The role of primary care physicians in climate change adaptation in Bangladesh

The healthcare system all over the world can generally be divided into three levels of care: primary, secondary, and tertiary. Secondary and tertiary care are mainly provided by specialists and hospital services, while primary care is the first level of care in the whole healthcare system and also the first point of contact for those who seek any type of health service. In other words, primary health care is the backbone of any healthcare system.

Since 1978, when the World Health Organisation (WHO) began its "Health for All" programme, it has recognised that strong "primary health care" is the key to attaining the target. In the primary health care team, a family physician or family doctor acts as a leader among front-line health workers who provide services to persons of all age groups, organ systems, and genders and play a pivotal role in healthcare systems worldwide. Their holistic approach to patient care emphasises continuity, comprehensiveness, and coordination, which are essential for promoting individual and community health. They are often the first point of contact for patients, providing preventive care, diagnosing and managing illnesses, and coordinating with specialists when necessary.

A family doctor is a specialist physician who is educated and trained in the discipline of family medicine. Worldwide, family medicine is also recognised as a distinct academic discipline that is imparted through structured residency training concerned with the total health care of the individual and the family. 

Understanding World Family Doctor Day: A day for primary caregive

World Family Doctor Day is a momentous occasion celebrated globally to acknowledge the significant role of family doctors in providing primary healthcare services. May 19 is declared World Family Doctor Day by the World Organisation of Family Doctors (WONCA). This year, World Family Doctor Day is being celebrated with the theme "Healthy Planet, Healthy People," which is a call to action for family doctors, healthcare professionals, and communities worldwide to recognise and respond to the health challenges posed by climate change.

Contrasting Bangladesh's healthcare system

Climate change, an escalating global crisis, has significant and multifaceted impacts on human health, particularly in vulnerable regions like Bangladesh, which, with its densely populated deltas and low-lying geography, is exceptionally susceptible to the adverse effects of climate change. Rising temperatures, an increased frequency of extreme weather events, and rising sea levels are some of the climate change phenomena affecting Bangladesh. These environmental changes have profound implications for public health, exacerbating existing health challenges and introducing new ones.

This year's theme of World Family Doctor Day highlights the intrinsic connection between the health of our planet and the well-being of our patients, emphasising the critical role primary healthcare can play in promoting sustainable health practices. Family doctors can make a difference by identifying how environmental changes influence health issues, adopting environmentally friendly practices in their clinics, and guiding patients on how to protect their health while also caring for the planet. 

Recent climate change in Bangladesh has significantly impacted public health, as rising temperatures have led to an increase in heat-related illnesses, particularly among vulnerable populations such as the elderly and outdoor workers. Furthermore, the spread of vector-borne diseases such as dengue fever and malaria has been facilitated by warmer temperatures, posing further health threats to communities across the country. Addressing these health impacts necessitates comprehensive health care planning through family doctors at the primary care level and promoting resilience in the face of ongoing climate change. 

In our country, some families had their own doctors, but we never entered into an era of family doctors as we could not establish a proper referral system. Recently, a few private organisations started family doctor-based health care services at their own initiative, such as PRAAVA Health-Family Doctors and Diagnostics and Unico Hospital. They are trying to familiarise and incorporate the concept among health seekers. 

As we are going to celebrate World Family Doctor Day, it is imperative to recognise the invaluable contributions of family doctors in promoting individual and community health. Climate change poses significant health challenges for Bangladesh, where primary care physicians and family doctors are pivotal in addressing these issues. A coordinated, proactive approach involving all stakeholders is essential to safeguarding public health in the face of climate change.

The writer is a senior consultant in family medicine at Praava Health, Dhaka. E-mail: drkabir.praava@gmail.com