Talking Dirty — The Politics of Clean Water and Sanitation (NE Jour Med)

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Talking Dirty — The Politics of Clean Water and Sanitation

Michele Barry, M.D., and James M. Hughes, M.D.

In the wake of Cyclone Nargis, which devastated the Myanmar delta in early May, and the seismic earthquake that shook China shortly thereafter, access to safe drinking water and proper sanitation have become top priorities among those attempting to prevent epidemic diseases. But even without catastrophic disasters, the lack of access to clean water and basic sanitation represents a silent crisis affecting more than a third of the world's population.1 Some 443 million school days are lost annually to water-related illness, millions of women and girls spend up to 2 hours a day collecting water, and every day in Bangladesh alone 28 million to 35 million people consume drinking water containing dangerously elevated levels of arsenic.2 Given that the United Nations has declared 2008 the International Year of Sanitation — and that in the United States this year marks the 100th anniversary of the first chlorination of a public water supply — this seems an appropriate time to reengage in an ancient conversation about safe water and sanitation.

The first documented attempts to treat drinking water, which may date back to 4000 B.C., were recorded in Greek and Sanskrit writings that describe the boiling and filtering of water, primarily to make it smell and taste better, although reducing visible particles and turbidity was also a goal. Hippocrates invented the cloth-bag filter (or Hippocratic sleeve) and was among the first to believe that this process also rendered water more healthful for the human body. The British scientist John Snow demonstrated that the source of a cholera epidemic centered on the odorless and seemingly clean water provided by a water pump. He proved that sand filtration and chlorination effectively prevented the spread of cholera. Despite 150 years of acceptance of the healthful effects of clean water, an estimated 1.1 billion people still lack access to it, and 2.6 billion people lack access to adequate sanitation.

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Global health issues have captured the attention of governments, global funds, and foundations. Yet most of this attention and the consequent investment have focused on diseases such as malaria, tuberculosis, and AIDS, which kill a fraction of the number of people who die from water-related diseases. The necessary political will has not been mustered to address the water and sanitation crisis, among the most neglected of the United Nations' millennium development goals. A recent cost–benefit analysis reported by the World Health Organization makes a strong case for investment in this sector, and, at its Tokyo summit meeting in July, the Group of Eight reaffirmed its commitment to addressing concerns about water.5 Political support is urgently needed at all levels for the development and implementation of evidence-based recommendations to improve access to safe water, for the enhanced surveillance of water-related diseases, for the financial support of relevant epidemiologic and laboratory research, and for the development of accessible educational materials. Clearly, we need to start talking dirty water.

more at:
http://content.nejm.org/cgi/content/full/359/8/784?query=TOC

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