The need for better global estimates for safe water and sanitation

Researchers from the University of North Carolina (UNC) estimate that the number of people without safe water and sanitation is much higher than previously thought. If you add actual service levels and the unreliability of some of the data to the equation the picture may be even bleaker.

Dr. Jamie Bartram

Jamie Bartram’s team from UNC’s Water Institute calculated that 1.8 billion people (28% of the global population) used unsafe water in 2010 [1] and that 4.1 billion (60% of the global population ) lacked access to improved sanitation [2]. The corresponding official United Nations (UN) estimates are 783 million and 1.2 billion respectively.

The UN estimates are taken from the WHO/UNICEF Joint Monitoring Programme (JMP) [3]. The JMP definition of safe water is linked to the use of improved drinking-water sources. In their definition of safe water, Bartram’s team also looks at the water quality and sanitary risk of the improved sources. For their calculations, they modelled and extrapolated data from a WHO/UNICEF study on the Rapid Assessment of Drinking-Water Quality (RADWQ) in 5 countries.

WASH by numbers: the latest on cost benchmarks, economic returns and handwashing

One of the most quoted WASH statistics was recently “downgraded”. For every $1 invested in water and sanitation, not $8 but “only” $4 is returned in economic returns through increased productivity. This recalculation [1], says the World Health Organization, is mainly a result of higher investment cost estimates and the more complete inclusion of operation and maintenance (O&M) costs.

Providing a better insight into O&M costs has been one of the achievements of the WASHCost project of the IRC International Water and Sanitation Centre. WASHCost has published minimum benchmarks for costing sustainable basic WASH services in developing countries [2]. The project collected data from Burkina Faso, Ghana, Andhra Pradesh (India) and Mozambique.

The main message is that spending less than the minimum benchmarks will result in a higher risk of reduced service levels or long-term failure. NGOs claiming that “US$20 can provide clean water for one person for 20 years” have clearly forgotten to include annual recurrent costs for operation and maintenance, capital maintenance and direct support.

The real cost for 20 years of basic water supply from a borehole and handpump would be, per person, between US$ 20 and US$ 61 for construction plus US$ 3-6 every year to keep it working. In total for the 20 years this would amount to US$ 80 to US$ 181 per person.

Similarly, for the most basic sanitation service, a traditional pit latrine, the combined costs would be US$ 37 – 106 per person over 20 years.

Study quantifies link between poor sanitation and child, maternal mortality

In countries with the poorest sanitation, child mortality is nearly 7 times higher than in countries with the best access to sanitation. This is one of the findings of a new study [1] by Canadian-based researchers who say they are the first to quantify the impact of unsafe water and poor sanitation on child and maternal mortality.

Researcher June J. Cheng. Photo: McMaster University

Researchers at the United Nations University and McMaster University analysed data on access to safe water and adequate sanitation across 193 countries and compared them with maternal and child deaths.

Dividing the countries into four tiers (“quartiles”), they found that countries ranked in the bottom 25% in terms of adequate sanitation had about 6.6 more deaths per 1,000 children under five years old compared to countries in the top 25% tier.

Similarly, when judged on access to safe water, countries ranked in the bottom quartile, child mortality was 4.7 higher than in the top quartile.

Relating adequate sanitation provision and maternal death rates (death within a year of childbirth), the paper says the odds of dying increase 48% from the top tier to each lower tier of countries; the corresponding odds with respect to unsafe inadequate sanitation: 42%.

[1] Cheng, J.J. et al., 2012. An ecological quantification of the relationships between water, sanitation and infant, child, and maternal mortality. Environmental Health, 11 (4). Available at:  
http://dx.doi.org/10.1186/1476-069X-11-4
[accessed 17 Feb 2012]

Related news:

• Diarrhoeal diseases: study predicts decline in global deaths, E-Source, 20 April 2011
• Health impact: effect of water quality, hygiene and sanitation in preventing diarrhoea deaths, E-Source, 22 Jun 2010

Related web sites:

• UNU-INWEH – Water-Health Nexus
• WHO – Water Sanitation and Health (WSH) – Burden of disease and cost-effectiveness estimates

Contact: June J Cheng (june.cheng@medportal.ca), Public Health and Preventive Medicine Residency Program, Dept. of Clinical Epidemiology and Biostatistics, McMaster University and United Nations University Institute for Water, Environment and Health (UNU-INWEH), Canada

Source: United Nations University, EurekaAlert!, 14 Feb 2011

Access to safe water and sanitation among top global public health achievements

Access to safe water and sanitation are among the ten top global public health achievements in the first decade of 21st century identified by the Centers for Disease Control and Prevention (CDC).

CDC asked experts in global public health to nominate noteworthy public health achievements that occurred outside of the United States during 2001–2010. CDC selected ten of these achievements and published an overview in Morbidity and Mortality Weekly Report (MMWR) of 24 June 2011.

Between 2000 and 2008, CDC reports that an additional 800 million people gained access to improved drinking water sources, and additional 570 million people gained access to improved sanitation. In addition, education and safe water technology have eradicated Guinea worm in all but four countries (Southern Sudan, Mali, Ethiopia, and Ghana), with complete eradication expected in 2012.

Global deaths from diarrhoea, malaria, AIDS declining, study predicts

Under-five child mortality from diarrhoeal diseases, which was 1.7 million in 2005, is expected to fall to just over half a million by 2030 and around 130,000 in 2060, a new study [1] predicts.

The study notes that headway is being made in fighting communicable diseases such as diarrhoea, malaria and AIDS. At the global level disease burdens are shifting from communicable diseases to chronic ones such as cancer, diabetes and heart disease.

Capacity gap: lack of engineers stifling development, says report

A shortage of engineers in developing countries is hampering development, according to a new UNESCO global report on engineering [1]. In developing countries there are on average only five engineers per 10,000 people – and less than one in some African countries – compared to 20–50 engineers per 10,000 in developed countries.

The poorest are hit hardest by the lack of engineers: 1.1 billion people have no access to clean water, 2 billion have no access to electricity and 800 million go hungry on a daily basis.

“The crucial thing is to address people’s basic needs: water supply, sanitation, better homes,” Tony Marjoram, editor of the report and head of engineering sciences at UNESCO, told SciDev.Net.

[...] Developing countries bear the brunt of climate change, so ensuring sustainable development is also important, he said.

“Engineering is often blamed for pollution but it can create solutions to reduce carbon emissions and make energy use more effective,” Marjoram said.

Water stress: new map identifies ‘high risk’ countries

China, India, the Middle East and North Africa, and Southern Africa are all rated as ‘high risk’ in a new study evaluating the vulnerability of 159 countries to water stress.

The Water Stress Index is developed by global risks advisory firm Maplecroft to identify the risks to governments, populations and business. The index is calculated by evaluating the ratio of a country’s total water use, from domestic, industrial and agricultural use, to the renewable supply of water from precipitation, streams, rivers and groundwater. The index is accompanied by a sub-national map, which utilises GIS (Geographic Information System) technology to pinpoint global water stress down to 50km² worldwide.

Population growth and rising global temperatures mean that water stress will continue to be a challenge for governments, business and society.

Water security: Pakistan and Egypt among nations facing “extreme” risk

The ten countries with the least secure supplies of water are Somalia, Mauritania, Sudan, Niger, Iraq, Uzbekistan, Pakistan, Egypt, Turkmenistan and Syria, according a review of 165 nations. This was revealed in the 2010Water Security Risk Index, published by Maplecroft, a firm specialising in corporate risk intelligence for multinationals.

The Water Security Risk Index is based on four key areas surrounding the issue. These include: access to improved drinking water and sanitation; the availability of renewable water and the reliance on external supplies; the relationship between available water and supply demands; and the water dependency of each country’s economy.

Maplecroft’s research finds that countries in the extreme risk category, including the emerging economies of Pakistan, Egypt and Uzbekistan, are already experiencing internal and cross-border tensions due to limited water resources. Furthermore, as the global climate changes, water stress is predicted to become more acute in these regions and has the potential to threaten stability.

In Africa there are 15 countries in the high and extreme risk categories.

Source: Maplecroft, 24 Jun 2010

Tackling global health risks prevents premature deaths

Global life expectancy could be increased by nearly five years by addressing five factors affecting health – childhood underweight, unsafe sex, alcohol use, lack of safe water, sanitation and hygiene, and high blood pressure, according to a new WHO report.

These are responsible for one-quarter of the 60 million deaths estimated to occur annually.

Global health risks describes 24 factors affecting health. These are mixture of environmental, behavioural and physiological factors, such as air pollution, tobacco use and poor nutrition.

The report also draws attention to the combined effect of multiple risk factors. Many deaths and diseases are caused by more than one risk factor and may be prevented by reducing any of the risk factors responsible for them.

Read the full press release: WHO, 27 Oct 2009

Read the full report

The report mentions that unsafe water, sanitation and hygiene is one of the the leading global risks for burden of disease, accounting for 4% of disability-adjusted life years (DALYs), The others are childhood underweight (6% of global DALYs), unsafe sex (5%) and alcohol use (5%) [see fig. 7].

In developing countries, unsafe water, sanitation and hygiene comes second behind childhood underweight as the highest risk for burden of disease [see tab 2.].

In the annexes of the report there are more detailed tables on health risk factors by WHO region (Africa, Southeast Asia, the Americas, Eastern Mediterranean, Europe and Western Pacific).

Source: WHO, 2009. Global health risks

Source: WHO, 2009, Global health risks

Water Facts & Trends updated, World Business Council for Sustainable Development

The World Business Council for Sustainable Development (WBCSD) has updated its Water Facts and Trends publication ( 3.5 MB) , which now includes recent information on access to water and sanitation, areas of economic and physical water scarcity and economic considerations in water management.

This working document provides an overview of some basic facts and societal challenges related to water. It has been developed by the WBCSD secretariat and is intended to support the ongoing dialogue within the WBCSD membership and with other stakeholders in civil society and government.

The emphasis in this document is on water availability and people’s use of water for agricultural, industrial and domestic purposes.

Data has been drawn from documents prepared for the World Water Forums, the OECD, the World Resources Institute and other research organizations.

The document is one of the outputs of WBCSD’s Water project that aim to help companies integrate water issues in their strategic planning. Other outputs include Water Scenarios to 2025 (2006) the Global Water Tool (2007) and Collaborative Actions for Sustainable Water Management (2005).

Source: WBCSD, 12 Aug 2009