2. 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)
3. 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
4. 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
5. 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
6. • 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…
7. 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.
8. • 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
9. 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
10. 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.
11. 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
12. 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
13. 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
14. 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_sa
nitation.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/
