Climate change and its impact on health in Bangladesh
Climate change affects human health both
directly and indirectly. People are exposed
This background paper was prepared for a
workshop on Climate Change and Health in
(temperature, precipitation, sea-level rise and
Bangladesh, held on 19–20 November 2007
more frequent extreme events) and indirectly
through changes in the quality of water, air and
jointly by the World Health Organization
food, and changes in ecosystems, agriculture,
industry, human settlements and the economy.
These direct and indirect exposures can cause
death, disability and suffering. Health problems
background paper was to facilitate discussion
increase vulnerability and reduce the capacity of
during workshop by providing latest scientific
individuals and groups to adapt to climate
assessment on: climate change and health;
change. At present the effects of climate change
burden and distribution of health impact in
Bangladesh related to climate change and
progressive increase in all countries and
extreme weather events; existing response
and human health is multidimensional, as
presented schematically in the diagram on page 23.
The recently-published Fourth Assessment
change effects on human health (IPCC 2007)
Report (AR4) of the Intergovernmental Panel
on Climate Change (IPCC) states clearly that
climate change is contributing to the global
• altered the seasonal distribution of
sustainable development and includes physical, social and psychological well-being,
it is crucial that the health impacts of climate
provide the best evidence for the relationship
between health and weather or climate factors, but such formal reviews are rare. The
*Executive Director, Bangladesh Centre for Advanced
evidence published so far indicates that:
Regional Health Forum – Volume 12, Number 1, 2008 Figure: Relationship between climate change and human health
2003). The health outcomes included in the
seasonality of some allergenic study were chosen on the basis of their known
sensitivity to climate variation, predicted
quantitative global models (or the feasibility
• climate plays an important role in the
of constructing them). The following health
seasonal pattern or temporal outcomes were included:
• cases of Plasmodium falciparum
regional and global levels was carried out by
morbidity and mortality due to a range of risk
factors, including climate change, and to
estimate the benefit of interventions to
health impacts will be the greatest in low-
remove or reduce these risk factors. The study
include, in all countries, the urban poor, the
estimated to have caused the loss of over
elderly and children, traditional societies,
160 000 lives annually. (Campbell-Lendrum
subsistence farmers and coastal populations.
et al., 2003; Ezzati et al., 2004; McMichael,
2004). The assessment also addressed the
level of future burden of climate change that
the burden of diarrhoeal diseases in low-
could be avoided by stabilizing greenhouse
income regions by approximately 2% to 5%
Regional Health Forum – Volume 12, Number 1, 2008
domestic product per capita of US$ 6000 or
more are assumed to have no additional risk
mortality due to diarrhoeal disease primarily
following measures be taken to address the
expected to rise in East, South and South-East Asia due to projected changes in the
• The planning horizon of public health
hydrological cycle associated with global
coastal water temperature would exacerbate
the abundance and/or toxicity of cholera in
that focus only on short-term risks will need to be modified.
vector-borne viral disease. Several studies
spatial, temporal or spatiotemporal pat erns
of dengue and climate (Hales et al., 1999;
Corwin et al., 2001; Gagnon et al., 2001;
Cazelles et al., 2005). The IPCC report also
states that approximately one third of the
world’s population lives in regions where the
climate is suitable for dengue transmission.
Malaria is a complex disease to model –
all published models have limited parameters
for some of the key factors that influence the
geographical range and intensity of malaria
transmission. Given this limitation, models
project that, particularly in Africa, climate
change wil be associated with geographical
malaria (Plasmodium falciparum) in some
regions and with contractions in other regions
(Tanser et al., 2003; Thomas et al., 2004;
Ebi et al., 2005). Some projections also
suggest that some regions will experience a
longer season of transmission. Although an
increase in the number of months per year of
transmission does not directly translate into an increase in malaria burden (Reiter et al.,
2004), it would have important implications
because the health of populations is an important element of adaptive capacity.
prominent if public health systems are not
efficient or if new pathogens arise that are
everywhere in the world. Recent impacts of
resistant to our current methods of disease
hurricanes and heat waves have shown that
control, leading to falling life expectancies
Regional Health Forum – Volume 12, Number 1, 2008
and reduced economic productivity. The total
likely to affect all of these conditions. The
number of people at risk, the age structure of
health effects of a rapidly-changing climate
the population and the density of settlements
are likely to be overwhelmingly negative,
are important variables in any projection of
particularly in the poorest communities.
• Increasing frequency of heat waves:
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
2004 (WHO, 2006). Other diseases such as
diarrhoea and dysentery, etc. are also on the
rise especial y 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
about additional stresses like dehydration,
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
• Variable precipitation patterns:
decline, and stratospheric ozone depletion.
direct or indirect impact on human health as
fresh water, thus increasing the risk of
diminishing and polluted natural resources.
problems, possibly due to climate change
and climate variability, will push back its
to precipitation patterns – this impacts
water, sufficient food, secure shelter and
• Malnutrition: Rising temperatures and
good social conditions. A changing climate is
Regional Health Forum – Volume 12, Number 1, 2008 Table: Incidence of some of the major climate-sensitive diseases occurring during the last few decades in Bangladesh
malnutrition. Malnutrition will further increase the vulnerability of those
• Vector-borne diseases: Changes in
is a regular disease in the major cities
• Rising sea levels: These increase the
Source: Data modified from WHO, 2006; Director-General, Health (Bangladesh); 1996, 1997; MoEF,
and cause many other health-related problems such as cholera, diarrhoea,
Overall assessment of the disease burden
malnutrition and skin diseases, etc. More than half of the world's
Since the country’s independence more than
30 years ago, the Government of Bangladesh
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
In Bangladesh, millions of people suffer
years there has been substantial improvement
in the health status of the people. However,
mental disorders and dengue, etc. A recent
despite these improvements, much still remains
study carried out jointly by the BCAS and the
to be done. Mortality rates, especially infant
National Institute of Preventive and Social
and maternal, continue to be unacceptably
Medicine (NIPSOM) in 2007 indicated that
high. The quality of life of the general
population is still very low. Low calorie intake
28 41 273 cases during the period 1988–
continues to result in malnutrition, particularly
in women and children. Diarrhoeal disease
26 23 092 cases during 1998–1996. Other
continues to be the major killer. Communicable and poverty-related diseases
that are preventable still dominate the top ten
hypertension and kala-azar also affect people
of different regions of the country. The following table shows the incidence of some
The government is aware of the situation,
of the major climate-sensitive diseases and
as well as of the major shortcomings that need
their trend during the last few decades.
to be addressed, such as development of an efficient project management mechanism
Regional Health Forum – Volume 12, Number 1, 2008
across the health system; improvement in the
chaired by the Prime Minister. At district and
logistics of drug supplies and equipment to
thana levels, intersectoral coordination
health facilities at district and lower levels;
committees have been organized, while at
improvement in the production and quality of
the lowest administrative level (union),
human resources; a system to ensure regular
intersectoral committees have been formed,
maintenance and upkeep of existing health
comprehensive plan to improve and ensure
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, but a dichotomy exists at
district and national levels. As a result, greater decentralization of management is
The cornerstone of Bangladesh’s national
health policy is the Health and Population
Sector Strategy (HPSS) which was introduced in
decided to formulate a national health policy
1998. The priority of the strategy is to ensure
in 1997, for which a health policy committee
universal accessibility to and equity in health
and five subcommittees were formed. This
care, with particular attention to the rural
population. The Maternal and Child Health
resulted in a change from a “top-down”
(MCH) programme receives priority in the
planning process for health to a participatory
public sector while “reproductive health” has
approach involving the stakeholders in the
recently become a priority concern. Moreover,
health sector. The first product that was
government’s financial allocation for health
formulated utilizing this approach was the
has also improved. Efforts are being made to
develop a package of essential services based
on the priority needs of clients, to be delivered
which is product-oriented and emphasizes on
from a static service point, rather than through
“outputs” rather than “inputs” is being tried
out with WHO’s assistance. Decentralization
workers. This will be a major shift in strategy
that will require complete reorganization of the
existing service structure. Such reorganization
is expected to reduce costs and increase
epidemiological surveillance and outbreak
efficiency as well as meet peoples' demands.
Privatization of medical care at the tertiary
communicable diseases have been initiated
level, on a selective basis, is also being
throughout the country. The routine Health
considered. The progress being made towards
achievement of the health-related Millennium
functioning with some limitation, though
Development Goals (MDGs) is given below:
activities have been undertaken to strengthen
Intersectoral cooperation: Intersectoral
it. Information support is not yet adequate.
committees have been formed at different
levels ranging from the national level to the
Strengthening of the HMIS through training,
use of existing data col ection tools, and
cooperation. At national level, for example,
establishment of information networks with
the nutrition and population councils are
Regional Health Forum – Volume 12, Number 1, 2008
emphasized in the intensified action reorganized itself internal y to cope with the
involves decentralized planning at thana and
union levels. A total of 12 districts (86 thanas)
are now covered under the intensified PHC
programme. Through intersectoral collaboration
and community participation, a joint action
handled as a separate, independent entity.
plan has been implemented involving 60 000
Individual faculty members and other relevant
village health volunteers (one each for 50
people have been trained in HSR, but there is
households). The participation of teachers
no coordination among researchers. Health
and religious leaders is encouraged. The
training institutions are yet to include HSR in
their curricula. Research culture is just
inputs are also utilized to support developing in Bangladesh, hence there is no
information, education and communication
effective critical mass of researchers to form a
networking among researchers and funding
Emergency preparedness: Currently, there
is no legislation in the country that underpins
national and sub-national levels. In the
absence of any legislation, the Ministry of
issued revised "standing orders for disasters."
These “orders” provide guidelines and
Health Education Bureau (HEB). In recent
instructions to various line departments and
years emphasis has been on school health
ministries. There are separate “standing orders”
education, hospital health education and
for different hierarchical levels of the health
sector, which include coordination committees;
organizations (NGOs). Constraints include
contingency plans for manpower deployment,
the lack of a national IEC strategy, the low
essential medical relief supplies and priority given to health education by health
maintaining a database; training in emergency
services, underutilization of health education
preparedness and response; a communication
professional advancement of those working
emergency management. A draft "Disaster
Management Act" is currently under review.
consideration are the inclusion of a health
organizations, namely the Bangladesh health policy and strengthening of
Institute for Cholera and Diarrhoeal Disease
Essential National Health Research (ENHR)
Dengue: Dengue was an unfamiliar disease
research findings are helpful in making policy
in Bangladesh til its outbreak in the summer
decisions. Research units have also been
of 2000. It started as an acute febrile il ness
opened by BMRC in medical colleges. Field
in three major cities of Bangladesh (Dhaka,
Regional Health Forum – Volume 12, Number 1, 2008
in hospitals). Emphasis is also placed on
incidence being in the Dhaka district. People
malaria surveillance, preparedness for control
of all ages and both sexes are susceptible to
dengue. The infection can lead to the fatal
dengue shock syndrome (DSS). This vector-
bednets. The main constraint is the reduced
capacity of the core technical unit for control
species of Aedes mosquito. Aedes aegypti
of vector-borne diseases to take on activities
and Aedes albopictus are peri-domestic
mosquitoes that lay eggs in small collections
of clean water such as in flower vases and
pots. Usually dengue transmission occurs
during the rainy season. Bangladesh never
experienced a serious epidemic of dengue
operations. At least 20 million people in more
until 2000. However, scattered studies did
than 27 districts are at risk. The estimated
indicate sporadic cases over the last few
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
DHF cases have been reported in Dhaka and
1994–1995 in 22 thanas of 11 districts
other major cities in the country. As of 2004,
successful and further expansion is now being
reported of which 210 were fatal. The case
planned. At least 8000 kala-azar patients
fatality rate (CFR) was 1.28%. The Director-
have been successfully treated to date. The
General, Health Services has taken initiatives
major constraint is similar to that faced in the
to develop national guidelines by adapting
needs. The objective of the guidelines is to
Eighteen mil ion people in 12 districts are
control transmission of dengue fever and
considered to be at risk of filariasis. A revised
DHF, reduce morbidity and prevent deaths.
strategy for the elimination of filariasis is being pilot-tested in one district. This strategy
ivermectin with albendazole yearly for a
Plasmodium falciparum to a number of
period of three years to the total population
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
Acute respiratory infection (ARI) accounts for
cases every year. WHO declared that malaria
about 145 000 (33%) deaths annually among
could not be eradicated and subsequently a
children less than five years of age (ICDDRB
new strategy for malaria control was launched.
1994). Forty to sixty per cent of outdoor visits
gradually. It emphasizes disease control
attributed to ARI. The programme for the
control of ARI continues to be implemented
elements (early diagnosis, prompt treatment,
recognition of treatment failures and recommended WHO strategies. management of severe and complicated cases
Regional Health Forum – Volume 12, Number 1, 2008
be responsible for significant morbidity and
mortality, the current strategies have reduced
mortality considerably. Multi-sectoral partners
are involved in mobilizing the community
timely referral. The availability of oral
rehydration solution (ORS) has increased
through the formation of ORS depots in the
community. Constraints include inappropriate
use of anthelmintics and anti-diarrhoeals,
sector hospital services delivery will be improved through greater autonomy
of management, local-level accountability, “cost-recovery”, fee
The HPSS (introduced in 1998), which forms
the basis for the future national health policy,
is based on several key principles: greater
orientation to client needs, especially women;
improved quality, efficiency and equity of
government health services; provision of a
expanded private sector role in providing
health and population services; and a one-
stop shopping via co-location of services.
reliance on “cost recovery” for public
• unify the bifurcated health and family
identified to achieve the above-mentioned
Regional Health Forum – Volume 12, Number 1, 2008
• Considering all the relevant climate
References Bangladesh Bureau of Statistics (BBS) 2005.
Dhaka (Bangladesh): Ministry of Environment and
Compendium of Environment Statistics of Bangladesh
Confalonieri UB, Menne R, Akhtar KL, Ebi M, Hauengue
Bangladesh Health System Profile 2005 [Internet]. New
RS, Kovats B, Woodward A, 2007. Human health. In:
Delhi (India): WHO, Regional Office for South-East Asia.
Climate Change 2007: Impacts, adaptation and
http://www.searo.who.int/LinkFiles/Bangladesh_Country
vulnerability. Contribution of Working Group II to the Fourth
HealthSystemProfile-Bangladesh-Jan2005.pdf.
Assessment Report of the Intergovernmental Panel on Climate Change. M.L. Parry, O.F. Canziani, J.P. Palutikof,
BCAS and NIPSOM 2007. Climate Change and Health
P.J. van der Linden and C.E. Hanson, Eds. Cambridge
Impacts. Report prepared for Climate Change Cell.
(U.K): Cambridge University Press. p. 391-431.
Regional Health Forum – Volume 12, Number 1, 2008
Director General of Health Services (DG-Health) 1999.
Ministry of Environment and Forests (MOEF) 2005.
Bangladesh Health Bulletin 1997. Ministry of Health and
National Adaptation Programmes of Action (NAPA) Study
Director General of Health Services (DG-Health) 1998. Bangladesh Health Bulletin 1996. Ministry of Health and Welfare, Government of Bangladesh.
Regional Health Forum – Volume 12, Number 1, 2008
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