Text: World Health Organization Reports on Water and Sanitation

22 March 2001

Text: World Health Organization Reports on Water and Sanitation

More than three million die annually from water-related diseases

Unsafe drinking water and inadequate sanitation cause millions of deaths and illnesses, according to a report issued by the World Health Organization (WHO) March 22. The report recommends immediate, simple and inexpensive measures that can be taken to improve water and health, according to a press release issued with the report, "Water for Health -- Taking Charge."

"We do not have the luxury of waiting around for large infrastructure investments to provide water supplies and basic sanitation services for all who need them. It makes no sense, and it is not acceptable to ignore the immediate priorities of the most needy," said Dr. Gro Harlem Burndtland, director-general of WHO. The report was issued in recognition of World Water Day March 22.

The report recommends more widespread chlorination of water, even in households that do not have piped water. Research conducted by the U.S. Center for Disease Control and Prevention (CDC) and the Pan American Health organization (PAHO) shows that chlorination can help reduce disease even in situations where sanitation is poor. The findings defy the conventional wisdom that chlorination treatment only works after water and sanitation services are in place.

The report also advocates a little known water purification technique known as SODIS, or solar water disinfection. This simple method of placing plastic water containers in the sun allows the ultraviolet light to kill microorganisms in the water.

Another method for reducing water-borne disease is encouraging improved hygiene.

A special Web site on World Water Day can be found at http://www.worldwaterday.org/news/pr0321.html

The following text is available in French at http://www.worldwaterday.org/lgfr/news/pr0321.html

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World Health Organization

World Water Day 2001: Water for Health

21 March 2001

Water -- Immediate Solutions For Persistent Problems

Brussels -- More than one billion people drink unsafe water and 2.4 billion, 40% of the human race, are without adequate sanitation, and 3.4 million people, mostly children, die every year of water-related diseases (more than one million from malaria alone), the majority of them unnecessarily. But the picture is neither gloomy nor hopeless, says the World Health Organization (WHO) in a report on water and sanitation released here on the eve of World Water Day, Thursday, 22 March.

"Clearly, a problem of this magnitude cannot be solved overnight, but simple, inexpensive measures, both individual and collective, are available that will provide clean water for millions and millions of people in developing countries -- now, not in 10 or 20 years," said Dr. Gro Harlem Brundtland, Director-General of WHO. "We do not have the luxury of waiting around for large infrastructure investments to provide water supplies and basic sanitation services for all who need them. It makes no sense, and it is not acceptable, to ignore the immediate priorities of the most needy." Optimistic but realistic, the WHO report, entitled "Water for Health -- Taking Charge", strongly urges several basic measures, including purifying water (chlorination and sodis), and improving hygiene, as immediate means of improving people's water supply in developing countries.

Chlorination, for example, is "a proven means of ridding water of disease-causing microorganisms in piped water," according to the report.

Moreover, research carried out at the Centers for Disease Control and Prevention in Atlanta, Georgia, and by the Pan American Health Organization, supports chlorination in households without piped water, even though the prevailing wisdom is that chlorination should follow and not precede the creation of water and sanitation services.

"We looked at how chlorinated water could be provided to poor households through a simple, low-cost treatment and secure storage method," says Mark Sobsey, Professor of Environmental Microbiology at the University of North Carolina in Chapel Hill. "One of our findings is that improving water quality alone does work and we can do this without improving sanitation.

"What we know now is that even in conditions of very poor sanitation and hygiene, where people are collecting whatever water is available to use for their household water supply, if the water is chlorinated, the water is improved microbiologically, and you can find statistically significant decreases in diarrhoeal disease."

A good example of successful chlorination is to be found in the Maldives where a national control program used it in wells and in oral rehydration salts against diarrhea. Rainwater was also collected for drinking. Twenty years after the program started, all of the Maldives islands have their own community rainwater collection tanks, and deaths from diarrhea are virtually unknown.

"Another easy, small-scale, cost-effective, immediate technique for providing safe water, individually or collectively, is a still little-known but highly effective solar thermal technique. It is called SODIS and was promoted by the Swiss Federal Institute for Environmental Science and Technology near Zurich," said Dr Jamie Bartram, Coordinator of WHO's Water, Sanitation and Health Program, which issued the report.

"SODIS, or solar water disinfection, is a nearly cost-free system because sunlight costs nothing, and the only other elements are throw-away plastic soft-drink bottles and a black surface," explains Martin Wegelin, a researcher at the Swiss Institute for Environmental Science & Technology.

Transparent bottles are filled with water and placed horizontally on a flat surface for about five hours. The illness-causing microorganisms (pathogens) in the polluted water succumb to the killing effect of the ultraviolet light in solar radiation. The process is enhanced when the solar water disinfection is combined with a "solar thermal water treatment" which makes use of the fact that the color black absorbs light. This is accomplished by painting the bottom half of the bottle black or placing it on black-painted corrugated iron or plastic sheets.

"Field studies in Bolivia, Burkina Faso, China, Colombia, Indonesia, Thailand and Togo," the report states, "show that the process works."

A third recommendation of the report calls for "changing behavior."

"Our research shows that washing with hand soap would probably sharply reduce deaths from diarrheal disease," asserted Valerie Curtis, a lecturer in hygiene promotion at the London School of Hygiene and Tropical Medicine. "All it requires is soap and motivation. But that's more easily said than done."

A three-year study in India, West Africa, the UK and The Netherlands proved that the traditional "scolding, moralistic" approach to changing behavior doesn't work. People turn off if they are warned, "You'll get sick or die if you don't change your filthy ways." Ms. Curtis says that Brazilians refused to cooperate in a cholera prevention program because they thought they were being accused of being "filthy dogs". "We used a positive motivation approach in a three-year project in Bobo-Dioulasso, Burkina Faso, and at the end they had tripled their use of soap." Studies of diarrhea show that the simple act of washing one's hands with soap and water reduces incidence of the disease by 35%.

Elsewhere, good water management has almost eradicated guinea worm, a disfiguring, disabling disease which afflicted 50 million people in Africa and Asia in the mid-1900s. By 1999 that number had fallen to below 100'000.

But poor irrigation water management, in sharp contrast, has led to a huge spread of schistosomiasis (snail fever) to areas of the world where it never existed before. An estimated 200 million people are infected today with schistosomiasis, according to WHO.

What should be done differently to prevent water-related diseases and to ensure that everyone has access to at least some safe water and sanitation?

For one thing, says the WHO report, the health sector must get fully involved in water management. It can no longer be left to water management authorities or to environmental ministries. Just as major development projects always have environmental impact assessment, they should also require health impact assessments. Those involved in water management have to be responsible for its effects on people's health. During the past 50 years there has been a strong emphasis on medical interventions including for example, drug use and this has tended to reduce the attention and priority given to safe water supply and adequate sanitation into the back seat. With the growing resistance to antibiotics, insecticides and standard drugs, health authorities now understand the limitations of a strictly medical approach. That makes safe water and sanitation more important than ever.

"Society generally looks at the contribution of development to health. The contribution of health to development has been largely ignored. It is time to reverse this way of looking at things. And it is high time to recognize safe water supply and adequate sanitation to protect health are among the basic human rights," said Dr Brundtland.

All WHO Press Releases, Fact Sheets and Features as well as other information on this subject can be obtained on Internet on the WHO home page http://www.who.int/ and this site.

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