Why Bangladesh needs a sustainable health promotion initiative

In Bangladesh, the majority of deaths are caused by non-communicable diseases (NCDs) such as heart attacks, strokes, cancer, chronic respiratory diseases, and diabetes. Tobacco use, unhealthy diets, lack of physical activity, and air pollution are identified as the primary risk factors for NCDs. Reducing deaths from NCDs and controlling these health risks is possible through the adoption and implementation of integrated health promotion measures.

The World Health Organization (WHO) emphasizes implementing an integrated approach involving all relevant public and private sectors, including health, finance, environment, transport, education, agriculture, and planning.

According to WHO's definition, 'health' is not merely the absence of disease, but a state of complete physical, mental, and social well-being. Generally, a 'healthcare system' encompasses five elements: (a) Health Promotion, (b) Disease Prevention and Protection, (c) Medical Care, (d) Rehabilitation, and (e) Palliative Care. However, under prevailing conventional perspectives, 'health' is often understood strictly as 'medical care.' According to the WHO Ottawa Charter of 1986, 'health promotion' refers to a process that enables people to increase control over, and improve, their health and its determinants. For example, encouraging individuals who are overweight and physically inactive to engage in at least 30 minutes of sweat-inducing exercise daily, avoid excess fat, salt, and sugar in meals, and refrain from tobacco and alcohol constitutes health promotion activity. Comparatively, this is a newer concept.

In 1987, Australia established the world's first autonomous health promotion authority named "VicHealth." Subsequently, 11 countries, including Switzerland, Austria, Thailand, and Singapore, placed emphasis on health promotion by establishing separate health promotion foundations, funds, or boards. Consequently, these countries observed significant improvements in public health.

In Bangladesh, 71% of total deaths result from various NCDs. Under Article 18(1) of the Constitution of Bangladesh, raising the level of nutrition and improving public health is among the primary duties of the State. To achieve the Sustainable Development Goals (SDGs), the government is committed to reducing NCD-related deaths by one-third by 2030.

In this context, 35 government ministries and divisions signed a "Joint Declaration" in 2025, marking a major milestone in inter-ministerial collaboration toward NCD prevention and control. This is a crucial step because addressing this burden is not the sole responsibility of the Ministry of Health; rather, it demands the unified and active participation of all relevant ministries.

The election manifesto of the current government signals a decisive shift toward preventative health by raising health spending to 5% of GDP and adopting preventive and control measures to curb the growing burden of NCDs, including hypertension and tobacco-related illnesses. As a result, Bangladesh has taken an imperative step forward by expanding its health allocation to 7.4% of the FY2026-27 national budget and 1.01% of GDP, a commendable move by the government that deserves sincere gratitude, especially after long-standing constraints in health spending. Although the government formulates and implements various programs, they remain somewhat fragmented rather than an integrated endeavor. A full-fledged health promotion institution could serve as a supportive force in achieving these goals.

Currently, out-of-pocket medical expenditure in Bangladesh stands at approximately 74%, two-thirds of which goes toward medicine. According to data from the Bangladesh National Health Accounts, almost 6 million people fall into poverty every year due to healthcare costs. If illness and treatment costs continue to rise at this rate, it will become impossible for either the government or individuals to bear the burden. However, if 'health promotion' and 'disease prevention' mechanisms are strengthened, the burden of illness, mortality, and healthcare expenditures on the population will decrease.

Broadly, health promotion activities globally follow three organizational models: 1. Autonomous bodies or foundations; 2. A unit under the Ministry or Department of Health; and 3. Semi-autonomous entities. According to research, the autonomous foundation model established in Thailand in 2001 has proven to be the most effective. Bangladesh can adopt this model, subject to necessary modifications and adaptations.

Given Bangladesh's low-resource setting, priority should initially be focused on scalable preventive measures and broad health promotion initiatives. With morbidity and mortality from NCDs rising rapidly, it is critical that this enhanced budget is strategically utilized toward preventive care, which will effectively reduce both out-of-pocket expenses for citizens and long-term healthcare expenditure for the government. Initially, the 1% Health Development Surcharge collected from tobacco products (approximately 300 crore BDT annually) should be deposited directly to a Health Promotion Foundation and allocated toward health promotion.

Subsequently, the health promotion institution should actively advocate for bringing alcohol, ultra-processed packaged food and beverages high in salt, sugar and saturated fat, and other products harmful to health under punitive taxes or surcharges. Across the globe, 40 countries collect 'health taxes' on harmful products like tobacco, alcohol, and sugar-sweetened beverages, with several countries, including Thailand, using these revenues directly for health promotion.

To combat the rising prevalence of non-communicable diseases, now is the opportune time for Bangladesh to emphasize establishing a dedicated, autonomous health promotion institution.

ABM Zubair is the Executive Director, PROGGA (Knowledge for Progress)

Disclaimer: The views and opinions expressed in this article are those of the author and do not necessarily reflect the opinions and views of The Business Standard.