Thursday, March 29, 2012

Safe Water

by Conroy

Gathering unsafe water in India
I’m fond of saying that the modern world started when indoor plumbing, fresh water and modern sanitation, became widely available. Not only did these innovations make conditions far more sanitary but it also promoted better hygiene [1]. For the United States, this happened in the later nineteenth and early twentieth centuries [2], and by the decade after World War II most urban and rural areas of westernized nations had modern plumbing; clean water was delivered to the house and dirty water carried away.

This development had a profound effect on public health. Cholera, dysentery, and typhoid fever were among the common epidemics suffered in London, New York, and other major western cities before what I’ll term the safe water infrastructure was in place. Now those diseases are largely unknown in the west. I’m guessing that for most readers of this blog, safe water is taken largely for granted, as it was by our parents and even our grandparents. In fact, a resident of New York or London probably thinks that the word cholera is quaint and foreign, when as little as 100 years ago it would have caused mortal dread.

Unsafe Water
This isn’t the case everywhere though. Cholera still afflicts millions of people worldwide each year, and a major outbreak occurred in Haiti after the massive, crippling 2010 earthquake. This is because even now, in 2012, billions of people across the globe still lack access to clean drinking water and modern sanitation. Here are a few eye-opening statistics from the World Health Organization (WHO):
  • 900 million people lack access to drinking-water from improved water sources (13% of the world population);
  • 2.6 billion people lack access to improved sanitation facilities (37% of the world population);
  • 2.2 million children die worldwide each year from unsafe water.
  • Unsafe water is a major risk factor for diarrheal disease, which is the second leading contributor to the global disease burden.

Here are a couple of maps, taken directly from the U.N.’s 2010 Global Annual Assessment of Sanitation and Drinking-Water (GLAAS) report that illustrate the current safe water crisis (click on them to enlarge):

The top map shows the state of improved sanitation. The pink colored countries are where less than 50% of the population has access to improved sanitation; the light green colored countries are where less than 75% of the population has access to improved sanitation. The first category includes the great majority of sub-Saharan Africa as well as south Asia. The second category includes China, the world’s most populous nation. Less than 90% of the populations of Brazil, Russia, Argentina, and Mexico have access to improved sanitation.

The bottom map shows the state of improved drinking water. The pink colored countries are where less than 50% of the population has access to improved drinking-water; the light blue colored countries are where less than 75% have access; and the medium blue colored countries are where less than 90% have access. The first and second categories include the great majority of sub-Saharan Africa. The third category includes India and China, the world’s two most populous nations. Not surprisingly, all of these nations, including India and China, fare very poorly in the U.N.’s Human Development Index, which attempts to quantify overall quality of life by country [3]. This is hardly surprising; it’s difficult to imagine human development being high where safe water is a luxury.

Only the most oblivious of westerners is unaware of the deep poverty that grips much of the world, including huge portions of Asia and Africa. Still, providing clean water and sanitation to the population should be a primary goal for all developing countries. The public health and general benefits of safe water are obvious, and have been obvious for generations. The WHO estimates that for every $1 invested in safe water, $3 to $34 in economic benefits are realized. Lower health care costs, fewer sick days, less time spent in search of clean water, and deaths averted, are only the most directly related outcomes. China is widely viewed as a new global power with the world’s second largest economy. India is viewed as a future power. Together they are home to more than 35% of the world’s population. Yet both have failed to provide universal access to safe water [4].

Slow Progress
A read of the 2010 GLAAS report provides a sobering overview of the current situation. The reasons why billions continue to lack safe water range from low prioritization and low investment in developing countries; to foreign aid that is poorly managed on a national level and inefficiently targeted to areas most in need; and various international, national, and sub-national bureaucracies working at cross purposes. International aid for safe water lags far behind spending on education and other health initiatives like HIV/AIDS prevention and treatment. The percentage of international aid dedicated to safe water has actually declined over the last 15 year from 8% in 1997 to just 5% today. It also appears that developing nations are spending only a tiny fraction of their GDP on safe water projects. Still, at least in rural areas there has been improvement since 1990, with 10% less of the global rural population exposed to unsafe water than was true two decades ago. Nevertheless, progress has been achingly slow.

What is frustrating to an outside observer is the fact that providing safe water to the vast majority of the world’s people, both urban and rural is an achievable goal. In some places, like the deserts and highly arid areas of Africa, true water scarcity is an issue, but in most locations adequate water sources exist. Clean water technology is straightforward even if it does require a lot of infrastructure [5]. But consider the chaotic mix of funding from dozens of international donor organizations, a developing nation’s (likely very strained) internal budget, competing national policies and politics, various national and regional improvement plans, the availability of national and local resources, chronic and acute national and local crises, shifting national priorities, the varying quality and stability of political leadership, the level of technical expertise, and the size and sophistication of the private sector. Out of all of that there needs to develop a coherent plan to provide safe water where it’s needed. No wonder progress has been slow and billions are likely to remain without safe water for decades to come.

A clean water pump in rural Africa
If annual international investment for safe water were to double from the current $7.5 billion to $15 billion, there is no doubt that huge gains could be made (assuming of course that the increased funding was appropriately targeted and managed). This figure is by no means a meager sum, but surely something the western world could support. For comparison, U.S. government non-military foreign aid in 2010 was $38 billion, and private donations to developing countries from the U.S. amounted to another estimated $12 billion. That’s $50 billion annually from one country. There’s enough money out there to provide safe water everywhere. And that doesn’t even consider the extra money that would be available if developing nations made providing universal safe water the priority it should be. The GLAAS report includes many recommendations to try and pull all of the disparate funding sources and various national policies into a manageable plan. Hopefully those recommendations will lead to better action.

I’m not optimistic that safe water will become universally available in the near term, but maybe the right leaders and the right policies will emerge to make unsafe water a piece of history for the developing world like it’s been for generations in the west. Think of the global benefit, both economically and in the broader quality of life measures that would come from providing everyone with safe water. I hope I live to see it.



[1] Cleanliness may be next to godliness, and it’s certainly related to better health. And let’s not overlook its role in more…um, pleasant…social interactions. 

[2] For example, I live less than a mile from Loch Raven reservoir just a few miles north of Baltimore. I run through the woods and along the shores of the reservoir several times each week. It's a very beautiful sylvan setting, but it has an important purpose. The reservoir was formed about a century ago when the Big Gunpowder Falls River was dammed to provide a large reliable source of drinking water for the city. The reservoir feeds an underground aqueduct that transports water seven miles to Lake Montebello in the middle of Baltimore. There the water is treated and pumped out to the city and most of Baltimore County, including my house, for consumption. Used water then flows from my house through sewers to the Back River waste water treatment plant just east of Baltimore. Once treated the water is clean and is released into Back River. This is a common urban approach to water delivery and treatment. Rural houses often get their water from wells and the waste water flows into an underground septic tank.

[3] The definition of human development provided in the 2010 report is: “Human development is the expansion of people’s freedoms to live long, healthy and creative lives; to advance other goals they have reason to value; and to engage actively in shaping development equitably and sustainably on a shared planet. People are both the beneficiaries and the drivers of human development, as individuals and in groups.”

[4] All four “BRIC” nations, the others being Brazil and Russia, also struggle to provide safe water for all of their citizens.

[5] For urban areas: a water source, treatment facilities, pumps and pipes to distribute clean water and collect waste water, and sophisticated waste water treatment facilities to ensure that the dirty water doesn’t pollute the water supply. For rural areas: a water source, which could be as simple as a local well, and sanitation facilities that collect waste water and ensure it does not contaminate the groundwater or other clean water source. In some places it may require long aqueducts to transport water to an urban area, but these have been successfully built – at a high cost – for both New York and Los Angeles.

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