There is a common confusion around the subject of health. Too many people confound it with healthcare, with discussions focused on a shortage of hospitals, doctors, nurses, and medical supplies. But health is not just healthcare. There is no question of the importance of being able to treat disease, and there is plenty of room for improvement here. But while expending money and effort on treatment, it would be unwise to neglect the issue of preventing illness and injury. Such efforts prevent unnecessary misery and pain, as well as additional spending on healthcare.

Rather than simply treat disease, we should, to the extent possible, prevent it by identifying and addressing the root causes of ill health. In the case of contagious disease, one problem is inadequate housing; helping ensure that people have decent housing is not only a humane but also a public health (and cost-cutting) measure. As for injuries, various measures are needed. Dangling electric wires cause electrocution; this should not be impossible to remedy. As to the many injured on our roads, reducing speeds, limiting the use of cars, improving public transport, and creating safer conditions for walking and cycling would all contribute to healthier outcomes.

The biggest source of disease is now non-communicable diseases (NCDs) such as heart disease, stroke, cancer, and diabetes. How are we to address those? The medical approach includes vital steps such as early screening and medical treatment, but can we also reduce the incidence of NCDs and help people live longer, healthier lives? Certainly.

One of the main causes of NCDs as well as communicable diseases, such as tuberculosis, is tobacco use. Back in 2005, thanks in part to intense pressure from civil society, the Bangladesh government passed a comprehensive tobacco control law, which has been amended and strengthened since then. Taxes still need to be further increased, but gone are the ubiquitous cigarette billboards and newspaper ads; most places are now smoke-free (although the recent surge of smoking zones in cafes and restaurants is a concern), and strong warnings are now on cigarette packets. All of these have contributed to control the tobacco epidemic, though much more needs to be done.

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The tobacco industry has fought tooth and nail against tobacco control laws and enforcement, but a strong and united civil society effort was able to work closely with the government to counter their lobbying and opposition. That collaboration should serve as an example in other areas.

To further reduce NCD risk factors, we need to make it easier for people to eat a healthy diet, get enough physical activity, and avoid pollution. A medical approach, in addition to looking for warning signs and treating disease, includes counselling individual patients. This approach is important but cumbersome, expensive, and of limited utility especially when it comes to pollution. The burden on health providers and hospitals would decrease if we implemented broader efforts aimed at keeping people healthy.

Looking for cues from tobacco control and beyond, those efforts could include banning or greatly limiting advertisements for unhealthy food and ensuring that people have access to affordable healthy food, preferably locally grown, through subsidies and support of farmers' markets; making it easier and more attractive to use active transport (walking and cycling) while curbing car use; and taking strict measures to reduce the extremely unhealthy and dangerous levels of air pollution in our cities. One crucial pollution control measure is to have car-free days when air pollution rises above a certain level, as is done in many European cities.

The alternative would be to allow industry to act freely to produce, promote, and sell unhealthy products, and to heavily influence our government, at the expense of our physical environment and the health of our people.

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Doctors have an essential role to play in creating a healthier society, but they also have a strong focus on individuals and treatment. Those trained in public health, whose broad perspective encompasses entire populations and who address root causes and not just effects, are more important than ever if we are to salvage our troubled healthcare system by reducing the need for treatment and hospitalisation. It is time that we prioritised public health and ensure adequate funding for it.

While we're at it, we could learn from countries like Thailand about the possibility of establishing a Health Promotion Foundation, whose purpose would be to help ensure that public health takes precedence over industry profits, leading us to a stronger and healthier Bangladeshi population.

Debra Efroymson is senior adviser to HealthBridge, a Canadian public health NGO.

Views expressed in this article are the author's own.

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