Dr. Forqan Uddin Ahmed :
In South-East Asia, the main public health issues are infectious diseases and communicable diseases. Public health has improved markedly in Bangladesh over the past three decades. Nevertheless, Bangladesh faces major health challenges. Bangladesh has one of the worst burdens of childhood malnutrition in the world. Communicable diseases are a major cause of death and disability in Bangladesh. Unsafe food remains a major threat to public health each year; citizens suffer from the acute effects of food contaminated by microbial pathogens, chemical substances and toxins. Bangladesh still ranks among the top ten countries in the world with the highest TB burden. Pneumonia and other infections are major causes of death among young children. In Bangladesh, only 1% of the population is reported to be HIV-positive, but rates are much higher among high-risk populations: injecting drug users, sex workers, and men who have sex with men. The toll of non-communicable diseases-chronic diseases, cancer, diabetes, cardiovascular diseases, and chronic respiratory diseases – is increasing in Bangladesh as the population becomes more urbanized. The converging pressures of global climate change and urbanization have a devastating effect on Bangladesh’s most vulnerable populations. The disease burden Bangladesh is further exacerbated by unsanitary living conditions that underscore the poor economic conditions of both urban and rural home dwellers.
There are still several issues that Bangladesh health care system is yet to tackle governance, accessibility, and affordability are key issues that are preventing the implementation of solutions to the public health issues in Bangladesh. ICDDRB, WHO, and several other global organizations are making attempt to aid Bangladesh in resolving its health problems. The converging pressures of global climate change and urbanization have a devastating effect on Bangladesh’s most vulnerable populations. At this moment, millions of people in the country are exposed to extremely high food and water-borne disease risks such as bacterial and protozoal diarrhea, Hepatitis A and E, and typhoid fever. The disease burden Bangladesh is further exacerbated by unsanitary living conditions that under-score the poor economic conditions of both urban and rural home dwellers. Sadly, these poor health outcomes disproportionately affect children under the age of five years, causing widespread morbidity and mortality; the second leading cause of death in children under five is diarrheal disease.
It is now widely accepted that climate change is occurring because of the accumulation of greenhouse gases in the atmosphere arising from the combustion of fossil fuels. Climate change may affect health through a range of pathways, for example as a result of increased frequency and intensity of heat waves, reduction in cold related deaths, increased floods and droughts, changes in the distribution of vector-borne diseases and effects on the risk of disasters and malnutrition. The overall balance of effects on health is likely to be negative and populations in low-income countries are likely to be particularly vulnerable to the adverse effects. The experience of the 2003 heat wave in Europe shows that high-income countries may also be adversely affected. Adaptation to climate change requires public health strategies and improved surveillance. Mitigation of climate change by reducing the use of fossil fuels and increasing a number of uses of the renewable energy technologies should improve health in the near-term by reducing exposure to air pollution.
A good system of regulation is fundamental to successful public health outcomes. It reduces exposure to disease through enforcement of sanitary codes, e.g., water quality monitoring, slaughterhouse hygiene and food safety. Wide gaps exist in the enforcement, monitoring and evaluation, resulting in a weak public health system. This is partly due to poor financing for public health, lack of leadership and commitment of public health functionaries and lack of community involvement. Revival of public health regulation through concerted efforts by the government is possible through updation and implementation of public health laws, consulting stakeholders and increasing public awareness of existing laws and their enforcement procedures.
There are several shortfalls that-need to be addressed in the development of human resources for public health services. There is a dire need to establish training facilities for public health specialists along with identifying the scope for their contribution in the field. The Public Health Foundation of India is a positive step to redress the limited institutional capacity in India by strengthening training, research and policy development in public health. Preservice training is essential to train the medical workforce in public health leadership and to impart skills required for the practice of public health. Changes in the undergraduate curriculum are vital for capacity building in emerging issues like geriatric care, adolescent health and mental health. Inservice training for medical officers is essential for imparting management skills and leadership qualities. Equally important is the need to increase the number of paramedical workers and training institutes in Bangladesh.
Identification of health objectives and targets is one of the more visible strategies to direct the activities of the health sector, e.g. in the United States, the “Healthy People 2010” offers a simple but powerful idea by providing health objectives in a format that enables diverse groups to combine their efforts and work as a team. Similarly, in India, we need a road map to “better health for all” that can be used by states, communities, professional organizations and all sectors. It will also facilitate changes in resource allocation for public health interventions and a platform for concerted intersectoral action, thereby enabling policy coherence.
In this changing world, with unique challenges that threaten the health and well-being of the population, it is imperative that the government and community collectively rise to the occasion and face these challenges simultaneously, inclusively and sustainably. Social determinants of health and economic issues must be dealt with a consensus on ethical principles – universalism, justice, dignity, security and human rights. This approach will be of valuable service to humanity in realizing the dream of Right to Health. The ultimate yardstick for success would be if every Indian, from a remote hamlet in Bihar to the city of Mumbai, experiences the change.
It is true that a lot has been achieved in the past. The milestones in the history of public health that have had a telling effect on millions of lives- launch of Expanded Program of Immunisation in 1974, Primary Health Care enunciated at Alma Ata in 1978, eradication of Smallpox in 1979, launch of polio eradication in 1988, FCTC ratification in 2004 and COTPA Act of 2005, to name a few. It was a glorious past, but the future of a healthy India lies in mainstreaming the public health agenda in the framework of sustainable development. The ultimate goal of great nation would be one where the rural and urban divide has reduced to a thin line, with adequate access to clean energy and safe water, where the best of health care is available to all where the governance is responsive, transparent and corruption free, where poverty and illiteracy have been eradicated and crimes against women and children are removed – a healthy nation that is one of the best places to live in.
(Dr. Forqan Uddin Ahmed, writer, columnist and researcher)
