Access to water and the burden of disease
Nadia Amokrane, Eleanor Gaff, William Loughborough and Richard Ruberti
Intercalating Medical Students International Health BSc, University of Bristol, Centre for Child & Adolescent Health, Bristol BS6 6JS.Address for correspondence: W Loughborough wl6995@bristol.ac.uk
2005-2015 is the so-called ‘Water for Life’ decade. Access to safe, clean drinking water is a basic provision and a fundamental necessity. However, we are now in the 21st century and 1·1 billion people, the equivalent of 17% of the world’s population, live without access to safe water sources.1 Consequently a vast number of people are affected by disease.
Unsurprisingly, the developing world bears the majority of the burden of communicable disease and much of this is as a result of poor water access. Sub-Saharan Africa, for example, only has 42% coverage of improved water supply.
Diseases associated with poor water access are varied and numerous. Diarrhoeal diseases are extremely common, killing about 1·8 million people a year, mostly children under 5 years of age—88% of this number die because of poor access to water, hygiene and sanitation.1
Trachoma is another common problem arising because of poor water access with about 500 million people worldwide at risk.1 Poor water access can also lead to exposure to intestinal helminths, schistosomiasis and hepatitis A. Disease is not the only challenge that poor water access poses; dehydration is a real danger, especially in emergency situations.
Safe water availability is further compromised by the effects of climate change. An increase in temperature is leading to less ground water and less rainfall in parts of the world and thus an escalation in water-related diseases and deaths from dehydration.
The rapidly rising rate of urbanisation in developing countries means that demand for water is also increasing. The demand-supply gap is set to increase in the near future for developing countries, exacerbating the burden of disease that poor water access is already inflicting here. Because of the lack of water sources, the same source of water is often used for washing, waste disposal, cooking and as a drinking spot for livestock.
Poverty compounds the issue of water scarcity in many regions of the world causing a vicious cycle. Lack of access to water is an obstacle to income generating activities such as farming. A poor performing economy or a history of recent conflict means the infrastructure for supplying water to the population is weak and government funds often don’t stretch to cover the costs of improving water provision and management. Water can be a costly commodity that poverty-stricken families struggle to afford. Poor populations simply cannot pay for water and so remain trapped.
The impact of having 1·1 billion people living without access to safe water and 2·6 billion without access to sanitation hampers development in many ways. Every day, millions of women and children walk long distances to collect water for their families—a time consuming activity, which could otherwise be spent on education and activities which help to reduce gender inequalities.
The UN Human Development Report of 20062 stated that access to safe water and sanitation were fundamental elements of development. They defined human development first and foremost as ‘about allowing people to lead a life that they value and enabling them to realize their potential as human beings.’ There can be no doubt that this cannot be achieved without the basic human need and the fundamental right of access to water.
Many targets have been made to encourage action to achieve universal access to safe drinking water, however so far they have all fallen short. The Millennium Development Goals (MDGs) are the newest of these targets and aim to reduce by half the proportion of people without sustainable access to safe drinking water by 2015. It is predicted that this target will be met if looked at on a global perspective but when each country or region is considered many areas such as sub-Saharan Africa will fall way below. Even if the target is met 800 million people will still lack access to safe drinking water in 2015.
It is also becoming apparent that competition for water is set to increase in the years ahead. Population growth, urbanization, industrial development, the impacts of climate change and the needs of agriculture are driving up demand for a finite resource. Globally, the technology and finance is available to address the water and sanitation crisis but only if it is put high on political agendas around the globe. Unfortunately, those who suffer the most from this crisis, often lack the voice to influence political leaders and assert their needs.
Many politicians around the world are aware that water is a basic human right but this statement alone does not seem to drive them to make water access a top priority. Water is politically underrepresented at both national and international levels. Dealing with this issue is often delegated to junior ministers, barely ever mentioned in Poverty Reduction Strategy Papers and at an international level, despite research in the field from 23 UN agencies. One strong agency could possibly prove more effective. There are many conferences and research studies highlighting the affects of the lack of water on development but subsequent action has not been forthcoming. A global agency, resembling the global fund to fight AIDs, TB and malaria, could perhaps be the key and could take control of spearheading an agenda with ‘Water for Life’ as the main objective. This would mobilise finance to committed governments and allow capacity building to support national strategies. It is time for the international community, including the health sector, to get serious about water.
References
1. WHO. World Health Organisation, Water, Sanitation and Hygiene links to Health. 2004 http://www.who.int/water_sanitation_health/factsfigures2005.pdf (Accessed 07/03/07)
2. United Nations Development Programme. Human Development Report 2006: Beyond scarcity: Power, poverty and the global water crisis. http://hdr.undp.org/hdr2006/report.cfm (viewed on 09/03/07)