On the eve of World Water Day (March 22), there is some good public health news that is unrelated to medical care for the “sick,” but to a critical investment that makes people healthier and more productive, and promises a higher quality of life, particularly among the poor.
The 2012 UNICEF/World Health Organization report, Progress on Drinking Water and Sanitation, says that at the end of 2010, 89% of the world’s population, or 6.1 billion people, had access to improved drinking water. This means that the related Millennium Development Goal (MDG) has been met well ahead of the 2015 deadline. The report also predicts that by 2015, 92% of people will have access to better drinking water.
But, the not-so-good news is that only 63% of the world has improved sanitation access, a figure projected to increase only to 67% by 2015, well below the 75% MDG aim. Currently 2.5 billion people lack improved sanitation. The report also highlights the fact that the global figures mask big disparities between regions and countries, and within countries (e.g., only 61% of the people in Sub-Saharan Africa have access to safe water).
Should this news matter to public health types like me who work with health systems, who are not sanitary engineers?
The answer is a definite yes, since improving water and sanitation systems is a necessary complement to primary health care services and targeted nutrition interventions for reducing deaths and ill health in rural and urban slums where the poor concentrate. Unsafe drinking water, inadequate availability of water for hygiene, and lack of access to sanitation together contribute to about 88% of deaths from diarrheal diseases, or more than 1.5 million of the 1.9 million children under age 5 who perish from diarrhea each year. This amounts to close to 20% of all under-5 deaths and means that more than 5,000 children are dying every day as a result of diarrheal diseases.
The dilemma for the international community is simple: Are we going to wait to treat sick children in newly renovated health clinics offering drug therapy and keeping them in costly hospital beds, or should we channel scare resources to building sustainable safe water and sanitation systems that prevent kids from getting sick?
Working in rural areas high in the Andes of my native Ecuador, I saw how improved access to safe water and sanitation alone could significantly reduce diarrhea-related morbidity combined with hygiene awareness and the use of latrines, safe disposal of feces, and hand washing. And regular vaccines and basic health checkups and proper nutrition, particularly to deal with children’s Iron, Iodine, and Vitamin A deficiencies, help eliminate much of the infectious diseases burden.
While we should rejoice about the good news on World Water Day 2012, we also should heed the example of John Snow, one of the pillars of modern public health, who in the mid-1800s successfully demonstrated that the removal of pumps that supplied contaminated water controlled the cholera epidemics that were common in London at the time. By applying our public health knowledge about how infectious diseases are diffused and spread within communities, we could make a major and lasting impact by working together with our water and sanitation colleagues to tackle the source of these diseases, rather than just their symptoms.
