Bangladesh boasts accomplishment of quite a few Millennium Development Goals (MDGs) -a couple of them ahead of time. The MDGs are only a step towards the Sustainable Development Goals (SDGs). Set by the United Nations General Assembly in September 2015, the SDGs have specified 17 goals, 169 targets and 230 indicators to be addressed by 2030. Of these there are 33 health-related indicators. Now from the point of health-related SDGs in 188 countries, as analysed on the basis of the Global Burden Disease Study 2015, Bangladesh's performance is deplorable. On this count, the country stands at 151st position -well below Iraq and Syria -two war-torn countries, Haiti, Swaziland and Zimbabwe -all highly impoverished countries. Only Afghanistan among the South Asian countries finds itself placed behind Bangladesh.
It is notable that the entire South Asia fares poorly excepting Sri Lanka which is even ranked 79th. This is the first ever global analysis to have assessed countries on SDG health performance. It was launched at a special event at the UN General Assembly on Wednesday, September 21 last. The study by an international collaboration on the Global Burden of Disease (GBD) has measured each country's progress towards achieving health-related SDG targets. The countries scored points on the basis of their progress in the specific areas set for the purpose. Their overall index score was the basis of their ranking.
Bangladesh's reasonably good performance has come in areas like prevalence of overweight people, level of alcohol consumption, and number of war-related deaths. But these are peripheral issues. Where its performance is really commendable is in the containment of tropical diseases and progress in family planning. Although the country has fared better than India, ranked 143rd, in reducing under-5 mortality, neonatal mortality, HIV, tuberculosis, malaria, stunting, suicide, alcohol, poisons and violence along with responding better to natural disaster, its performance still left much to be desired on these fronts.
The country still cannot count on adequate skilled birth attendance and respond to hepatitis B and family planning needs. Its measures and campaign against smoking are yet to prove effective enough. However, its glaring failure is in maintaining a standard of sanitation and hygiene for its people. Air pollution –both indoor and outdoor - has been found to be far above an acceptable level. Occupational risk burden weighs heavily too.
One most important aspect that often evades notice is that education and wealth are not often the sole determinants of social progress. Income, education and fertility have been found to be the drivers of improved health in a family situation. Then the income needs to be rational for citizens irrespective of their social standings. Education alone is not enough unless there is opportunity for employment. When education and employment complement each other, fertility also declines with spacing of child birth. There has to be cultural backing and adequate infrastructure for pulling the backward community out of their miseries.
Health indicators can as well be deceptive. Malaria was eliminated from most parts of South Asia but it has staged a comeback in countries like India and Bangladesh. Safe hygiene practice, particularly when it concerns adolescent girls' health, depends on a number of factors -not necessarily related to education alone. Hygienic material should be available and at a low cost. It is, therefore, not surprising that India scores only 8.0 on a scale of 0-100 and Bangladesh lags its giant neighbour on this count.
Sure enough Bangladesh's nutritional status has improved because of increasing fish production, poultry and farm output. Vegetables and fruits are now commercially produced by farmers because returns on them are better than on cereal production. Yet the country has a long way to go before the entire population get to manage and know about their balanced diet along with healthy practice. Those who have more than they need to eat are averse to burning calories and those who are engaged in hard labour do not have the kind of nutritious foods they need to eat.
So it is not always a problem of paucity, it is a problem of plenty too at certain levels of society. It is exactly at this point the income distribution has to be rational. Already the pattern of labour at farms has changed somewhat with working hands becoming short in supply. Mechanised farming has been introduced to some areas. But in an overpopulated country like Bangladesh this does not augur well. If farming is too much mechanised, farm labourers will stay idle and their source of income dry up. So there is need for staying cautious in this regard.        
One of the most important prerequisites for achieving health-related SDGs is an updated and caring healthcare system. But narrowing the gap between social classes is no less important. This makes it incumbent on the government here to adequately address both urban slums and rural poverty. Children in affluent and educated families are growing taller in general than their parents but at the lower levels of poor families the picture is just the opposite. At this level children suffer from malnutrition and stunting. A substantial proportion of the ill health and diseases they suffer owes to lack of sanitation and hygiene. Bangladesh must gear up its programmes in order to ensure availability of safe drinking water for the poor segment of population first. Then their sanitation and hygienic issues should be taken care of under a coordinated programme because a number of non-government organisations are working in these areas.
nilratanhalder2000@yahoo.com

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Source: The Financial Express