Title: Global Water Sanitation and Health: What this Course is about
1Global Water Sanitation and Health What this
Course is about
- Mark D. Sobsey
- University of North Carolina
- Department of Environmental Sciences and
Engineering - Sobsey_at_email.unc.edu
2Kofi Annan United Nations Secretary-General
- We shall not finally defeat AIDS, tuberculosis,
malaria, or any of the other infectious diseases
that plague the developing world until we have
also won the battle for safe drinking-water,
sanitation and basic health care.
3Global Burden of Disease Attributable to Selected
Major Risk Factors
Underweight
Tobacco
Unsafe sex
Alcohol
Overweight
Water, sanitation and hygiene (5.5)
5 -
Percent of total burden (within region)
Indoor air (3.7 )
Physical inactivity
Zinc deficiency
Tobacco
Alcohol
Occupational risks
1 -
Overweight
Unsafe sex
Ambient air
Lead
Occupational injuries
Ambient air
Water, sanitation and hygiene
Climate change
Lead
Developed countries
Developing countries (high mortality)
More recent estimate even higher!
4Global Burden of Poor Water, Sanitation and
Hygiene (WSH)
- 1.1 billion people (17 of the population) lack
access to improved water - tap water in house/yard from public distribution
systems, - protected wells springs
- public stand posts
- rain water collection
- 2.6 billion (42 of population) lack access to
basic sanitation - sewerage, on-site septic waste treatment system,
latrine
5Global Burden of Poor Water, Sanitation and
Hygiene (WSH)
- 1.8 million people die every year from diarrheal
diseases (including cholera) - 90 are children under 5
- mostly in developing countries.
- 80 of the population without access to
drinking-water are rural dwellers, but future
populations will be mainly urban - Peri-urban slums are among the most underserved
and unsanitary places on earth!
6The Older Conventional View
Lack of WSH Disease and Poverty
- Inadequate water supply
- Unsafe water resources
- Inequitable access
- Time, financial cost
- Disease burden
- Health care costs
POVERTY
7The Newer Optimistic View!
WSH An Engine for Development and Productivity
- Improved water supply
- Safe water resources
- Universal access
- Time, financial savings
- Averted disease costs
- Healthy populations
Development
8Millennium Development Goals
- Goal 1 Eradicate extreme poverty and hunger
- Goal 2 Achieve universal primary education
- Goal 3 Promote gender equality and empower women
- Goal 4 Reduce child mortality
- Goal 5 Improve maternal health
- Goal 6 Combat HIV/AIDS, malaria, and other
diseases - Goal 7 Ensure environmental sustainability
- Target 9 Integrate the principles of sustainable
development into country policies reverse loss
of environmental resources. - Target 10 Halve by 2015 the proportion of people
without sustainable access to safe drinking water
and basic sanitation - Target 11 improve the lives of at least 100
million slum dwellers - Goal 8 Develop a global partnership for
development
9What a lot of this course will be aboutThe Fs
of WSH
- Feces
- Fingers
- Flies
- Fields/Food
- Fluids
- Fomites
Water Treatment
10A Lot of What Else this Course is About
- Air pollution
- Solid waste management
- Vectors vector-borne diseases
- Disasters and emergencies
- Climate change health effects
11Human SanitationFundamental but Often Lacking
- Excreta management and disposal
- Hygiene behaviors
- Handwashing
- Safe water
12Sanitation Our Biggest Failure
- Our sanitation systems dont work well and result
in pathogen release - Whether community or on-site, they all fail or
have serious deficiencies - Sanitation is one of the biggest technological
gaps we have globally - Pathogens go everywhere as a result
Roman latrine
VIP latrine
Latrine
13Inferior/Absent Community Wastewater Treatment
Systems
Rx.
No Rx.
Rx. Often Absent!
Untreated/poorly treated wastewater is discharged
to land or natural waters
14Water, Disease and Health
- Water-borne
- Exposure mainly by ingestion of contaminated
water - Primarily enteric diseases transmitted by the
fecal-oral route - Water-washed
- exposure is reduced by water use for personal and
domestic hygiene washing (clothes, floors, other
household chores), bathing other personal
hygiene - Water contact and water vector-borne
- Exposure by skin contact with infested water
- Ex schistosomiasis
- Exposure to water habitat "insect vector"
diseases
15The Microbial World Types and Sizes of Microbes
SOME BAD ONES!
Amebic dysentery Giardiasis
Cholera Diarrhea Dysentery Typhoid fever
Norovirus Hepatitis AE Rotaviruses Polio-/enterov
iruses
BACTERIUM 1 µM
Helminth (Worm) (eggs shed in feces)
gt30 microns
(Ascaris lumbricoides)
16Waterborne Pathogens Come Primarily from Feces by
Various Routes of Exposure
E. coli from Spinach Lettuce Tomatoes!
Adapted from Charles P. Gerba et al. 1975
17Issues in Water and Health
- Quality
- Quantity
- Access
- Habitat and Ecology
- Resources and Management
- Economics
- Behavior and Beliefs
- Enabling Environment and Policies
18Analyzing the Role of WSH in Reducing Disease
- Recent meta-analysis shows major impacts by
- Hygiene
- Sanitation
- Water quality
- Water supply
19Comparison of Impacts of WSH Interventions
Fewtrell et al. 2005 vs. Previous Studies
Good Studies
All Studies
- Water quality interventions (POU water Rx) was
more effective than previously thought - Multiple interventions (combined WSH) were not
more effective than single interventions (?)
20Piped and Non-Piped Water Supplies
- Most people lack piped water
- They collect water or have it delivered
- Most wells in developing countries deliver NO or
UNSAFE water! - Sources are often contaminated
- Piped water is often contaminated
- Classified as improved, but still unsafe
21Piped and Non-Piped Water Supplies
- Collected, stored water often becomes
contaminated in the home - Water is often not treated, but used directly
- Boiling is widely practiced
- Disadvantages
- Cost
- Inconvenience
- no residual protection (gets recontaminated in
use!) - environmental degradation (deforestation)
- air pollution (health effects)
22Barriers against Microbial Contamination and
Waterborne Disease
- Collect from a safe source
- Store it with contamination safeguards
- Treat water to reduce microbial contamination
- Physical treatments
- Heat, sunlight (heat UV), UV lamp radiation
filtration - Chemical treatments (disinfection)
- chlorine
- Combined physical-chemical treatments
- coagulation-flocculation-chlorination
(conventional Rx)
23Behavioral and Educational Components of WSH
Interventions
- Increase awareness of the link between the 5Fs
and disease and the benefits of appropriate
hygiene behaviors - Behavior change techniques
- social marketing
- community mobilization
- motivational interviewing
- communication
- education
24World Health Organization Health-Risk Based
Framework
- Risk-based framework
- Source-to-consumer management approach
- Establishes health based-targets for performance
- Can set acceptable level of risk appropriate to
setting and population - Establish and carry out Management Plans
- Independent surveillance
- Integrated. Consistent across, compatible with
and applicable to all WSH measures
These principles apply to all types of WSH
measures!
25WSH, Addressing the Global Burden of Disease by
Working towards Meeting the MDGs Still Plenty
to Do
- Research
- Implementation/Dissemination
- Communication
- Advocacy
- Finance
- Policies
- Diplomacy and Politics
26Celebrating Water for LifeThe International
Decade for Action2005 to 2015
2008 International Year of Sanitation