There is substantial evidence that Bangladesh lacks policies and programmes to make the public health systems management more effective. Many countries consider a good health policy a part of a good economic policy.
Although Bangladesh has major health challenges, the country has been transformed from being a 'basket case' to an example of 'good health at low cost'. Childhood malnutrition, communicable and non-communicable diseases, mental health issues, unsafe and contaminated foods are among the few of many health challenges Bangladesh is facing.
The Covid-19 pandemic is a global challenge, for now, requiring an immediate remedy. However, the most important health challenges worldwide are non-communicable diseases (NCDs), which are responsible for seven out of 10 deaths around the world. Cardiovascular diseases, cancers, diabetes and chronic lung diseases are the four main NCDs, and together they are globally responsible for over 80 percent of all NCDs related to premature deaths.
The prevalence of NCDs in low and middle-income countries is rising rapidly and causing around 75 percent of all deaths. The NCDs account for an estimated 60 percent (886,000) of total deaths in Bangladesh in a year. In Bangladesh, around 20 percent of men and 32 percent women have hypertension.
Over seven million people are suffering from diabetes in the country. There are also around 3.7 million undiagnosed diabetes cases. In 2015, the disease caused around 127,000 deaths in Bangladesh.
Globocan, a global cancer research project, reported that every year around 150,000 people are diagnosed with cancer in Bangladesh while only one-third of the patients receive treatment. Some 108,137 people died of cancer in 2018 in the country. The World Health Organization (WHO) recommends a cancer centre for every 10 million people, but Bangladesh has only 18 cancer centres.
The Global Initiative for Chronic Obstructive Lung Disease has estimated 12.5 percent prevalence of chronic obstructive lung diseases (COPD) in Bangladesh. Some of the known contributors to the high prevalence of COPD in Bangladesh are outdoor air pollution, smoking habit and indoor air pollutions from biomass fuel burning. According to the WHO, in 2018, lung disease deaths in Bangladesh reached 64,762 or 8.34 percent of total deaths.
Chronic kidney diseases (CKD) are another cause of premature deaths. According to the Kidney Foundation, out of about 18 million CKD patients, around 35,000-40,000 develop kidney failure in Bangladesh. Due to a lack of proper medical facilities and professionals to treat CKD, the majority of the patients fail to continue their treatment. Just after six months of dialysis, 75 percent patients cannot afford to meet the cost of dialysis and discontinue treatment.
A recent report has identified that household expenditure on the medical care of NCD-affected families is around 6.7 percent point higher than households with no reported conditions.
To meet the treatment cost, 85 percent of NCD-affected families are more likely to sell assets or borrow money from informal sources which usually ends up with catastrophic results for the future of the family. The impact of NCDs on the national economy, families and individuals is unbearable, which will become more catastrophic in coming years if no action is taken.
Policies and programmes to support the preventive actions for the management and treatment of NCDs are unfortunately lacking. Prevention about healthcare is the avoidance of disease before it starts, i.e. an action or plan or measures to prevent the onset of a disease or other health conditions before the occurrence of an undesirable health event.
Preventative measures are also early diagnosis and prompt treatment of a disease or illness to prevent further development of the problems such as screening for high blood pressure, breast self-examination etc.
A healthy lifestyle is the most effective preventative action. A healthy lifestyle can be built through reducing smoking and alcohol use, tackling obesity, identifying appropriate food and nutrition, avoiding excess sugar, salt and fat, conducting more physical activities and exercise.
A food policy, promoting and advocating healthier food, should be formulated to facilitate healthy lifestyle activities for all citizens. Measures are also needed to be supported for tackling marketing, advertising or sponsoring of unhealthy foods.
Health education for all ages is one of the key elements of prevention. Promoting the health of our children along with teaching them health education could prepare them to make informed decisions about prevention, self-care and wellbeing in their future life. Our school infrastructures, particularly in urban areas, are not children-friendly and lack facilities for the child's physical activities.
Moreover, health education is almost absent in the school syllabus. Therefore proper policies and programmes should be taken to build a healthy future generation.
Research focuses and initiatives are also required to identify the NCD conditions. With poor urban planning, we struggle to cater to a healthy lifestyle. Healthier and more sustainable communities could be created using appropriate urban planning.
Preventive healthcare is always neglected and poorly funded in Bangladesh. However, a minor rise in prevention funding will result in considerable health gains and potentially will reduce future health care costs.
Establishment of a body or taskforce to identify national health priorities and develop a national preventative health strategy is now an urgent need to address the health challenges and better manage the public health system.
Effective policies and preventative health programmes are critical to help citizens improve their health at all stages of life, through early intervention, better information, and targeting risk factors.
Dr Ezaz Mamun is a policy scientist and columnist.