Climate Change Impacts on Public Health of Bangladesh by nchakori

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									Asia-Pacific Journal of Public Health

 Probable Impacts of Climate Change on Public Health in Bangladesh
                              Shamsuddin Shahid
 Asia Pac J Public Health 2010; 22; 310 originally published online May 14, 2009;
                        DOI: 10.1177/1010539509335499

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                                                                                                            Asia-Pacific Journal of Public Health

Probable Impacts of                                                                                                                22(3) 310–319
                                                                                                                                   © 2010 APJPH
                                                                                                          Reprints and permission: http://www.
Climate Change on Public                                                                        
                                                                                                             DOI: 10.1177/1010539509335499
Health in Bangladesh                                                                                            

Shamsuddin Shahid, MSc, PhD1

The recent report of the Intergovernmental Panel on Climate Change confirmed that there
is overwhelming evidence that the global climate will severely affect human health. Climate
change might have severe consequences on public health in Bangladesh, especially in light of
the poor state of the country’s public health infrastructure. A number of possible direct and
indirect impacts of climate change on public health in Bangladesh have been identified in this
article. Adaptive measures that should be taken to reduce the negative consequences of climate
change on public health have also been discussed.

climate change, public health, Bangladesh

Because of its geographical position, Bangladesh is one of the most disaster-prone countries in
the world.1 Almost every year, the country experiences disasters of one kind or another, such as
tropical cyclones, storm surges, floods, and droughts, causing heavy losses of life and property.2
Bangladesh is one of the most densely populated countries in the world. With about 950 people
per square kilometer, Bangladesh has a per capita annual income only about US$1400. More than
40% people of the country live below poverty line. High spatial and temporal climatic variability,
extreme weather events, high growth rate and population density, high incidence of poverty and
social inequity, low literacy rate, poor institutional capacity, inadequate financial resources, and
insufficient infrastructure have made Bangladesh highly vulnerable to climate change.
   Public health effect might be one of the most significant impacts of global climate change in
Bangladesh.3 The combination of higher temperatures and potential increases in precipitation
will create the conditions for greater intensity or spread of many infectious diseases in Bangladesh.
Increased risk to human health from increased flooding and cyclones seems most likely. Though
the causes of outbreaks of diseases are quite complex and often do not have a simple relationship
with increasing temperature or change in precipitation, it is clear that climate change will present
increased risks to human health in Bangladesh, especially in light of the poor state of the coun-
try’s public health infrastructure.3 Only few studies have been carried out so far to identify the

 Department of Applied Physics, Rajshahi University, Rajshahi, Bangladesh

Corresponding Author:
Shamsuddin Shahid, Geophysical Research Laboratory, Department of Applied Physics & Electronic Engineering,
Rajshahi University, Rajshahi 6205, Bangladesh

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Shahid	                                                                                                            311

impacts of climate change on human health in Bangladesh.3-9 Most of the studies are concen-
trated on cholera and other diarrheal diseases.5,7-9 Besides these, climate change impacts on few
infectious diseases have been discussed in the International Center for Diarrhoeal Disease
Research–Bangladesh report.6 Rahman3 mentioned some of the health effects of climate change
and mainly concentrated on existing response mechanisms and the possible measures that
Bangladesh should take to reduce the health impacts from climate change. Nelson4 used a method
known as “disability-adjusted life year” to quantify the impact of major storms on deaths and
injuries in Bangladesh in the context of climate change.
    The objective of the present article is to identify the possible direct and indirect ways through
which climate change can affect public health in Bangladesh. A number of health effects ranging
from psychological stress caused by increased natural disaster to diseases caused by lack of water
for sanitation and personal hygiene have been discussed. It is hoped that this will help grow
awareness among the stakeholders, including policy makers, nongovernmental organizations
(NGOs) working in public health, and health professionals in Bangladesh as well as in other
countries having similar climate and geography.

Climate Change in Bangladesh
Situated in the subtropical region, the climate of Bangladesh is characterized by wide seasonal
variations in rainfall, moderately warm temperatures, and high humidity.10 The rainfall of
Bangladesh varies from 1400 mm in the west to more than 4400 mm in the east. Average tem-
perature of the country varies from 17°C to 21°C in winter and from 27°C to 30°C in summer. In
some places, in the western part of Bangladesh, the maximum temperature in summer rises up to
40°C or more.11 The climate models projected that temperature of Bangladesh would rise 1.0°C
by 2030, 1.4°C by 2050, and 2.4°C by the end of this century.12 The models also predict 3.8%
increase of rainfall by 2030, 5.6% by 2050, and 9.7% by the end of 21st century.12 Small changes
in the mean and standard deviation values of rainfall and temperature can produce relatively large
changes in the probability of extreme weather events.13 The impacts of more variable precipita-
tion and extreme weather events are already felt in Bangladesh. Floods in 1988, 1998, 2004, and
2007; and cyclones and tidal surges in 1991, 1998, 2000, 2004, and 2007 record the increase of
extreme events both in frequency and severity in Bangladesh.14

Health Effects of Climate Change in Bangladesh
A change in climatic conditions can have direct and indirect kinds of health impacts in Bangladesh.
Direct impacts are caused by weather extremes, for example, impacts of thermal stress, death/
injury in cyclones and storms, and so on. Indirect impacts can be in 2 forms: (a) health conse-
quences due to environmental change and ecological disruption that occur in response to climate
change; and (b) the diverse health consequences, for example, traumatic, infectious, nutritional,
psychological, and so on that occur in demoralized and displaced populations in the wake of
climate-induced economic dislocation, environmental decline, and conflict situations.15 Identifi-
cation of probable impacts of climate change on public health is essential to adopt necessary
adaptation strategies in advance. Possible direct and indirect impacts of climate change on public
health in Bangladesh are discussed below.

Direct Impacts
Climate change can affect human health in numerous ways. Some of the possible direct impacts
of climate change on human health in Bangladesh are described in the following sections.

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The	Impact	of	Temperature	Rise	and	Heat	Waves
It can be anticipated that increased temperature will increase heat waves in Bangladesh. It has
been observed that prevalence of heat stress or hypothermia, diarrheal diseases, dehydration, and
aggravation of cardiovascular and respiratory diseases increased during extreme temperatures
and heat waves in Bangladesh. Rowland16 found that the seasonal peak of Escherichia coli
diarrhea in Bangladesh coincides with the time when food is most contaminated due to higher
bacterial growth caused by high temperatures. Huq et al17 found significant correlations of tem-
perature with the occurrence of cholera toxin-producing bacteria (presumably Vibrio cholerae)
in Bangladesh. Hashizume et al8 reported an increase in rotavirus diarrhea in Dhaka by 40.2% for
each 1°C increase of temperature above 29°C. In another research5 the authors found that the
number of noncholera diarrhea cases in Dhaka increases with higher temperature, particularly in
those individuals at a lower socioeconomic and sanitation status. Feldacker18 observed that chol-
era in Bangladesh increases with the increase in sea surface temperature. Therefore, it is very
clear that rise of temperature due to global warming will increase diarrheal diseases in Bangla-
desh. Another significant impact of rising temperature will be on heat stress or hypothermia
specially those living in urban areas. It has been mentioned in a government report that incidence
of heat stroke among rickshaw pullers and the people working in industries has increased in the
recent years.19
    Rise of temperature can also increase the renal disease and mental disorders especially among
older people. Hansen et al20 found that admissions for renal disease and acute renal failure increases
during heat waves. They suggest that as heat waves become more frequent, the burden of renal
morbidity may increase in susceptible individuals as an indirect consequence of global warming.
In another research,21 the same authors observed a positive association between ambient tem-
perature and hospital admissions for mental and behavioral disorders among the older people
above a threshold temperature of 26.7°C. Specific illnesses for which admissions increased
included organic illnesses, including symptomatic mental disorders; dementia; mood (affective)
disorders; neurotic, stress-related, and somatoform disorders; disorders of psychological devel-
opment; and senility.
    Rickshaw pullers, people working in industries, and farmers working in the open field are
most vulnerable to heat stroke due to the rise of temperature. Children and older people are at
particular risk to the diseases caused by elevated temperatures especially those living in cities
because of the effect known as the “urban heat island.”

The	Impact	of	Frequent	Natural	Disasters
Bangladesh is one of the most vulnerable countries of the world to floods and cyclones. Tropical
cyclones and storms batter Bangladesh almost every year. Deaths and injuries by cyclones or
tornados in the last 45 years in Bangladesh are given in Table 1. It has been projected that climate
change will cause more frequent and severe floods, cyclones, and droughts in Bangladesh.22
Increase of extreme weather events will cause more losses of lives. Threatened or actual loss of
valued resources due to natural disaster might lead to psychological distress, that is, negative
mood, stress-related physical symptoms, and psychological symptoms.23

The	Impact	of	Stagnant	Weather	Conditions	and	Air	Pollution
Air pollution is a major problem in densely populated cities of Bangladesh. Stagnant weather
conditions can trap both warm air and air pollutants, leading to smog episodes with signifi-
cant health impacts, that is, cardiovascular, respiratory, and allergy diseases, including lung

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Table 1. Number of People Died/Injured by Cyclones, 1965-2008a

Year                                                        Died                                                         Injured

1965                                                       48 921                                                      600 000
1966                                                          850                                                     Not available
1969                                                          849                                                        15 530
1970                                                      300 317                                                     Not available
1973                                                         1900                                                        15 000
1974                                                         2800                                                     Not available
1977                                                          634                                                        10 600
1978                                                         1030                                                           100
1981                                                         1085                                                        12 000
1983                                                          685                                                           350
1985                                                       10 050                                                          2000
1988                                                         2440                                                     Not available
1990                                                          715                                                           700
1991                                                      138 987                                                      139 149
1995                                                          772                                                          1570
1996                                                          766                                                        36 091
2007                                                         3113                                                          3322
Only the years in which the death toll more than 500 are given.

infections, asthma, chronic obstructive pulmonary disease, lung cancer, coronary artery disease,
and heart-rhythm problems.24,25

Indirect Impacts
Indirect impacts of climate change on public health of Bangladesh will be much more severe
and diverse compared with direct impacts. Some of the possible indirect impacts are dis-
cussed next.

The	Impact	of	Frequent	Floods	and	Waterlogging
In Bangladesh enteric infections and infectious diseases are common due to the tropical climate,
combined with the existence of large open water bodies and dense population. Directly transmit-
ted infectious diseases are least likely to be influenced by climate change, because the agent
spends little to no time outside the human host. However, indirectly transmitted anthroponoses
especially waterborne anthroponoses are highly susceptible to climate change because the patho-
gens exist in the external environment during part of their life cycles.26 Waterlogging, destruction
of fresh water resources, and contamination of drinking water wells caused by frequent floods
and cyclones may increase the health-related problems, such as cholera, diarrhea, malnutrition,
and skin diseases in Bangladesh. Hashizume et al8 reported that river level, above a threshold
(4.8 m), is associated with an increase of rotavirus diarrhea in Bangladesh by 5.5% per 10-cm
river-level rise. According to a government report, flood-related diarrheal disease cases and
number of death due to diarrhea in Bangladesh have increased in recent years.19 Cholera out-
breaks occur in Bangladesh during the monsoon season.27 A recent research predicted that the
regions of Bangladesh where cholera is merely a seasonal disease can become regular phenom-
ena in future due to the climate change.6

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The	Impact	of	Variable	Precipitation
There will be a change in rainfall pattern in Bangladesh both in intensity and timing due to global
warming. Many diseases in Bangladesh have direct relation with rainfall pattern. Rowland16 found
that some diarrheal diseases of Bangladesh are found to reach at their peak during rainy season.
Therefore, the changing rainfall pattern can influence the transport and dissemination of infectious
agents in Bangladesh. Outbreaks of waterborne diarrheal diseases caused by parasites, such as
Giardia and Cryptosporidium, are associated with heavy rainfall events, and are therefore likely to
become more frequent in Bangladesh.28 Hashizume et al5 found that the number of noncholera diar-
rhea cases in Dhaka increased both above and below a threshold level with high and low rainfall.

The	Impact	of	Increased	Breeding	of	Vectors
Climate change is likely to have important effects on the prevalence of vector-borne diseases in
Bangladesh. The Anopheles mosquitoes tend to prefer a temperature range from 24°C to 27°C.
If the overall temperature rises, their habitat may be reduced. However, at the same time breed-
ing period of mosquitoes may be shifted and prolonged, leading to a possible change in malaria
pattern in Bangladesh. It has been found in a research6 that global warming would produce more
rapid replication of the dengue virus, which is a major infectious disease of Bangladesh. Japanese
encephalitis virus is an emerging cause of encephalitis in Bangladesh. Higher rates of breeding
of mosquitoes can accelerate the transmission of Japanese encephalitis in Bangladesh. Visceral
leishmaniasis (also known as kala azar) cases seem to cluster near flood control embankments.
Building more embankments, a likely response to sea-level rise, may favor visceral leishmania-
sis vectors and result in increasing cases of visceral leishmaniasis in Bangladesh.6

The	Impact	of	Sea-Level	Rise
Sea-level rise due to global warming may cause an increase of salinity in river water as well as
in groundwater of Bangladesh. At the same time it may also increase the risk of coastal flooding.
Increase salinity in drinking water will increase the risk of diarrhea and skin diseases.29 Pro-
longed exposure to water containing salts (total dissolved solids >500 ppm) can cause kidney
stones. Increased cases of diarrhea and gynecological diseases have been observed in the coastal
areas of Bangladesh in a recent study.30 In another study, it has been found that the health-related
risk and the number of disease-affected people have increased in the coastal districts.19 Inland
intrusion of salt water may turn former freshwater habitats into salt-marsh areas, which could act
as a breeding ground of salt-marsh mosquitoes and may in turn increase the vector-borne diseases
in the coastal areas of Bangladesh.

The	Impact	of	Groundwater	Overexploitation
Climate change may increase the daily uses of water for irrigation in Bangladesh. As almost 96%
irrigation water in Bangladesh during dry season comes from groundwater, the increased irriga-
tion water use will certainly increase the abstraction rate of groundwater, which may aggravate
the situation of declining trend of groundwater level in many parts of the country as well as the
vulnerability of groundwater to arsenic contamination. It is well accepted that arsenic is released
from the sulfide minerals (arsenopyrite) in the shallow aquifer due to oxidation. The large-scale
withdrawal of groundwater may cause rapid diffusion of oxygen within the pore spaces of sedi-
ments as well as an increase in dissolved oxygen in the upper part of groundwater.31 Oxidization

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Shahid	                                                                                                            315

of arsenopyrite forms hydrated iron arsenate compound known as pitticite in presence of water,
which breaks into fine soluble particles due to the light pressures of tube-well. The data collected
by the governmental bodies, NGOs, and private organizations reveal that a large number of
populations in Bangladesh are affected by the arsenicals. Most of the people are suffering from
melanesia, leukomelanosis, keratosis, hyperkeratosis, dorsum, nonpetting edema, gangrene, skin
cancer, and so on.31,32 Climate change may adversely affect the situation due to the spread of arse-
nic in groundwater.

The	Impact	of	Increased	Recharge	in	Monsoon	and	Groundwater	Pollution
Higher groundwater recharge because of increased precipitation during monsoon, river flow at
higher level, and flood may bring the groundwater level near to the surface during monsoon in
some parts of Bangladesh. This will make the groundwater more vulnerable to pesticide and
fertilizer pollution. Pesticides in groundwater above the prescribed level have already been
reported in many parts of Bangladesh.33 As more than 95% of drinking water in Bangladesh
comes from groundwater, presence of toxic pesticides in groundwater may increase the cases of
nervous, reproductive, and endocrine systems damages.34 Specially, children are more suscepti-
ble to pesticides as they are still developing and have faster metabolisms.35

The	Impact	of	Droughts	and	Lack	of	Water
Because of the land use changes within the country and in the neighboring country, Bangladesh
has already shown an increased frequency of droughts in recent years.1,36 Droughts will only
get more frequent and more severe in the future as the climate changes. Lack of clean water for
drinking, public sanitation, and personal hygiene can lead to a wide range of life-threatening

The	Impact	of	Decreased	Food	Production	and	Malnutrition
One of the most severe impacts of climate change in Bangladesh will be on agricultural produc-
tion. Food production will be reduced due to the elevated temperature. Chronic malnutrition may
be caused by shrinking food-grain absorption. Protein-energy deficiency may increase cases of
child death. Deficiencies in micronutrients (vitamins and minerals) can also affect mental and
physical health.39

The	Impact	of	Hostile	Conditions
Land inundation due to sea-level rise, prolongedwater logging in the coast region due to frequent
flooding, and severe droughts in southwestern Bangladesh can create hostile conditions that may
cause extensive damage to already shrinking food supplies and force a large number of people
to become so-called “refugees of climate change” and create diverse health consequences, for
example, trauma and psychological stress. Bhui et al40 found that anxiety, depression, suicidal
thinking, and other psychiatric symptoms are common among the refugees.

The Public Health Response and Adaptation Measures
Adaptation measures should be taken in advance to reduce the negative consequences of climate
change on public health in Bangladesh. The Government of Bangladesh has made climate change
an integral part of national development strategy and have started to build the country’s capacity

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316                                                                             Asia-Pacific	Journal	of	Public	Health	22(3)

to tackle the impacts of climate change. Climate Change Strategy and Action Plan (CCSAP) has
been developed through a participatory process involving all relevant ministries and agencies,
civil society, including NGOs, research organizations, and the business community. One of the
most fundamental pillars of the strategy is food security and health to ensure that most vulnerable
in society are protected from climate change. Now it is required to take necessary initiatives to
grow people’s awareness about diseases and health problems that may be exacerbated by climate
change, ensure people access to public health services, implement sustainable water manage-
ment policy to ensure safe and adequate water supply, improve sanitation in areas at risk from
climate change, for example, coastal areas, flood-prone and drought-prone areas, encourage
people for environmental designing of houses to reduce the heat effect, redesign the cities to
reduce the urban heat islands, strengthen the disaster management system, ensure food security,
and develop infrastructure for flood control and seawater intrusion as the primary preventive
measure to reduce exposures projected to occur in Bangladesh with climate change.
    Adaptation activities must involve the full range of stakeholders, including community lead-
ers, health professionals, local government, private organizations, and the NGOs. Because
the effects of and responses to climate change will depend on the local context, including geo-
graphic, demographic, social, economic, infrastructural, and other factors, adaptation options
will be more effective if designed, implemented, and monitored with strong community engage-
ment.41 Vulnerable groups to different diseases that may be intensified by climate change can be
identified by their geographical position and socioeconomic conditions. NGOs and other private
and public organizations working in the health sector of Bangladesh could play an active role to
identify the vulnerable groups, grow awareness among local community, and encourage them to
adjust their lifestyle accordingly.
    Immediate governmental initiatives are necessary to strengthen disease surveillance programs
and improve the capability of the health systems to meet future demands. It is also required to
enhance the institutional capacity to government agencies, civil society, and private sector to
meet the challenges of climate change. Public health researchers can play an active role in devel-
oping early warning system of the emergence of diseases through research on climatic influence
on diseases, which is one of the most important secondary measures to prevent the onset of
adverse health outcomes due to climate change.
    Bangladesh has achieved sufficient efficiency in disaster preparedness and management
through community involvement. The people of Bangladesh have adapted over generations to
the risks of floods, droughts, and cyclones. In areas where inundation is a risk, they raise their
houses on mounds, above the normal flood level, and adjust their cropping patterns to take
advantage of the flood waters.42 Therefore, it can be hoped that strong community involvements
would also successfully increase the resilience of vulnerable groups from the negative health
impact of climate change in Bangladesh.

Concluding Remarks

Climate change may affect public health of Bangladesh in numerous ways. A few of the possible
ways are discussed in this article. Climate change may cause increased heat waves, higher pre-
cipitation, frequent floods and waterlogging, increased salinity, frequent natural disasters,
prolonged dry events, and pollution of groundwater in Bangladesh. It has been observed that the
number of diarrhea cases in Bangladesh increases with such phenomena, particularly in those
individuals who are at a lower socioeconomic and sanitation status. As the majority of people in
Bangladesh live below or near the poverty level without access to proper sanitation facilities, it
is very likely that climate change will cause most severe impact on diarrheal disease–related

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health problem in Bangladesh. Increased cases of vector-borne diseases might be another signifi-
cant negative impact of climate change in Bangladesh as the rise of temperature may increase or
change the breeding pattern of vectors. Because health is the primary goal of sustainable devel-
opment and includes physical, social, and psychological well-being, it is crucial that the health
impacts of climate change be understood and properly addressed. The major objective of the
present study was to improve the knowledge of climate change impacts on human health of
Bangladesh. It is hoped that the improved knowledge of climate change impacts in general will
assist in guiding the operational responses of the various government and nongovernment author-
ities to embrace necessary adaptation strategies to reduce the adverse impacts of climate change
on public health in Bangladesh.

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