The finding that one in every five people aged 40 years or above in two salinity-prone coastal upazilas faces a moderate-to-high risk of cardiovascular disease (CVD) is alarming. Preliminary findings of the research, conducted by icddr,b in collaboration with Imperial College London, assessed close to 15,500 adults in Koyra of Khulna and Assasuni of Satkhira. Of them, on an average, 21.6 per cent were estimated to have at least a 10 per cent chance of developing CVD within 10 years. The researchers also surveyed drinking water reservoirs of local villages and found that more than half of the Koyra water sources and less than a quarter of those in Assasuni contained salinity. Notably, a previous World Health Organization (WHO) survey put the national cardiovascular risk among adults aged 40-69 at 9.02 per cent, against around 11 per cent for the same age group in the two upazilas. In that case, findings of the study led by icddrb,b in Koyara and Assasuni villages show that coastal population now faces a graver health risk from drinking water.
Increasing sodium exposure through saline water can contribute to high blood pressure and related cardiovascular and kidney diseases. Women face additional danger during pregnancy, since saline drinking water was also found to be associated with gestational hypertension and pre-eclampsia. But the hazard is neither new nor confined to human health. Sea-level rise, tropical-cyclone storm surges, reduced upstream freshwater flow, excessive groundwater withdrawal and poorly regulated brackish-water aquaculture have long pushed salt farther inland. In consequence, salinity has been depressing crop yields, changing fish habitats, affecting livestock, degrading wetlands and biodiversity and weakening the livelihoods of farmers, fishers and coastal people. With tens of millions living along the coast, even the 11 per cent risk, if reflected more widely, would leave millions exposed. Evidently, what appears in the study as a health statistic is part of a larger crisis involving safe water, food security, employment, ecology and climate justice.
Against this backdrop, the integrated water and primary-healthcare package designed by the research team is well-timed. Its proposed combination of communal and household rainwater harvesting, pond-sand filters and suitable tube wells should improve access to low-salinity drinking water. Regular water-quality testing, a digital registry of drinking-water sources, maintenance, community participation and local monitoring must be integral to the arrangement. Equally important is the proposed digital screening, referral, treatment and follow-up system for hypertension, diabetes and chronic kidney disease through trained community health workers and primary healthcare facilities. Such a system can identify vulnerable people before their conditions become critical, while pregnant women should receive priority screening and advice on safe water. In this connection, national institutions should work with international researchers to determine appropriate health-based salinity thresholds. The package should not remain another short-lived one. After rigorous evaluation, it needs sustained public financing and phased expansion across salinity-affected coastal districts.
The government can no longer allow its ministries and agencies to deal with drinking water, health, agriculture, fisheries, livestock and climate adaptation in separate compartments. An effective response would require coordination among the health, water resources, environment, agriculture, fisheries, disaster-management and local-government authorities. Maintaining and, where necessary, raising polder embankments, quickly restoring ponds and shallow groundwater after storm surges, conserving freshwater reservoirs, reviving rivers and wetlands and regulating activities that intensify salinity are essential. Farmers, fishermen and livestock rearers will simultaneously require salt-tolerant technologies, extension support, affordable credit and reliable forecasts. International agencies, for understandable reasons, too, have a responsibility to support long-term research, concessional climate finance and locally manageable water technologies. Salinity mitigation should be an integral part of the country's overall climate-adaptation strategy rather than one confined to scattered water projects. The government and international agencies concerned must act together in order to avoid a public-health and livelihood emergency.
