Assignment

on
Climate change: An emerging issue in health
sector of Bangladesh

Submitted by
Dr. Samiha Kaisar
Roll: 115
Program: MPH (Occupational and Environmental Health)
Session: 2017-2018

Submitted to
Prof. Dr. Md. Anisur Rahman
Course-In-Charge
Department of Epidemiology

National Institute of Preventive & Social Medicine (NIPSOM)

Mohakhali, Dhaka-1212

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Table of Contents
1.0 Introduction ........................................................................................................ 3
2.0 Country situation and climate change context: Bangladesh .............................. 3
3.0 Burden and distribution of disease: Bangladesh scenario ................................. 4
3.1 Increasing frequency of heat waves ............................................................... 5
3.2 Variable precipitation patterns ....................................................................... 5
3.3 Malnutrition .................................................................................................... 5
3.4 Vector-borne diseases..................................................................................... 6
3.5 Rising sea level ................................................................................................ 6
4.0 Overall assessment of the disease burden in Bangladesh ................................. 6
5.0 Bangladesh’s response to its existing disease burden ....................................... 7
5.1 Health policies and strategies ......................................................................... 7
5.2 Organization of the health system .................................................................. 7
5.3 Health information system ............................................................................. 7
5.4 Community action ........................................................................................... 8
5.5 Emergency preparedness ................................................................................ 8
6.0 Health services .................................................................................................... 8
6.1 Health education and promotion.................................................................... 8
7.0 Prevention and control of locally endemic diseases .......................................... 8
7.1 Dengue ............................................................................................................ 8
7.2 Malaria ............................................................................................................ 9
7.3 Other diseases ................................................................................................. 9
8.0 Conclusion ........................................................................................................... 9
9.0 Recommendations ............................................................................................ 10
References ................................................................................................................... 11

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1.0 Introduction

Bangladesh is the most vulnerable country in the world to climate change as it is

situated on the largest delta in the world, and two-thirds of the country is less than
five meters above sea level. It is at risk of serious flooding as a consequence of
shrinking glaciers in the Himalayas, increased monsoon rainfall and sea level rise. Sea
level rise will increase salinity in coastal areas leading to drinking-water shortages
and reduce food production. Societal exposure to the impacts of climate change will
be exacerbated by widespread poverty, high population and population density. This
report will discuss the current issues of climate change in Bangladesh and its impact
on health sector in Bangladesh. Furthermore this report will critically evaluate the
country response towards the diseases in different sectors. Finally this report will
include some recommendations about the context.

2.0 Country situation and climate change context: Bangladesh

Health and wellbeing are the basic rights for all mankind depend largely on a healthy
biosphere with a stable ecosystem. These pillars of human health are at greater risk
due to climate change (Doha Declaration, 2012). The extent and severity of climate
change varies, however, it is extreme in some countries because of their
geographical position such as Bangladesh (Rahman et al., 2011). Due to its
geographical setting it is very easy to destroy and damage the ecological balance of
Bangladesh (Salequzzaman & Stocker, 2001). Bangladesh is a small country in South
Asia with a population of almost 162 million (WHO, 2011). Mountains and hills
covering three-fourths of the country and the funnel shaped Bay of Bengal in the
south have made the country more vulnerable to natural disaster. Bangladesh has
been plagued by innumerable natural disasters over the years. Tropical cyclones,
tidal surges, tornados, floods, droughts and river erosion are the main natural
disasters that the country has faced. The Bay of Bengal is one of the regions in the
world that is disposed to cyclone and the cyclonic disturbances; these are five to six
times higher in the Bay of Bengal compared to the Arabian Sea. This is due to the
fact that Sea Surface Temperature (SST) over the Arabian Sea is cooler than that of
the Bay of Bengal (Alam, 2012). According to UNDP (2010) statistics, about four

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percent of the world’s cyclones hit Bangladesh. Coastal areas, especially heavily
populated mega delta regions in South, East and South-East Asia, will be at greatest
risk due to increased flooding from the sea (IPCC, 2007). The Global Climate Risk
Index 2013 by German Watch (2012) listed Bangladesh in 4th position in the climate
risk index and the most vulnerable nation going to be affected by the changing
climate after Honduras, Myanmar and Nicaragua respectively. Bangladesh was hit by
the world’s most devastating cyclone to date in 1970, which caused 500000 deaths
(WHO & WMO, 2012). Higher population density increases vulnerability to climate
change especially water related disaster in Bangladesh (Agrawala et al., 2003). Over
a period of 100 years, 508 cyclones have affected the Bay of Bengal region, of which
17 percent made landfall in Bangladesh. A severe cyclone occurs almost once every
three years. Although the frequency of cyclones is not unusual compared to other
cyclone hotspot countries, the impact it causes stands out: 53 percent of the
cyclones that claimed more than 5,000 lives took place in Bangladesh (GOB, 2008).

3.0 Burden and distribution of disease: Bangladesh scenario

Bangladesh is vulnerable to outbreaks of infectious, waterborne and other types of

diseases (World Bank, 2000). Records show that the incidence of malaria increased
from 1556 cases in 1971 to 15 375 in 1981, and from 30 282 cases in 1991 to 42 012
in 2004 (WHO, 2006). Other diseases such as diarrhea and dysentery, etc. are also on
the rise especially during the summer months. It has been predicted that the
combination of higher temperatures and potential increase in summer precipitation
may cause the spread of many infectious diseases [Ministry of Environment and
Forests (MoEF), Bangladesh]. Climate change also brings about additional stresses
like dehydration, malnutrition and heat-related morbidity especially among children
and the elderly. These problems are thought to be closely interlinked with water
supply, sanitation and food production. Climate change has already been linked to
land degradation, freshwater decline, biodiversity loss and ecosystem decline, and
stratospheric ozone depletion. Changes in the above factors may have a direct or
indirect impact on human health as well. Bangladesh also carries the burden of high
population, natural disasters and diminishing and polluted natural resources. The
added burden of increased health problems, possibly due to climate change and
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climate variability, will push back its developmental achievements. Public health
depends on safe drinking water, sufficient food, secure shelter and good social
conditions. A changing climate is likely to affect all of these conditions. The health
effects of a rapidly-changing climate are likely to be overwhelmingly negative,
particularly in the poorest communities. Some of the health effects of climate
change include:

3.1 Increasing frequency of heat waves

Recent analyses show that human induced climate change contributed significantly
to the occurrence of the European summer heat wave of 2003 and of 2007. This has
implications for Bangladesh since the elderly and children suffer the most from
increased temperatures. Even though no formal study on increase of heat waves in
Bangladesh has been undertaken, we are already observing yearly trends in rise in
temperatures. The health impacts associated with heat waves are heat stroke,
dehydration and aggravation of cardiovascular diseases in elderly people. It is also to
be noted that Bangladesh does not have records on illnesses and deaths related to
heat waves. However, it was generally observed that prevalence of diarrheal
diseases increased during extreme temperatures and heat waves, particularly in
children.

3.2 Variable precipitation patterns

Changes in precipitation patterns are likely to compromise the supply of fresh water,
thus increasing the risk of waterborne diseases. They are also associated with floods
and waterlogging that increase the incidence of diarrhea, cholera and skin and eye
diseases. Agricultural production and food security are also linked directly to
precipitation patterns – this impacts the nutritional status of the population.

3.3 Malnutrition

Rising temperatures and variable precipitation are likely to decrease agricultural

production, thereby increasing the risk of malnutrition. Malnutrition will further

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increase the vulnerability of those affected to infectious and water- and vector-
borne diseases.

3.4 Vector-borne diseases

Changes in climate are likely to lengthen the transmission seasons of important

vector-borne diseases, and alter their geographic range. Already, dengue is a regular
disease in the major cities of Dhaka and Chittagong.

3.5 Rising sea level

These increase the risk of coastal flooding, and may necessitate population
displacement, and cause many other health-related problems such as cholera,
diarrhea, malnutrition and skin diseases, etc. More than half of the world's
population now lives within 60 km of the sea. Some of the most vulnerable regions
are the Nile delta in Egypt, the Ganges-Brahmaputra delta in Bangladesh, and many
small islands, such as Maldives, and the Marshall Islands and Tuvalu in the Pacific
Ocean.

In Bangladesh, millions of people suffer from diarrhea, skin diseases, malaria, mental
disorders and dengue, etc. A recent study carried out jointly by the BCAS and the
National Institute of Preventive and Social Medicine (NIPSOM) in 2007 indicated that
the annual incidence of diarrhea was 28 41 273 cases during the period 1988– 2005
and that of skin diseases was 26 23 092 cases during 1998–1996. Other health
problems such as malnutrition, hypertension and kala-azar also affect people of
different regions of the country. The following table shows the incidence of some of
the major climate-sensitive diseases and their trend during the last few decades.

4.0 Overall assessment of the disease burden in Bangladesh

Since the country’s independence more than 30 years ago, the Government of
Bangladesh has invested substantially in the institutionalization and strengthening of
health and family planning services, with special attention to rural areas, and is
committed to the key health-for-all (HFA) and primary health care (PHC) approaches.
Over the last 30 years there has been substantial improvement in the health status

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of the people. However, despite these improvements, much still remains to be done.
Mortality rates, especially infant and maternal, continue to be unacceptably high.
The quality of life of the general population is still very low. Low calorie intake
continues to result in malnutrition, particularly in women and children. Diarrheal
disease continues to be the major killer. Communicable and poverty-related diseases
that are preventable still dominate the top ten causes of morbidity. The government
is aware of the situation, as well as of the major shortcomings that need to be
addressed, such as development of an efficient project management mechanism
across the health system; improvement in the logistics of drug supplies and
equipment to health facilities at district and lower levels; improvement in the
production and quality of human resources; a system to ensure regular maintenance
and upkeep of existing health facilities; and development of a comprehensive plan to
improve and ensure the quality of health resources.

5.0 Bangladesh’s response to its existing disease burden

5.1 Health policies and strategies

The cornerstone of Bangladesh’s national health policy is the Health and Population
Sector Strategy (HPSS) which was introduced in 1998. The priority of the strategy is
to ensure universal accessibility to and equity in health care, with particular
attention to the rural population. The progress being made towards achievement of
the health-related Millennium Development Goals (MDGs) is given below:

5.2 Organization of the health system

Committees have been formed, including an inter-ministerial committee, to

integrate/merge the health and family planning departments. Functionally, health
and family planning personnel work closely at Thana, union and outreach levels.

5.3 Health information system

Weekly epidemiological surveillance and outbreak control reporting system for

selected communicable diseases have been initiated throughout the country. The
routine Health Management Information System (HMIS) is functioning with some

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limitation, though activities have been undertaken to strengthen it. Information
support is not yet adequate. The use of data remains limited.

5.4 Community action

The roles of the individual, family and community are emphasized in the intensified
action program for PHC implementation, which involves decentralized planning at
Thana and union levels.

5.5 Emergency preparedness

Currently, there is no legislation in the country that underpins the management of

natural disasters at national and sub-national levels. In the absence of any
legislation, the Ministry of Disaster Management and Relief in 1997 issued revised
"standing orders for disasters." These “orders” provide guidelines and instructions to
various line departments and ministries.

6.0 Health services

6.1 Health education and promotion

Educational support to national health programs has been provided by the Health
Education Bureau (HEB). In recent years emphasis has been on school health
education, hospital health education and coordination with nongovernmental
organizations (NGOs). Constraints include the lack of a national IEC strategy, the low
priority given to health education by health services, underutilization of health
education officers.

7.0 Prevention and control of locally endemic diseases

7.1 Dengue

Dengue was an unfamiliar disease in Bangladesh till its outbreak in the summer of
2000. It started as an acute febrile illness in three major cities of Bangladesh (Dhaka,
Chittagong and Khulna) with the highest incidence being in the Dhaka district. People
of all ages and both sexes are susceptible to dengue. The infection can lead to the

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fatal dengue shock syndrome (DSS). This vector borne disease is transmitted by
certain species of Aedes mosquito.

7.2 Malaria

In 1992 an epidemiological follow-up found that the resistance of Plasmodium

falciparum to a number of antimalarial drugs was increasing and that in relation to
1982 the number of malaria cases had doubled. The government introduced a
National Guideline for Treatment of Malaria in 1994, which was revised in 2004.
Statistics from 2001 to 2005 show a marked increase in the proportion of
Plasmodium falciparum cases every year.

7.3 Other diseases

Kala-azar has reemerged since the cessation of dichlorodiphenyltrichloroethane

(DDT) spraying operations. At least 20 million people in more than 27 districts are at
risk. The estimated cumulative disease-specific burden is 35 000 cases. Under the
project for integrated control of vector-borne diseases, an emergency plan for the
control of kala-azar was initiated in 1994–1995 in 22 thanas of 11 districts
(population five million). The plan was successful and further expansion is now being
planned. At least 8000 kala-azar patients have been successfully treated to date.

8.0 Conclusion

Bangladesh is one of many countries already facing enormous challenges due to

extreme events such as droughts and land and coastal flooding. Added to these
challenges are demographic and socio-economic factors, such as rapid population
growth and fast urbanization, poverty, poor health conditions, water scarcity, and
inadequate sanitary conditions. Climate change is, therefore, an additional stressor
that is expected to increase the burden of diseases, notably through increased
morbidity and mortality. Bangladesh is particularly vulnerable to outbreaks of
infectious, water-borne, and vector-borne diseases. These risks and diseases are not
new, and the health sector is already tackling them. However, the capacity to cope
with potentially increasing levels of risks and diseases arising from climate change is

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still limited in Bangladesh. Furthermore, there is insufficient capacity for assessment,
research, and communication on climate-sensitive health risks, as well as insufficient
capacity to design and implement mitigation and adaptation programs.

9.0 Recommendations

 Firstly, there is an urgent need in Bangladesh to incorporate health concerns

into the decisions and actions of sectors, as they plan to mitigate and adapt
to climate change, so that these decisions and actions enhance health.
Measures to mitigate the adverse health impacts of climate change need to
be considered beyond the health sector: for example, integrating health
sector, water and sanitation, urban planning, a weather early warning
system, and a disaster management system. Resources should be spatially
targeted to reach the most vulnerable locations that are likely to be at high
climate and health risk to ensure cost-effectiveness.
 Second, policy makers need to recognize the full scale of the health threat as
a result of rapid but poorly planned urbanization and act quickly on the issue
of inadequate safe water and sanitation services, particularly in urban slum
areas with the fastest population growth. The evidence of poor geographic
targeting of past public investment in health and environmental
infrastructure highlights the need to develop a comprehensive spatial
database—at a disaggregate level such as in rural areas and slum and non-
slum locations in urban areas—for monitoring and improving spatial
targeting.
 Third, despite several decades of experience in programs and projects
designed to improve health in Bangladesh, evidence on the cost-effectiveness
of different interventions is lacking. Significant financial resources will be
committed to climate change adaptation and resilience from programs, and
cost-effectiveness analysis should be conducted routinely when allocating
resources to programs and projects, both by government units and by
development partners.

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References

Agrawala, S., Ota, T., Ahmed, A. U., Smith, J., & Aalst, M. (2003). Development and
Climate Change in Bangladesh: Focus on the Coastal Flooding and Sundarban. OECD,
Head of the publication service, 75775 Paris, Cedex 16, France.

Alam, M, S. (2012). Tropical Cyclones in Bangladesh. Edited By Ahmed, R., &

Shamsuddin, S.D. in Climate Change: Issues and Perspective for Bangladesh. Shahitya
Prakash, Dhaka, Bangladesh.

Doha, D. (2012). Health must be central to climate action, COP18, December 2012.
[Online]. Available from: http://dohadeclaration.weebly.com [Accessed date
08/12/2012]

German watch. (2012). Global Climate Risk Index 2013. Bonn,Germany.

GoB. (2008). Super Cyclone Sidr 2007: impacts and strategies for interventions.
Dhaka.

IPCC. (2007). Climate change 2007: Impacts, adaptation and vulnerability.

Contribution of working group II to the Fourth Assessment Report of the
Intergovernmental Panel on Climate Change. M.L. Parry, O.F. Canziani, J.P. Palutikof,
P.J. van der Linden, C.E. Hansson (Eds.). Intergovernmental Panel on Climate Change
(IPCC), Cambridge University Press, New York.

Rahman, M. S., Haque, M. M., & Khan, M. B. K. (2011). Perception on Climate

Change: An Exploratory Study on Urban Citizens. European Journal of Economics,
Finance and Administrative Sciences, 31, 17-30.

Salequzzaman, M., & Stocker, L. (2001). The context and prospects for
environmental education and environmental careers in Bangladesh. International
Journal of Sustainability in Higher Education, 2(2), 104-127.
http://dx.doi.org/10.1108/14676370110388309

UNDP. (2010). UNDP Bangladesh [Online]. Available from

http://www.undp.org.bd/info/events. hp?newsid=720. [Accessed date 13/09/2011].

WHO & WMO. (2012). Atlas of health and climate. Geneva, Switzerland, WHO.

WHO. (2011). WHO Bangladesh. [Online] Available from:

http://www.who.int/countries/bgd/en/ [Accessed date 12/09/2011]

WHO. (2006). Protecting Health from Climate Change: Connecting Science, Policy
and People. Geneva, Switzerland: World Health Organization.

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