious effects of smoking – low self esteem, say, or an unhealthy and unhappy home life – are also the kind of things that contribute to depression. More tantalizing though, is some preliminary evidence that the two problems might have the same genetic root. For example depression is believed to be the result, at least in part, of a problem production of certain key brain chemicals, in particular the neurotransmitters known as serotonin, dopamine, and norepinephrine.  These are the chemicals that regulate mood, that contribute to feelings of confidence and mastery and pleasure. Drugs like Zoloft and Prozac work because they prompt the brain to produce more serotonin: they compensate, in other words, for the deficit of Serotonin that some depressed people suffer from.

Nicotine appears to do exactly the same thing with the other two key neurotransmitters – dopamine and norepinephrine.

Those smokers who are depressed, in short, are essentially using tobacco as a cheap way of treating their own depression, of boosting the level of brain chemicals they need to function normally.  This effect is strong enough that when smokers with a history of psychiatric problems give up cigarettes, they run a sizeable risk of relapsing into depression.

Here is stickiness with a vengeance: not only do some smokers find it hard to quit because they are addicted to nicotine, but also because without nicotine they run the risk of debilitating psychiatric illness.

This is a sobering fact. But it also suggests that tobacco may have a critical vulnerability: if you can treat smokers for depression you may be able to make their habit an awful lot easier to break.”

There goes our Happiness

And so it got me thinking that in a country like ours where we have very high levels of depression (more on that later) and less than basic psychiatric care or facilities where people are left to self medicate with alcohol and drugs, smoking for now, would actually be more of a benefit rather than a hindrance.  It would be something to overlook for now, rather than take punitive measures against.  After all if our people can find a “cheap way of treating their own depression” as Malcolm says, then why stop it – unless we can, like other governments, provide alternate care?

In Bhutan there has been no study, but if one were to be conducted I am sure statistics would indicate a sharp increase in substance abuse among the youth and young adults since our ban on smoking laws came into effect.  I would rather have a relative smoke and feel good rather than have him/her abuse drugs or alcohol.  For which Bhutanese has not lost a relative or friend to either drugs or alcohol?

And if what Reuters reports is true – that the government can raid homes in the name of tobacco – then this means we have just set a dangerous precedent for things to come and the loss of yet some more of our freedom and our happiness.

Previously published at Sonam Ongmo’s blog on January 12, 2011. Shared here with permission.

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