Historically, Bangladesh has done a good job on public health, but in the last 10 or 20 years, emphasis shifted towards curative health service system, CDC Bangladesh director tells Dhaka Tribune in his first ever interview to the country’s media
The Centers for Disease Control and Prevention (CDC), a national public health institute in the United States under the Department of Health and Human Services, has been quietly working in Bangladesh to promote public health for 40 years.
Currently, CDC Bangladesh, the presence of which is almost unknown to people, is working with the Bangladesh government on the Covid-19 pandemic management, in addition to its existing different projects.
The US federal agency, with a yearly budget of nearly $12 billion, works nationally and globally in accordance with the mandate set by the US Congress.
The CDC has been maintaining a strong collaboration with the International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), a premier global health research institution in Dhaka, to strengthen the country’s capacity to detect emerging infectious diseases.
It has also developed a robust partnership with the Institute of Epidemiology, Disease Control and Research (IEDCR) within the Bangladesh Ministry of Health and Family Welfare, to further strengthen the country’s ability to detect and respond to disease threats.
Internationally, as part of its global health security program, the CDC has offices in about 50 countries, including Bangladesh.
“In Bangladesh, I work on what is called global health security, which is trying to strengthen the country’s ability to respond (to) public health issues,” Dr Michael S Friedman, CDC country director in Bangladesh, said about his organization’s work.
The CDC has been working with the government with respect to the Covid-19 pandemic from the very beginning, and trying to enhance the capacity to face the disease, he said, citing an example of activities in Bangladesh.
Dr Friedman said that there is a lot of confusion globally regarding the difference between public health and clinical medicine system, and it needs to be understood in order to reap the benefits from improving public health.
“You can wait until people get sick to have a health problem, and you address that health problem. That’s curative medicine. For many, that makes a lot of sense,” he said.
“There is another approach. It’s more holistic and more about promotion of health. So why don’t I take control of my health, try to avoid illness as much as possible? This approach is called public health approach,” he added.
Bangladesh has historically done a good job since its independence in the fields like family planning, safe water and nutrition, which are the pillars to make people healthier and happier, said the country director.
“There is a great success in Bangladesh in those areas. Life expectancy has increased, infant death has decreased. Bangladesh’s story is a global success story. When I used to work in Africa and other places, I used Bangladesh as a positive example,” he said.
Despite not being a rich country, Bangladesh has done very well with respect to public health, compared to the rich countries, he added.
Dr Friedman went on to say that primary education, and especially female education, were the most important aspects behind Bangladesh’s success in public health, as both are directly linked.
Finding the balance between preventive and curative measures
“It is the CDC’s feeling that in the last 10 or 20 years, in Bangladesh there has been a kind of shift towards curative health service system. It is now little bit distorted… becoming little bit unbalanced,” Dr Friedman told Dhaka Tribune.
“One of our goals here in Bangladesh is to try to help or to advocate to the government towards that balance,” he added.
“Like I said, historically Bangladesh has done a very good job, but in recent years emphasis is being given on curative health. This is not a criticism of Bangladesh. This is a reality of the world, including in America. It’s a global trend,” said Friedman, a former US Navy official.
People have now opted for fancy hospitals and fancy testing, but these do not necessarily lead to better health, he said.
The director acknowledged that curative medicine is very important, but there needs to be a balance between these two approaches.
“So, that is our major mandate in Bangladesh – trying to promote these aspects of public health,” he said.
“There are many examples. The Covid crisis is the most pressing and most obvious example. You can also think about the rising increase of non-communicable disease like heart attacks, strokes and cancer. These are the number one, number two and number three killers. You can solve these by going to specialists. But, the better way to deal with them is to address them right from the beginning,” said Friedman, who has experience of 24 years.
He also mentioned diabetes, obesity, physical fitness. “It’s not easy to do these things. But these are cost-efficient.”
“Covid is another good example. We can try to treat Covid. But there has to be public health approach to prevent this type of illness and try to contain the disease. There are a lot of other examples, said Friedman.
“The other big mandate of the CDC in Bangladesh is to try to work with the government to build capacity in public health and public health epidemiology. So we run a lot of training programs at different levels, mostly focusing on mid-career physicians to train them on how to better look at the population-based health outcomes and health issues to better understand and address the issues, and how to create strategies to address some of the most important issues facing Bangladesh,” he said.
“The CDC is trying to get the host government to use more data, more information, more science to help drive decision-making and driving strategies. A lot of them is happening, but of course we want to strengthen the process,” said the director.
There are also some specific projects related to lesser use of antibiotics and immunization.
US CDC in Bangladesh
* Trying to work with the government to build capacity in public health and public health epidemiology
* Working with the government to help contain the Covid-19 pandemic since the beginning
*The US federal agency works to strengthen Bangladesh’s ability to respond public health issues
*Public health approach is better than curative medicine approach, and CDC’s goal is to help Bangladesh have a balance between the two