Water and sanitation and their impact on health

Why is water and sanitation so important for health?

• Diseases arising from poor quality water and sanitation are a huge cause of mortality and morbidity worldwide, especially in children

• Diarrhoea kills 1.6 million children every year, more than malaria, measles and HIV/AIDS combined (WaterAid)

• Diarrhoeal disease caused by contaminated water contributes to malnutrition and respiratory disease. This results in about 2.4 million preventable deaths every year, mainly in children, from a combination of these factors (WaterAid report, July 2008)

• WHO estimates that a tenth of the global disease burden could be prevented by improving water, sanitation and hygiene (WHO report, June 2008)

Why is water and sanitation so important for health?

• Economic implications: a recent report estimated that poor water and sanitation costs Indonesia US$6.3 billion per year (nearly 2.5% GDP) (Water and Sanitation Program report, August 2008)

• Hygiene and sanitation promotion are the most cost-effective ways to reduce Disability-Adjusted Life Years (DALYs) in children

• Historical background: shows that improving water and sanitation is the most effective public health intervention

A bit on the history of water and sanitation in Britain

• 1834: Edwin Chadwick’s Poor Law Amendment Act put forward the case for relieving poverty by improving sanitation

• 1848: Public Health Act (heavily influenced by Chadwick’s act)

• 1848: John Snow makes the connection between cholera and contaminated water (though people have contested his importance)

• Spending on water and sewer systems steadily increased over the second half of the 19th century

• Life expectancy increases by 15 years between 1880 and 1920

• 2007: readers of the BMJ voted the “sanitary revolution” as the greatest medical advance since 1840, over the discovery of antibiotics

MDG7: Ensure environmental sustainability

• Millennium Development Goal 7 targets– To reduce the proportion of people without

access to safe water by half by 2015– To reduce the proportion of people without

access to improved sanitation by half by 2015

• 1.1 billion people still lack access to safe water and 2.5 billion people to improved sanitation.– There has been progress; since 1990, 1.6 billion people

have gained access to safe water and 1.1 billion to improved sanitation but this is plainly not enough

– By current estimations the water target might be met but the sanitation figures are lagging severely (e.g. in sub-Saharan Africa the sanitation target will not be met until 2108 at the current rate of progress).

– Urban/rural disparity e.g. 96% of the urban population has access to safe water, compared to 78% of the rural population worldwide.

The current situation…

Despite the obvious importance of water and sanitation, its profile is very low on international development agendas and is generally seen as an engineering/quality of life issue that follows later in development, rather than an integral health issue that needs to be addressed first.

• MDG7 sanitation target was added as an afterthought in 2002

• UN declared 2008 the International Year of Sanitation in order to raise the international profile of sanitation

• Much less attention on sanitation than water, though the two go hand in hand in preventing disease

• 2.5 billion people lack access to improved sanitation (where excrement is hygienically separated from people) but 1.5 billion of those have no sanitation options at all and practice open defecation

• Again, sanitation coverage is better in urban areas than rural areas (79% coverage compared to 49%, respectively) but can especially be a problem in large slums e.g. the “flying toilets” of Kibera, Nairobi.

The sanitation shortfall

Other issues within water and sanitation

• Impact on women– Collecting water usually left to

women and girls. Walking to distant water sources or queuing in cities for pumps or kiosks can take up a huge amount of time and is often a factor in preventing girls from being sent to school

– Girls may leave school once they reach adolescence due to inadequate sanitation facilities

–Where open defecation is the only sanitation option, women are more vulnerable to attack–While women place a higher value on improved water and sanitation than men, they are rarely included in development discussion and implementation, despite calls for them to be more involved e.g. the Beijing declaration in 1995

Other issues within water and sanitation cont.

• The wider environment– Climate change, an increasing global population and

changes in consumption habits (particularly related to agriculture and meat production) are putting pressure on water resources

– The UN Intergovernmental Panel on Climate Change estimates that over 3 billion people could be suffering acute water shortages by 2080

– Natural disasters such as floods and droughts are becoming more common and lead more communities to need emergency intervention

– Better and more coordinated water management is needed to ensure that more people are provided with enough safe water.

Why is so little being done?

• Some of the logistical problems:– Water and sanitation are neglected on both

donor and recipient agendas.– Responsibility for water and sanitation is

divided between departments and organisations e.g. different government sectors, agriculture, private water companies and there is little, if any, coordination with health and education programs

The policy situation• What governments are doing (or not doing):

– Japan (which is one of the biggest aid contributors to water and sanitation) had promised to bring the issues of water and sanitation to 2008’s G8 summit in Hokkaido but the meeting was overshadowed by other subjects such as the world food crisis.

– DFID produced a report in October 2008 affirming the UK government’s commitment to improving water and sanitation and pledging £1 billion over the next five years, but there were few references to health

• NGOs and civil society:– Groups such as End Water Poverty and the World Toilet

Organisation continue to campaign for international recognition of water and sanitation

Summary• Improvements in water and sanitation are brought

about by officials and engineers, not doctors, but they are still health issues

• Poor water and sanitation are responsible for a huge global burden of disease

• Water and sanitation also link into gender, educational and environmental concerns

• They have a low priority on international development agendas but are essential for achieving the MDGs, especially MDG4

References/links• MDGs

– http://www.un.org/millenniumgoals/• 2008 WHO report: safe water, better health

– http://whqlibdoc.who.int/publications/2008/9789241596435_eng.pdf• 2008 WaterAid report

– http://www.wateraid.org/documents/tackling_the_silent_killer_the_case_for_sanitation.pdf

• 2008 International year of sanitation– http://esa.un.org/iys/

• DFID policy– http://www.dfid.gov.uk/pubs/files/water-sanitation-policy-08.pdf

• End Water Poverty– http://www.endwaterpoverty.org/

• World Toilet Organisation– http://www.worldtoilet.org/