A recipe for good health: safe water and sanitation


This page in:

Also available in: Français中文 Drinking water from a pump in Mali (credit: Curt Carnemark).

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.


Blog: Global Sanitation Targets Risk Missing the Mark on Hygiene and Health Linkages


Health and the World Bank
Water and Sanitation and the World Bank


Patricio V. Marquez

Senior Associate, Johns Hopkins University Bloomberg School of Public Health

Join the Conversation

March 21, 2012

This an excellent post, Patricio, and most timely, too.

Hopefully it will help the health sector leaders shift from fundraising for the treatment of a "disease du jour", to preventing many more cases of disease and premature death by acting at the sources of the problems.

As you note, there is enough science to say what the sources are and enough economics to explain that it's far cheaper to prevent than to treat.

Unfortunately it appears to be difficult to be concerned about problems that have not yet occurred, though we know that occur they will if no preventive actions are taken.

Patricio Marquez
March 22, 2012

Your points are right on the mark and lead to the realization that the development paradigm needs to continue to move from sectoral projects or programs to a problem-solving modus operandi.

By focusing on problems we will be able to identify "entry points" and "interventions" that would help address the underlying root causes and not only the symptoms.

Ezeanochie Nnamdi
March 23, 2012

A nice read Patrico. This goes to show that with the right commitment from all stake holders, the application of science and economics can help save humanity. However, the reasons for slow pace of this "simple" merger are because of the various barriers that still challenge development work especially in Sub-Saharan Africa.
These barriers span from weak governance in a locality, to the poor handling of water projects by community members. Although most critics blame these issues on the use of inappropriate technology and a poor needs assessment, my observation is that people in poor resource areas seem to have contextual factors that prevent them from having a full understanding of the value of these projects, even when people enjoy its benefits.
These contextual factors, presently may surpass the knowledge of developers, therefore, more focus on qualitative research may help in this case.
Overall, the reality is that even areas designated as having access to safe water, may presently not be true; Taps may have been damaged ,wells re-contaminated and water facilities abandoned. The complexities development work faces must be evaluated to ensure a TRUE and steady progress

Patricio Marquez
March 26, 2012

In full agreement. It is imperative that we place added attention to understand the progression from need,demand and actual utilization of services at the community level. And more importantly, to identify mechanisms that would promote involvement of beneficiaries from the onset in order to ensure the sustainability of water and sanitation investments. Indeed, the involvement and contribution of communities contribute to raising the value of the investments and their benefits in the eyes of the beneficiaries.

May 15, 2012

Hi Patricio,

I am really impress with what you had posted.I am a medical student and currently doing research about healthy tips.We have to conserve water and always make sure that it is clean.


Patricio V Marquez
June 16, 2012

Thanks. Indeed, safe water water is a critical disease prevention investment that would go a long way in helping countries confront the health-based poverty trap as forcefully argued by a couple of MIT researchers (see "Poor Economics. A Radical Rethinking of the Way to Fight Global Poverty" by Banerjee and Duflo). Even in the absence of piped water, adding low-cost chlorine to purify drinking water could easily help to reduce diarrhea in young children.