Cambridge Alliance to Protect Bangladesh from Long-term Environmental Hazards (CAPABLE)

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In recent decades, Bangladesh has been in the midst of a rapid transition: disease burden has shifted markedly from a profile dominated by infectious diseases, under-nutrition and conditions of childbirth to one increasingly characterised by chronic disease ("non-communicable diseases") such as heart attacks, strokes, diabetes, lung diseases, and cancer. Estimates suggest that at least 60% of adult deaths in Bangladesh today are due to such chronic diseases. As well as producing profound disabilities and cutting short millions of lives each year, the rise of chronic disease in Bangladesh has created major societal problems, limiting economic advancement, reducing human welfare, and skewing scarce resources toward costly treatments and away from social progress. This situation is unsustainable, especially as Bangladesh's population ages and continues to grow.The causes of chronic disease in Bangladesh include distinctive social, environmental, and behavioural factors. For example, Bangladesh has one of the world's worst environmental and lifestyle risk profiles, characterised by:Severe water and air pollution: According to the World Health Organisation (WHO), arsenic-contaminated water in Bangladesh, which affects ~100M people, is "the largest mass poisoning of a human population in history". A 2016 WHO report on ambient air pollution judged Bangladesh to be the fourth worst polluted country worldwide.Nutritional disorders: Deficiencies of elements (such as iron) required for normal growth and development are widespread. An evolving and complex background of persisting undernutrition and emerging obesity also increase disease risks.Risk behaviours: "Western" lifestyles (eg, unhealthy diets, physical inactivity) are increasing, and may amplify adverse effects of traditional risk behaviours, augmenting disease risk. These social, environmental, and behavioural risk factors tend to cluster in households, share antecedents and causes, amplify each other's effects, and depend on one another in complex (and non-obvious) ways. Importantly, they can also exert importantly different effects in differing contexts such as across rural, urban, and slum settings. Hence, approaches that could tackle such chronic disease risk factors in combination rather than in isolation are likely to be more powerful, as well as approaches that can take account of the context in which they occur. Yet, Bangladesh's research infrastructure is not configured to evaluate the country's multiple risks and multiple settings, perhaps preventing the emergence of evidence that could suggest "joined up" solutions. Our proposal aims to address this grand challenge. We will mobilise a multidisciplinary team of about 25 leading investigators from seven organisations in Bangladesh and the UK that have a substantial track-record of working together. We will adopt a wide-angle approach, focusing on intertwined risk factors for chronic disease that have not previously been considered in an integrated framework. The plan offers a fundamentally new approach to address this problem because it combines four innovative and inter-linked components:1) Creation of a 100,000-participant study ("cohort") in urban, rural, and slum areas to enable study of the social, environmental, and behavioural risk factors for chronic diseases.2) Conduct of cross-disciplinary research projects that will use the new cohort help understand the interplay of risk factors, and how to combat them, drawing on the complementary strengths of sociologists, engineers, behavioural scientists, chemists, biostatisticians, public health scientists and others.3) Delivery of an integrated programme of research capacity strengthening that targets three inter-linked levels of activity: individual, organisational, and institutional.4) Mobilisation and deepening of partnerships between Bangladesh and UK centres of excellence.