Public health approach to achieve health equity

While a doctor treats people who are sick, those who are working in the public health sector try to prevent people from getting sick or injured in the first place

Though Bangladesh is progressing in the health sector, more needs to be done to ensure health for all. Public health (PH) approach can be the best option to achieve the objectives. We can define PH as one of the efforts organized by society to promote, protect and restore people’s health. It is directed to the maintenance and improvement of the health of all the people through collective or social actions. The programmes, services and institutions involved emphasize the prevention of disease and the health needs of the population as a whole.
This work is achieved by promoting healthy lifestyles, researching disease and injury prevention, and detecting, preventing and responding to infectious diseases. While a doctor treats people who are sick, those who are working in PH try to prevent people from getting sick or injured in the first place.
PH helps find ways to deliver clean water, make health care affordable, stop infectious diseases before an epidemic begins, or create more livable cities. Through research, teaching, community work, and outreach, PH promotes better health and quality of life for all people.
A number of countries in the world such as Cuba have achieved progress in their health sector through adopting the PH approach. Bangladesh can also get positive result if it adopts the approach.  
In Bangladesh, public health has improved markedly over the past three decades. Life expectancy at birth is approximately 70 years, just above the World Health Organization’s world average of 69 years. Maternal mortality, infant and child mortality, and malnutrition rates have all declined substantially, and Bangladesh is on track to achieve its Millennium Development Goals for maternal and child health.

Nevertheless, Bangladesh faces major health challenges. While fertility has declined, women have on average 2.3 children, and only about half use modern and effective contraceptive methods. Despite improvements in maternal health, Bangladesh still ranks in the bottom fourth of countries worldwide with approximately 240 deaths per 100,000 live births.  
Only one-in-four births takes place in a health care facility, putting both mothers and babies at risk. Although infant and child mortality is decreasing, poor nutrition is a critical health problem in Bangladesh. About half of children age 6-59 months suffers from anemia; four-in-ten are stunted; and one in three is underweight. 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. While the prevalence of tuberculosis has declined substantially, Bangladesh still ranks among the top ten countries in the world with the highest TB burden.
Pneumonia and water-borne diseases also are widely prevalent. Pneumonia and other infections are major causes of death among young children.
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. Cancer is the sixth leading cause of death in Bangladesh, accounting for more than 150,000 deaths annually.

There are more challenges. These are:

Improving health care-seeking behaviour such as education, awareness-raising and skills building in recognizing and treating pneumonia and obstetric emergencies. Rapid urbanization which creates conditions that make slum dwellers vulnerable to disease as a result of problems of sanitation, hygiene and the supply of clean water. Action on a range of fronts to reduce the number of deaths from accidents.

Bangladesh has a severe shortage of physicians, nurses, midwives, and health technicians of various kinds. Inadequate number of appropriately trained human resources for health in Bangladesh is a strong limiting factor for population health.

Moreover, the human health resources are heavily concentrated in urban centers, depriving rural areas of much needed human resources for health.

According to Bangladesh Health Watch report (BNHA 2011), 62% of medical doctors in Bangladesh are working in the private sector.

However, the physicians in public sector often provide services in private hospitals. Moreover, Bangladesh has only 0.4 hospital bed per 1,000 population compared to that of 0.9 bed per 1,000 population in Ghana (WHO, 2011).

Though the initiative of launching community clinics was good, but it failed to provide health services to people. In remote areas of Bangladesh, community clinics usually do not have even meagre infrastructural facilities.

The existing inequity in the health system is too obvious to be ignored.

It is extremely difficult for the poor to access needed health care services. The challenges must be resolved in order to improve the existing health system, so that the disadvantaged and vulnerable people can get better access to basic health care services.

Health is a fundamental human right, and regardless of their socio-economic status everybody has the right to enjoy optimal health status.

Equity must be the overarching guiding principle underpinning the health system.

It is time for the government to take a PH approach to eliminating disparities in health.

We emphasize the importance of a multisectoral comprehensive approach to improve the health system.

Ayurveda and Unani, traditional systems of medicine, can play a significant role in the health sector. Regarding the problems prevailing in our health sector, it can be said that there is no alternative to seeking and developing all systems of treatment. We can use the natural systems smoothly as these are easily available in the country.

Our country is in serious crisis with shortage of allopathic medicine practitioners e.g. doctors, nurses and midwives. The dearth of this shortage in allopathic workforce can be well compensated if the Ayurvedic/Unani workforce could be utilized and recruited in our health system.

So, we can use the workforce to ensure health for all. It is high time for us to recognize the workforce of alternative medicines and utilize them in our health sector. If it is done, I hope that, it would be possible to achieve remarkable success in our health sector.             

Ayurveda is one of the world's oldest holistic (whole-body) healing systems whose fundamental concept is to maintain health.

It offers a body of wisdom designed to help people stay vibrant and healthy while realizing their full human potential.

Ayurveda and Unani are now backed by modern scientific research and technologies and provide its gentle healing touch to millions around the world. Its aim is to provide guidance regarding food and lifestyle so that healthy people can stay healthy and folks with health challenges can improve their health.

Ayurveda provides a holistic concept of how people can cure diseases and lead healthy life with proper application of healthy foods, medication and exercise. Ayurvedic medicine promotes the use of herbal compounds, special diets, and other unique health practices.

The traditional medicinal systems also have further advantages in reducing our dependency on costly imported medicines and instead use local resources for development of cost-effective medicines. Many modern drugs have been discovered from close observations of traditional medicinal practices.

If proper initiatives are taken, the natural systems of treatment will be improved further, providing improved healthcare to our people. It is hoped that awareness among the people would be raised about the importance of the system.                 

The writer is Executive Director of Public Health Foundation of Bangladesh

Public health approach to achieve health equity

While a doctor treats people who are sick, those who are working in the public health sector try to prevent people from getting sick or injured in the first place

Though Bangladesh is progressing in the health sector, more needs to be done to ensure health for all. Public health (PH) approach can be the best option to achieve the objectives. We can define PH as one of the efforts organized by society to promote, protect and restore peoples health. It is directed to the maintenance and improvement of the health of all the people through collective or social actions. The programmes, services and institutions involved emphasize the prevention of disease and the health needs of the population as a whole. This work is achieved by promoting healthy lifestyles, researching disease and injury prevention, and detecting, preventing and responding to infectious diseases. While a doctor treats people who are sick, those who are working in PH try to prevent people from getting sick or injured in the first place. PH helps find ways to deliver clean water, make health care affordable, stop infectious diseases before an epidemic begins, or create more livable cities. Through research, teaching, community work, and outreach, PH promotes better health and quality of life for all people. A number of countries in the world such as Cuba have achieved progress in their health sector through adopting the PH approach. Bangladesh can also get positive result if it adopts the approach. In Bangladesh, public health has improved markedly over the past three decades. Life expectancy at birth is approximately 70 years, just above the World Health Organizations world average of 69 years. Maternal mortality, infant and child mortality, and malnutrition rates have all declined substantially, and Bangladesh is on track to achieve its Millennium Development Goals for maternal and child health. Nevertheless, Bangladesh faces major health challenges. While fertility has declined, women have on average 2.3 children, and only about half use modern and effective contraceptive methods. Despite improvements in maternal health, Bangladesh still ranks in the bottom fourth of countries worldwide with approximately 240 deaths per 100,000 live births. Only one-in-four births takes place in a health care facility, putting both mothers and babies at risk. Although infant and child mortality is decreasing, poor nutrition is a critical health problem in Bangladesh. About half of children age 6-59 months suffers from anemia; four-in-ten are stunted; and one in three is underweight. 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. While the prevalence of tuberculosis has declined substantially, Bangladesh still ranks among the top ten countries in the world with the highest TB burden. Pneumonia and water-borne diseases also are widely prevalent. Pneumonia and other infections are major causes of death among young children. 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. Cancer is the sixth leading cause of death in Bangladesh, accounting for more than 150,000 deaths annually. There are more challenges. These are: Improving health care-seeking behaviour such as education, awareness-raising and skills building in recognizing and treating pneumonia and obstetric emergencies. Rapid urbanization which creates conditions that make slum dwellers vulnerable to disease as a result of problems of sanitation, hygiene and the supply of clean water. Action on a range of fronts to reduce the number of deaths from accidents. Bangladesh has a severe shortage of physicians, nurses, midwives, and health technicians of various kinds. Inadequate number of appropriately trained human resources for health in Bangladesh is a strong limiting factor for population health. Moreover, the human health resources are heavily concentrated in urban centers, depriving rural areas of much needed human resources for health. According to Bangladesh Health Watch report (BNHA 2011), 62% of medical doctors in Bangladesh are working in the private sector. However, the physicians in public sector often provide services in private hospitals. Moreover, Bangladesh has only 0.4 hospital bed per 1,000 population compared to that of 0.9 bed per 1,000 population in Ghana (WHO, 2011). Though the initiative of launching community clinics was good, but it failed to provide health services to people. In remote areas of Bangladesh, community clinics usually do not have even meagre infrastructural facilities. The existing inequity in the health system is too obvious to be ignored. It is extremely difficult for the poor to access needed health care services. The challenges must be resolved in order to improve the existing health system, so that the disadvantaged and vulnerable people can get better access to basic health care services. Health is a fundamental human right, and regardless of their socio-economic status everybody has the right to enjoy optimal health status. Equity must be the overarching guiding principle underpinning the health system. It is time for the government to take a PH approach to eliminating disparities in health. We emphasize the importance of a multisectoral comprehensive approach to improve the health system. Ayurveda and Unani, traditional systems of medicine, can play a significant role in the health sector. Regarding the problems prevailing in our health sector, it can be said that there is no alternative to seeking and developing all systems of treatment. We can use the natural systems smoothly as these are easily available in the country. Our country is in serious crisis with shortage of allopathic medicine practitioners e.g. doctors, nurses and midwives. The dearth of this shortage in allopathic workforce can be well compensated if the Ayurvedic/Unani workforce could be utilized and recruited in our health system. So, we can use the workforce to ensure health for all. It is high time for us to recognize the workforce of alternative medicines and utilize them in our health sector. If it is done, I hope that, it would be possible to achieve remarkable success in our health sector. Ayurveda is one of the worlds oldest holistic (whole-body) healing systems whose fundamental concept is to maintain health. It offers a body of wisdom designed to help people stay vibrant and healthy while realizing their full human potential. Ayurveda and Unani are now backed by modern scientific research and technologies and provide its gentle healing touch to millions around the world. Its aim is to provide guidance regarding food and lifestyle so that healthy people can stay healthy and folks with health challenges can improve their health. Ayurveda provides a holistic concept of how people can cure diseases and lead healthy life with proper application of healthy foods, medication and exercise. Ayurvedic medicine promotes the use of herbal compounds, special diets, and other unique health practices. The traditional medicinal systems also have further advantages in reducing our dependency on costly imported medicines and instead use local resources for development of cost-effective medicines. Many modern drugs have been discovered from close observations of traditional medicinal practices. If proper initiatives are taken, the natural systems of treatment will be improved further, providing improved healthcare to our people. It is hoped that awareness among the people would be raised about the importance of the system. The writer is Executive Director of Public Health Foundation of Bangladesh