The changing pattern of lifestyle and age structure have started to contribute towards the development of many chronic diseases, posing new challenges for the health care system in Bangladesh, analysis of different studies suggest.
“This is worrying,” Dr Asad Khan of the University of Queensland, Australia, whose research is focused on the epidemiology of physical activity, sedentary behaviour, and their inter-relationships with health and wellbeing, told Bangladesh Post in an interview.
He said the government should take the issue of ‘active lifestyle’ seriously and invest in it with firm commitments. “The alternative is the spectre of rapidly rising non-communicable diseases (NCDs), unhealthy population and increasing medical costs of treatment of NCDs that the country may find difficult to afford,” Dr Khan, who is also the Chair of the Active Healthy Kids Bangladesh, said.
Bangladesh has made remarkable progress in reducing poverty, and increasing literacy rates and per capita food production through sustained economic growth in recent years. The country has also done well to achieve multiple health targets –reduced under-5 infant mortality, eradicated most communicable diseases, and increased life expectancy.
Along with economic development, Bangladesh is going through rapid urbanisation with large shifts in population from rural to urban areas, industrialisation, and mechanisation in domestic and workplace activities.
Even people living in rural settings are increasingly adapting urbanised lifestyle with motorised transports and less labour-intensive occupation.
Lack of physical activity has been recorded as the 3rd leading risk factor for NCDs in Bangladesh. Dr Khan’s research shows that two in five (39percent) adults do not engage in the recommended levels of physical activity and among these, women and urban people are less active.
Furthermore, three in five (59percent) children do not meet the World Health Organization (WHO) recommended daily physical activity guidelines.
Sedentary behaviour that constitutes non-physical idle/relaxed behaviour such as sitting, reclining or lying such as watching TV or playing on computers has also increased considerably in recent past years.
“This is mainly due to rapid urbanisation and modernisation where people are more technology-centred with an increased access to labour-saving technologies and motorised vehicles, and prolonged engagements with screen-based entertainments,” Dr Khan said.
Deaths due to NCDs accounted for 58.3 percent of the total fatalities in 2010 in Bangladesh. In six years, according to the WHO, it rose to 66.9 percent in 2016. One in four Bangladeshi adult aged 25 years or over are hypertensive, while one in 10 having had diabetes in 2016.
“Indeed, recent increase in NCDs poses a threat to the country’s overwhelmed health care systems, which are fragmented and lack adequate resources and capacity to respond to the growing burden – financial, logistics and emotional – the NCDs cause,” Dr Asad Khan said.
He said deaths caused by NCDs that include mainly heart disease, stroke, diabetes and breast and colon cancers are on the rise and this is due to several reasons but most important among these, is lack of regular exercise or physical activity.
But this inactive lifestyle is a ‘much ignored’ health risk, he said.
A new report of the WHO and the NCD Alliance (NCDA), released at the Global NCD Alliance Forum in Sharjah in February, called upon the governments around the world to accelerate their response to the global epidemic of NCDs to save millions of lives by 2025.
The US-based AstraZeneca Young Health Programme (YHP) focused on youths at the Forum since NCDs are by far the greatest cause of premature death and disability globally.
“Good news is that there is remedy,” Dr Khan said. “WHO’s 2013-2020 Action Plan for the Global Strategy for the Prevention and Control of NCDs has called for increasing physical activity at all levels.”
The action plan sets a global target to a 10 percent reduction in physical inactivity by 2025 and offered pragmatic policy options for member countries to promote physical activity at the community level.
The WHO policy actions on physical activity are also linked to many targets of the SDGs such as SDG 3 - ensure healthy lives and promote well-being. “Effective implementation will require bold leadership combined with cross government and multi-sectoral partnerships at all levels to achieve a coordinated, whole-of-system response,” WHO emphasised.
To complement the SDGs with physical activity dimension of health a similar framework has also been endorsed in the 2016 Bangkok Declaration on Physical Activity for Global Health and Sustainable Development.
The Bangkok declaration has identified physical activity as an important component of healthy lifestyle that has the potential to promote development more sustainably and equitably.
“This warrants urgent prioritisation and action on it with a much greater commitment of resources,” Dr Khan said. “It is well established that having an inactive lifestyle can cause a variety of chronic diseases including stroke, heart diseases, type 2 diabetes and certain cancers.”
The government of Bangladesh has initiated a number of policies related to NCDs including the Multi-sectoral Action Plan for Prevention and Control of Non-communicable Diseases 2018-2025.
“But, these policies are somewhat ad hoc, inadequately resourced, and fragmented and thus lack the capacity to improve things in a more integrated manner,” Dr Khan said.
For example, he said, the recent 2016-2021 Health, Nutrition and Population Strategic Investment Plan that has suggested ‘lifestyle approach’ to reduce future costs of treating rapidly increasing chronic NCDs is not complemented by relevant and specific details as to how to go about it.
Although the operational plan of the 2018-2025 Multi-sectoral Action Plan for Prevention and Control of NCDs sets a target of a 10 percent reduction in prevalence of physical inactivity, there is no specific details about how that target will be achieved or how the different stakeholders would involve and/or contribute to meet the target, he said.
“The other concern is that despite its established health and psychosocial benefits, active lifestyle is yet to be recognised as a priority agenda of health promotion in any of the country’s existing policy documents. Furthermore, despite its deleterious effects on health and wellbeing of people none of the policies have recognised ‘sedentary behaviour’ as a risk factor.”
“This is unhelpful,” he said.
The 1998 National Sports Policy suggested establishing and maintaining open space for playgrounds in all educational institutions.
Likewise, the 2010 National Education Policy urges to take necessary steps to create facilities of playgrounds, sports, games and physical exercises in all educational institutions for the healthy growth of the physical and mental qualities of the students.
However, these policies have not been implemented fully. Most of the educational institutions in Bangladesh, especially in urban areas, lack adequate facilities for sports and physical activities.
“Prevention is an important aspect of combating NCDs, as recommended by WHO, but so far none of the governments in Bangladesh have come up with a comprehensive prevention strategy as a priority,” Dr Khan said.