With significant shifts in population distribution and demographics, Bangladesh’s health sector must realign its focus on medical care for the fast-growing urban and ageing population, says a report of the Health Sector Reform Commission.
Citing data from multiple studies, the commission said the country saw a surge in urban population over the last few decades, highlighting the need for a fundamental transformation in planning, structure, management, and financing of healthcare services.
For all latest news, follow The Daily Star’s Google News channel. Though Bangladesh still has a predominantly young population, it is gradually transitioning into an ageing society, warranting a well-organised elderly care system, said the report submitted to Chief Adviser Prof Muhammad Yunus early last month.
The commission identified non-communicable diseases such as respiratory and heart-related illness, tuberculosis, and cancer as major health risks in the country. It urged the government to spend more on preventive measures, early detection, rehabilitation, and long-term medical care.
SURGE IN URBAN POPULATION
Referring to the 2022 data of Bangladesh Bureau of Statistics, the commission said that in 1974, around 9 percent of the population lived in urban areas, which rose to 32 percent by 2022.
The annual population growth rate in rural areas is only 1.2 percent, compared to 4.4 percent in urban areas, it said.
The country’s population density is over 1,200 people per square kilometre, while more than 1,750 people reside per square km in Dhaka city and its surrounding areas, which continue to expand.
“In light of this reality, it is time to reshape the country’s healthcare system.” The primary healthcare structure was developed with a focus on the rural population, but the situation has changed, the report pointed out.
Rapid urbanisation has created new demands and challenges such as overcrowding, lack of safe water and sanitation, severe air pollution, and the growing burden of non-communicable diseases, said the commission, stressing the need for innovative solutions to make the urban healthcare system more inclusive and effective.
DEMOGRAPHIC CHANGE
According to the 2021 Global Burden of Disease report, more than one-fourth of the population is below the age of 20, and a significant portion falls within the working-age group (between 20 and 64).
Fifty-seven percent of the population was of working age in 2021, up from 41 percent in 1990. Projections show this group will peak at 64 percent by 2040.
Conversely, the proportion of children under the age of five decreased to just 8 percent in 2021 from 17 percent in 1990. If this trend continues, it is likely to fall further to 4 percent by 2050.
In the 2030s, the number of elderly people (aged 65 and above) will surpass that of children under five for the first time. The elderly are projected to make up 18 percent of the population in 2050. Moreover, life expectancy has been on the rise — it went up to 72 years in 2021 from 60 years in 1990.
This means Bangladesh now needs to start building a well-organised elderly care system and a robust social protection framework, said the report.
Every stage of life — childhood, adolescence, working age, and old age — must be supported with appropriate healthcare services, taking gender and social context into account, it added.
CHANGES IN DISEASE BURDEN
Referring to the 2021 report, the commission said both the number and rate of age-specific deaths and Disability-Adjusted Life Years (DALYs) in the country have changed dramatically over the past decade.
DALY is a widely used public health metric that quantifies the total burden of disease by measuring the number of years lost due to ill-health, disability, or early death.
Individuals aged 65 and above account for more than half of all deaths and also have the highest mortality and DALY rates, said the commission.
Though mortality among older adults has decreased slightly, their quality of life is worsening due to chronic conditions and decline in their ability to perform everyday activities, it mentioned.
“This clearly indicates a growing need for long-term and integrated healthcare services as the population ages.”
Among the working-age population, mortality rate remains relatively low, but this group carries the largest share of the total disease burden.
The growing DALY burden in this age group is mainly driven by non-communicable diseases, accidents, and mental health issues, most of which are preventable. “Yet, the existing healthcare system has not been effective in addressing these challenges,” the commission noted.
“The analysis shows that the primary challenge for the healthcare system is no longer just saving lives but also ensuring that people stay healthy.”
According to the 2021 Global Burden of Disease report, cardiovascular disease is the leading cause of death, accounting for 36 percent of all deaths in the country.
It is followed by respiratory infections and tuberculosis (19 percent), chronic respiratory diseases (11 percent), and cancer (8 percent). Various non-communicable diseases also account for a major share of the total DALYs.
For both the working-age population and the elderly, prevention and early diagnosis of these diseases, rehabilitation, and long-term care are vital to help them not only live longer but live well, added the report.
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