Around the world, the growing phenomenon of child obesity is recognised as a likely cause of great deal, in the future, of the heartbreak of the loving family of the young man in Ramna Park. In countries like Bangladesh there are two aspects of the tragedy that gives pause for thought.

First, the irony, some might even call it obscenity, of a country experiencing, on the one hand, the hardship of malnutrition amongst the poor; and on the other, the consequences of obesity amongst the rich.

Second, the fact that, in a country with generally low standards of literacy and real education, it is often the urban pupils of schools and universities, the affluent section of the society, over whom hangs the cloud of obesity and lack of physical activity, with its attendant consequences of diabetes, heart disease and other likely causes of premature death.

Sadly, Bangladesh is probably one the world leaders in premature death. Death by drowning running at 10,000 a year; road accidents, by some calculations costing up to 6% of GDP each year, and killing over 30,000 under 18, and total of 70,000; plus consequential injury, many life impairing, life-long disability.

It is often said that 'Accidents don't just happen, they have causes.'

The Centre for Injury Prevention and Research, Bangladesh (CIPRB), led by distinguished Medical Practitioner, Professor Fazlur Rahman, was set up in 2004 to investigate the causes of accidents and support the development of facilities to mitigate their effects. However, with the best of intentions, despite both local and international support, there is a clear limit to the work that CIPRB is able to do. Perhaps most conspicuous of its present activities is the work, covered by recent BBC World Programme, teaching village children to swim is, means of, at least, helping to reduce the number of avoidable deaths by drowning each year. Needless to say such a programme would also greatly benefit those living in the cities.

Recognising, however, that in the priority areas of prevention of avoidable deaths, both those by accidents and those by neglect, such a dietary and activity mismanagement, together with the development of skills for primary response everywhere, the training of both young and their adult carers in safer activity, and the development of excellent facilities for mitigation and treatment of injuries and improvement in the availability of the kind of facilities for rehabilitation provided by the Centre for Rehabilitation of the Paralysed (CRP) in Savar, requires a far higher level of commitment than at present. To that end Professor Rahman and I have agreed to develop a new programme, with a significant element of voluntarism, called "Activate Bangladesh!"

My own background, as a specialist in Community Medicine and in Sports Medicine, together with my work with BTV as both commentator and presenter, has given me a wide perspective on many of the issues involved, particularly through my involvement in such work throughout South-Asia.

My research work in Bangladesh has revealed some facts, at the same time, both disturbing, and yet, simultaneously, promising prospects for improvement, in the field of organised sport.

In Dhaka city it is unfortunate that more than 75% of the schools either don't have any playground, or the playground is not at all suitable for physical activity of any kind. Little more than 10% boys and girls of Bangla-medium schools and less than 7% in English-medium schools are taking part in any active sport or physical activity.

In most countries in the world, organised sporting activity is a central platform of most levels of education. The recognition that "An active body is essential to an active mind", commonplace of most, if not all, the world's leading academic and educational institutions, is almost completely ignored in the education sector in Bangladesh.

As an example, whilst many private universities seek comparison and association with American institutions there is, in fact, in these salient areas, no comparison. Whilst, Harvard and Yale Alumni will readily recognise a 'jock' environment, and bask in the reflected glory of the those famous academic colossi in many sporting fields, the prevalence of sport as a key dimension of US academic institutions, sport scholarships and all, find no echo at all in Bangladesh.

Of over 40 private universities in Dhaka, only two or three have sports grounds. Whilst such university authorities may subscribe to 'sports clubs' within the university, in reality there is no effort to overcome the natural lassitude of overfed computer games junkies of the young or, more importantly, the blind belief of both guardians and teachers responsible adults in regarding classroom learning as the only acceptable form of academic achievement.

It is, of course, reasonable to understand and sympathise with the guardian's fear of injury and its potential effect on study, or even the risk of long term disability. However, not only are extra curricular activities normally also a pre-requisite for a successful first career step in multi-national organisations around the world, but sporting achievement is widely accepted as a measure of such activity; and medical fitness is, increasingly, in the age of life insurance and health benefits as a part of remuneration package, also coming under increasing scrutiny.

In passing, it may also be worth noting that, curiously, obesity is not the only result of lack of physical activity. In fact, lack of activity causes lack of appetite, too, and results in poor diet and poor eating habits, that can themselves, result in malnutrition, listlessness and lack of energy, even for study!

A little attention to training can considerably mitigate the risk of injury. In 2003, the Bangladesh Football Federation (BFF) undertook a study during the Dhaka Metropolis Schools Football Tournament, from the quarter-finals stage. This revealed that 142 players were injured with a total of 230 separate injuries, i.e. 32.85 injuries per match. In 2004, following elementary guidance on match times out of the heat of the day re-hydration strategies, coaching changes on non-fouling strategies, etc, the level of injury per match was more than halved to 7.4 injuries per match.

Similar work within the Schools Cricket Leagues also resulted in significant reduction in injury. The task, of course, requires the involvement and commitment of the guardians. With, therefore, unquestionably ambitious objectives, Activate Bangladesh programme is under development. Its work focuses on three strategic parts: (a) Advocacy for Activation, (b) Sports friendliness, and (c) Environment in academic institutions,

The first strategic objective will involve a cultural changing initiative, one that mirrors initiatives such as the Family Planning initiative, the Smiling Sun initiative on Mother and Child health, and, more recently HIV/AIDS.

Since it is becoming increasingly clear that obesity and its consequences may well threaten more lives in Bangladesh than HIV/AIDS, and those are the lives of leaders of tomorrow, the parallel may be an appropriate one. Even in the midst of our pre-occupations with the political environment in Bangladesh, it is necessary to engage the leaders of our society in the need for activation of our young people in a constructive, outdoor environment.

In focussing on Team Sport as a solution, I am simply responding to the prospect of both the involvement of greater numbers and the possibility of literally raising our game internationally in team sporting activities. But there are, of course, a whole lot of other options.

In Cox's Bazaar some local lads have been facilitated to take up surfing, Hawaiian Style! Around Dhaka, the occasional roller-blading commuter may be seen! Trekking and walking, and mountain biking are certainly gaining adherents. Both of the latter, together with beach versions of some team sports will form the core activities for our Activate Bangladesh, such as the Longest Beach Walk/Ride and Sports Day over Independence Day Weekend in 2007, which will both launch our programme and, through sponsorships of walkers and riders who will, we hope, include participants from abroad, raise money for other forms of activation.

The success of a visible and participatory launch such as this, for our programmes will, we believe, help the private sector to see the opportunities for advertising and promoting their products and services to a growing sector of the market in Bangladesh. Such success feeds on itself: "Nothing succeeds like success" is an often quoted tenet of activity. If it is true, and I believe it is, it becomes not merely the advertising and sponsorship opportunities that can sustain our work, but also the commercial opportunities in the development of facilities and equipment for activity.

Such advocacy is, of course, the pre-requisite for the promotion of Sports Friendly Schools. The demand needs to be created before the relevant authorities can respond. But it is not only the Sports Friendly Environment that concerns us; it is also the development of facilities to train those who will implement the environmental changes that we are focused on.

At the same time, we are conscious of the fact that "Life can be dangerous". Tens of thousands of Bangladeshis confront the reality of that fact every year, many paying for it with their lives. It is entirely possible that "Activation" could increase those risks. The third of strategic paths, there fore, is "Primary Response, Everywhere".

It is often immediate, on site response, to injury that can mitigate, or even negate both short term and, more importantly, long term effects. The child overwhelmed by immersion in water can be resuscitated readily by immediate trained action. A lengthy journey to medical facility can, all too often, be the difference between life and death. From cuts and burns, to broken bones and trauma, a primary responder, on the scene, can make all the difference between life and death before a doctor is located or hospital facilities reached.

It is idle to pretend that Bangladesh could rapidly emulate the resources for such response of, for example, the United Kingdom, but, as the great Chinese leader, Mao, once observed, "Every journey begins with a single step".

The UK has one of the most enviable Primary Response environments in the world, and the plain truth is that it depends, to a significant degree of voluntarism. There are few public functions in UK that are not attended by officers and Cadets of St. John's Ambulance Brigade: a largely volunteer organisation, Cadets are recruited from age eight, and commence First Aid, or Primary Response training at that age.

St. John's, as a form of fund raising, also undertake a significant proportion of the training required in the work environment of every employer in the UK for meeting Primary Response requirements for Health and Safety at work which, of course, further spreads the skills through the community.

It is, of course, much easier to fund such work in the UK. In the context of activation, and funding, throughout the developed world we rely on so much public involvement. In mid 2006, "Run for Life" in UK, raising awareness and funds for Breast Cancer work, mobilised over 750,000 women to run 5 Km, and raised over £43 million! In setting up Activation Bangladesh!, through one of our sponsoring/ partner organisations, Mystic People Foundation, we have been fortunate to acquire the professional services of a highly experienced Communications and Marketing Consultant, Tim Steel, who will add to our expertise in this area.

The work of organisations like St. Johns add to the work in First Aid training undertaken by youth organisations and community groups, such as, particularly, the scouts and girl guides who, even in Bangladesh, have traditionally been one of the few groups to interest themselves in such work, and you see what Primary Response, Everywhere, may means. The scouts and guides in Bangladesh have a similar line of training and activity at different levels, from seven years of age onwards.

It is to that end, in Dhaka and Chittagong cities, and in two Upazilas in rural areas, we plan to pilot a National Youth Volunteer Primary Response Brigade.

The activities, we believe, offer an opportunity, not only to define a growing problem for our people but promote solutions consistent with our rallying cry... "Activate Bangladesh! Don't just educate, Activate".

The author, a medical doctor, is Instructor, Sports Nutrition & Doping, Federation of International Sports Medicine, and President, Bangladesh Sports Doctors' Forum.