Healthcare and happiness in the Kingdom of Bhutan.

Bhutan is a small landlocked country measuring 38,394 km2,(1) with a population of 745,153.(2) It recently celebrated 108 years of monarchy; however, the country introduced its first constitution in 2008.(3) When the current King of Bhutan, Jigme Khesar Namgyel Wangchuck, was crowned in 2008, Bhutan was transformed into a unitary parliamentary constitutional monarchy.(2) The second and reigning Prime Minister of Bhutan, and the political head of the country, is Tshering Tobgay. Bhutan is divided into three regions (Western, Central and Eastern) and has 20 districts called dzongkhags. Bhutan’s currency is the ngultrum (Nu) and its value is on par with and pegged to the Indian rupee. The major sectors that contribute to Bhutan’s economy are tourism, agriculture, forestry and the sale of hydroelectric power. According to the 2011 National Health Accounts, its gross domestic product (GDP) per capita was USD 2,121.(2) Bhutan is known for measuring its happiness with the Gross National Happiness (GNH) Index.The term was coined by the fourth king of Bhutan, Jigme Singye Wangchuck, in 1972 to show his commitment toward building the economy in a sustainable manner, based on Buddhist spiritual values and well-being.(4) The Constitution of Bhutan also expresses the importance of GNH, as it states “the state shall strive to promote those conditions that will enable the pursuit of Gross National Happiness”.(5) GNH has four underpinning pillars and nine domains (Fig. 1).(4)Fig. 1Flowchart shows the four pillars of Gross National Happiness (GNH).In 2010, the following nine domains and their respective indicators were developed:(3)Psychological well-being: life satisfaction, positive emotions, negative emotions, spirituality.Standard of living: assets, housing, household income per capita.Good governance: government’s performance, fundamental rights, services, political participation.Health: mental health, self-reported health status, healthy days, disability.Education: literacy, schooling, knowledge and value.Community vitality: donations (time and money), community relationships, family, safety.Cultural diversity and resilience: speak native language, cultural participation, artistic skills and Driglam Namzha (social etiquette).Time use: work and sleep.Ecological diversity and resilience: ecological issues, responsibility towards environment, wildlife damage (rural), urbanisation issues.