The world’s biggest public health story: Clean drinking water and sanitation
In 2002, World Leaders committed to the eight Millennium Development Goals, Goal 7 of which is “to halve, by 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation”. The world is on track to meet the drinking water target, but at current levels of progress will miss the sanitation target by 700 million people (UN IYS 2008).
In numbers
The sanitation and health story is usually told in numbers, and most of the news is not good. 884 million people – about half of whom live in Asia – still rely on drinking water from unimproved sources such as ponds, streams, irrigation canals and unprotected dug wells. 2.5 billion (two in five) lack access to safe sanitation. 3.6 million people die each year from water-related diseases, 43 per cent of which are due to diarrhea. Most, 98 percent, are from developing countries and 3 million of which are children under fourteen. 5000 children under age 5 are killed every day by diarrhea alone (UNICEF 2009).
Water salesman. Photo by Camilla Wirsén, PeePoople.
A costly non-investment
The burden of disease costs the world USD 4.1 trillion each year (WHO) and lack of safe sanitation is the world’s biggest cause of infection. This makes it the world’s biggest public health story. Almost one-tenth of the global disease burden could be prevented by improving water supply, sanitation, hygiene and management of water resources. Open defecation and unsanitary practices contaminate water and food and spread disease that cost developing countries 5 billion working days lost to hygiene related illness each year (WSSCC and 2006 Human Development Report).
Helping women
Poor women and girls are hit hardest by the absence of toilets. They care for the sick and are in greatest physical contact with human waste. Lacking toilets in overcrowded slums means going the whole day without relieving oneself and then risking exposure – or even assault – at night, a humiliating daily routine that can damage health. Menstruation adds considerably to the need for sanitary facilities. Sexual harassment and rape are also a risk in rural areas, where women often seek privacy in the darkness, and in refugee camps, which all too often fail to provide safely located, women-only toilets. These realities absorb women’s time, imperil their physical well-being, and limit their free and equal participation in the economic and social life of their societies.
Smart money
Almost two in three people lacking access to safe drinking water survive on less than $2 a day and one in three on less than $1 a day. This means that household investment in financing sanitation is difficult for those who lack access. But hand-washing, safe disposal of excrement, and good general hygiene around food, domestic animals, and sick family members, are the world's most cost-effective health interventions. Research has shown that for every dollar invested in sanitation, up to $34 more in health, education, and social and economic development costs can be saved (UNICEF 2005). Using existing, proven approaches and technologies (see Dr. Pathak), and for about USD 10 billion a year the world could meet the MDG sanitation target to halve the proportion of people without access to basic sanitation by 2015, and provide everyone with a toilet by 2025.
