Water for Health - Taking Charge
3. Where we need to act
Water And Health for the Rural Poor - Arsenic In Drinking-Water - Fluoride - Schistosomiasis - Water, Health And The Urban Poor - Indigenous People
It is estimated that it would cost about US$ 23 billion per year to achieve the international development target of halving the percentage of people unserved with improved water sources globally (currently at 18%) and improved sanitation services (currently at 40%) by the year 2015. But governments presently spend US$ 16 billion a year in building new infrastructure. The additional US$ 7 billion a year needed to supply good water and sanitation to some who lack it is less than one tenth of what Europe spends on alcoholic drinks each year, about the same as Europe spends on ice cream and half of what the United States spends each year on pet food. Compared to what governments expend on military weapons, the cost of providing people with the means to improve their health is small.
Water And Health for the Rural Poor
Managing water supply can be difficult in rural areas. Of the 1.1 billion people without access to improved water sources worldwide, around 84% live in rural areas. Drinking-water quality is especially difficult to control and even in the most developed countries, small community water supplies frequently fail on basic microbiological quality. Rural communities have a different relationship to water than do urban dwellers. Water dominates every aspect of their lives. People in the countryside live off the land and depend on water to grow their crops. Scarce water supplies are used sparingly for household needs. Water is the source of their livelihood and, when unclean or mismanaged, the source of ill-health and continued poverty. Water contains many trace elements and minerals, which may be benign, beneficial or toxic. Everything depends on how much. While some minerals may be beneficial in low concentrations, most can be toxic in excess. Only a few chemicals - for instance, arsenic and fluoride - are thought to be major public health issues. The problems they and nitrate cause are most common in rural areas.
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To achieve the international development target of halving the proportion of people without access to improved water or sanitation by 2015, an additional 1.6 billion people will require access to water supply and about 2.2 billion will require access to sanitation facilities. |
Arsenic In Drinking-Water
One of the worst examples of a do-good project gone wrong is occurring in Bangladesh. About two decades ago, millions of small wells began to be drilled in an effort to provide safe water to the population. At the time, all attention was focused on preventing diarrhoeal disease which ravaged the population. No one, until the 1980s, identified naturally-occurring arsenic as a health hazard. A recent study published in the Bulletin of the World Health Organization suggests that Bangladesh is grappling with the largest mass poisoning in history, potentially affecting between 35 and 77 million of the country's 125 million population, threatening them with potential epidemics of cancers and other fatal diseases. Attacking the problem in Bangladesh is not easy. There are millions of wells and those that are dangerous are mixed in with those that are safe. There are several technical solutions but no single universal method. Well-to-well testing is needed.
Arsenic Contaminated Drinking-Water - A Public Health Emergency
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Fluoride
Fluoride is present in all waters. Low amounts of this element can be good for teeth. But, excessive amounts of fluoride in drinking-water can be toxic. People with teeth discolored by fluoride are found worldwide, and crippling skeletal effects are prominent in at least eight countries. It is estimated that 30 million people suffer from chronic fluorosis in China where the custom of burning fluoride-rich coal in the household may further aggravate the problem. These issues can be solved and answers are available, but implementing projects, especially in the rural areas where the disease is most prevalent, is often difficult.
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The farmer with the black teeth seemed fine the first time I saw him - out all day working. I know that he carried on drinking the same fluoride-rich water he had drunk since he was born. Five years later when I returned to the village his legs had buckled under him. He was practically a cripple. I don't know what he did for a living any more. Source: Eli Dahi: researcher Des world |
Schistosomiasis
Of all the water-associated tropical diseases, schistosomiasis, a water-based parasitic disease, best illustrates the complexities of the various water issues with which mostly the rural poor are faced. For part of their lifecycle, Schistosoma parasites depend on aquatic snails. The disease is maintained through faecal/urine contamination of open waters with parasite eggs, the presence of the snails and frequent water contact for recreational, domestic or occupational purposes.
Water management can play an important role in reducing transmission risks. But it must be combined with drug treatment, the provision of safe drinking-water and adequate sanitation. Health education is also important. Canal lining, regular rapid draw-down of reservoirs, and increased flow rates in irrigation canals all favour snail elimination, but are only efficient if they have a positive effect on agricultural production at the same time.
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200 million people in the world are infected with schistosomiasis, of whom 20 million suffer severe consequences |
Water, Health And The Urban Poor
Competition for water in the world's ever-growing cities is fierce. Industry, urban agriculture and households all rely on and demand water to meet their needs. But water is becoming scarce, and this often results in the inequitable distribution of what is available. Municipal water regulations, government subsidies, public and private investment all tend to favour traditional water-supply services which provide piped .water directly into peoples’ homes, but neglect the urban poor. Hygiene practice is closely linked to the availability of water and sanitation facilities. In places where these may be lacking, communal areas which offer facilities for hand-washing, bathing and laundry may effectively encourage good hygiene. Education is also important. For instance, the health of communities can be enhanced if they are able to protect their water sources, dispose of solid waste and excreta, and provide wastewater drainage.
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25% of all community water systems are currently posing a health and safety risk to the community. Of the 425 community sewage-treatment systems, 9% are experiencing problems that could affect the health and safety of the community. -“Water Quality Monitoring in Canadian Aboriginal Communities” by Jeff Moore |
Urban habitats provide breeding grounds for diseases such as dengue fever and urban malaria. Control methods for reducing breeding-sites for the insect vector is a proven and effective means of cutting disease. Unfortunately, they are difficult to implement in densely-populated shanty towns with inadequate waste disposal.
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In Ethiopia, unsafe water, unhygienic handling of food, storage of food at ambient temperature for a long time, poor domestic and personal hygiene may have contributed to the gross contamination of weaning foods. The contamination of food may lead to increased diarrhoeal diseases in infants and children |
Indigenous People
Contamination of traditional food sources is becoming an increasing issue of concern among indigenous populations, many of whom derive most of their drinking, irrigation and food from local lakes and rivers. In South America for example, indigenous peoples in the Andes and Amazon regions are exposed to high levels of arsenic and mercury in local water systems and fish. This is creating health problems among children and breastfed infants. For many tribal groups in Africa, unsafe drinking- water and unhygienic handling of food is contributing to high levels of diarrhoeal diseases in infants and children.
Indigenous peoples in rich countries may also live in abject poverty and suffer from the kind of ill-health and economic deprivation that are commonly found in developing countries. However, the outlook for disadvantaged communities in these societies is usually better because of active social support networks.
Canada is a wealthy country with a large indigenous population which, according to statistics, has a lower life expectancy, higher infant mortality and greater disease burden than the rest of society. A study of water and sewage facilities conducted by Health Canada.and the Department of Indian Affairs examined 863 First Nations community water-treatment systems and 425 community sewage-treatment systems. It found that vast improvements in health, leading to economic development and poverty reduction, could be achieved by providing native communities with a good water supply and sanitation.
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Fish collected in the Beni river, food source for indigenous Amazonian populations, were contaminated and contained almost four times the amount of mercury considered safe by WHO. High levels of mercury in fish lead to an increase in contamination in indigenous children, and young children still being breast-fed. |
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Indigenous Atacamena people in Chile who live on the banks of pre-Andes river are exposed to very high concentrations of arsenic - over 50 times the national standard. This has a large impact on the Atacamena, who derive most of their drinking and irrigation water source from the water. |