Investigator(s)
| Submitter |
ugyen dem JDWNRH KGUMBS ugyen dem 
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| Principal Investigator |
ugyen dem JDWNRH KGUMBS ugyen dem
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| Co-Investigator(s) |
Bikram Chhetri JDWNRH Bikram Chhetri
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| Co-Investigator(s) |
Sonam Choden Rinchen KGUMSB Sonam Choden Rinchen
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| Co-Investigator(s) |
Ngawang Samten JDWNRH Ngawang Samten
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| Co-Investigator(s) |
Kelzang Gyeltshen JDWNRH Kelzang Gyeltshen
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| Co-Investigator(s) |
choki yonten JDWNRH choki yonten
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Title(s) and abstract
| Scientific title | Rapid Ethnographic Assessment of Alcohol Access, Use, and Perceptions in Bhutan |
| Public title | Rapid Ethnographic Assessment of Alcohol Access, Use, and Perceptions in Bhutan |
| Background | Bhutan faces a substantial public health burden from alcohol consumption. Alcohol consumed per capita was estimated at 4.4 litres of pure alcohol in 2022, exceeding the regional average of 3.6 litres, with 39.8 % of drinkers reporting heavy drinking in 2023 (World Health Organization, 2025). Alcohol-related diseases rank among the top ten causes of morbidity and mortality in Bhutan (Wangdi and Jamtsho, 2019). Alcohol-related liver disease (ALD) is particularly lethal (Ministry of Health, 2024), accounting for approximately 15 % of all deaths between 2014 and 2016, and representing 97 % of deaths from liver diseases in 2016 (Wangchuk, 2018). Alcohol is deeply embedded in Bhutanese cultural and social practices, often being offered during rituals and celebrations. More than 30% of households report home-brewing unregulated alcohol beverages, such as Ara (World Health Organization, 2025), which may contribute to increase the risk of alcohol-related harm. In January 2026, the Government of Bhutan is scheduled to implement a new excise tax on specific goods, including an additional Nu1,200 per litre of pure alcohol content in alcohol beverages (National Assembly of Bhutan, 2025). Increasing taxes on alcoholic beverages is internationally recognized as one of the most cost-effective policy measures for reducing alcohol consumption while simultaneously generating tax revenue to strengthen health financing (World Health Organization, 2017; Akter et al., 2025). However, the cost-effectiveness of such a policy critically depends on social context in which the tax is implemented (Isaranuwatchai et al., 2020). In the context of Bhutan, the potential responses of alcohol consumers, their families, and the wider community to the policy remain unclear. From an institutional and public health perspective, the health effect of the tax can be mitigated by unintended changes in alcohol consumption patterns through substitution towards higher-strength beverages or increased reliance on untaxed home-brewed alcohol. The tax could also lead to an increased proportion of household exp |
| Objectives | Using a rapid ethnographic assessment approach (REA), the primary objective of this study is to qualitatively examine, prior to the implementation of the alcohol tax in Bhutan how alcoholic beverages are obtained (either purchased or home-brewed) and used, and how their cultural and health-related implications are perceived by alcohol consumers, their families, and the wider community (including, but not limited to, shop keepers, hospital managers, primary care facility managers, local administration, and religious leaders). In addition, we will assess perceptions of how these aspects may change following the introduction of the alcohol tax. |
| Study Methods | Rapid ethnographic assessments (REA) provide a way of quickly learning about people’s daily lives, habits, and opinions by spending time in their communities and talking directly with them (Bond et al., 2023). REA will typically take 10 to 15 days. For these REA we will focus on understanding how alcohol is purchased/brewed and consumed in real life, from the point of view of the people living in the communities where we conduct the study. In Bhutan, before the new alcohol tax begins, the REA can help us find out how alcoholic drinks are made, bought, and used, and how people see their cultural and health impacts. This is especially important because home-brewed drinks are a part of many celebrations and may not be taxed under the new law. This information can help inform how the policy may work as intended and avoids unexpected problems, like people switching from taxed commercial drinks to untaxed home-brewed ones. The assessment will be carried out in three study sites, with one community selected from each of western, central, and eastern Bhutan. For study site selection, we will first identify patients with alcohol-related disorders from referral hospitals in the three regions. We will then randomly select one study site from each region within the patient’s district or region of residence. This approach ensures that study areas are selected where alcohol-related disorders are prevalent, while also reducing the risk of breaching confidentiality. Specifically, the REA will involve the following steps (total 10 to 15 days for each community): 1. Pre-fieldwork Method: Review administrative records, published and unpublished research, and mapping resources to gather background information. Identify contextual factors relevant to alcohol production, consumption, and health impacts. Consult with local leaders and organisations to locate additional documents. Participants: None 2. Community-representatives group discussion Method: Conduct a group discussion with approximately 10 community representatives to produce a participatory map of key alcohol-related loc |
| Expected outcomes and use of results | Using a rapid ethnographic assessment approach (REA), the primary objective of this study is to qualitatively examine, prior to the implementation of the alcohol tax in Bhutan how alcoholic beverages are obtained (either purchased or home-brewed) and used, and how their cultural and health-related implications are perceived by alcohol consumers, their families, and the wider community (including, but not limited to, shop keepers, hospital managers, primary care facility managers, local administration, and religious leaders). In addition, we will assess perceptions of how these aspects may change following the introduction of the alcohol tax. |
| Keywords | Rapid Ethnographic Assessment, Alcohol, Bhutan |
Research Details
| Student research | No |
| Start Date | 05-Nov-2025 |
| End Date | 30-Apr-2026 |
| Key Implementing Institution | London school of tropical medicine |
| Multi-country research | No |
| Nationwide research | Yes, with randomly selected geographical areas |
| Bhutan, Bhutan, Bhutan | |
| Research Domain(s) | Non-communicable diseases & Healthy Lifestyles |
| Research field(s) | Other (RAPID ETHANOGRAPHY ASSESSMENT ON ALCOHOL USE IN BHUTAN) |
| Involves human subjects | Yes |
| Qualitative Study | |
| Data Collection | Primary and secondary data |
| Proposal reviewed by other Committee | Approved |