1.3 Contribute to hygiene and health through water and sanitation

Key organisations :
World Health Organisation (Coordinator), United Nations University – Institute for Water, Environment and Health, Académie de l\'Eau, SARAR Transformacion

It is estimated that almost 10 % of the global burden of disease is associated with lack of access to adequate sanitation and safe drinking-water, of proper hygiene and of effective water management1. More specifically, diarrhoea is estimated to kill almost 2.4 million children under five every year2. This largely preventable burden affects not only individuals and families, but puts a burden on health care systems and economic productivity. In Africa alone, it is estimated that economic losses due to the lack of water and sanitation represent approximately 5 % of annual GDP (US$ 28.4 billion)3. Equity is a major cross-cutting issue in this context, and adverse impacts disproportionately affect women and female children as providers and carers within the household. Improvements in sanitation have been demonstrated to reduce child mortality by more than 30 %4 and overall morbidity by almost 37 %5, especially when in combination with improved water supplies and handwashing with soap6,7. Improving access to safe water and basic sanitation has direct implications for better health, as it leads to the interruption of the transmission pathways for many gastro-intestinal and other infectious diseases. Furthermore, such access in the family home or community increases the likelihood of hygiene practices such as handwashing with soap. Without a convenient supply of adequate quantities of water, hygiene becomes a luxury compared to the need for water for consumption. In the broader, ecological context, improved management of water resource and their use in agriculture, dams and urban drainage has a significant potential to reduce vector-borne diseases such as malaria, dengue and schistosomiasis. It is essential to understand the linkages between water, sanitation, environment, hygiene and health in order to ensure sustainable practices that reduce transmission of these diseases in a local context. Moreover, handwashing with soap is a critical barrier in transmission of all infectious diseases (for example: influenza8), not just those related to contamination of water and food. Finally, it is impossible to ignore the broader health impacts associated with a lack of adequate water and sanitation, such as child malnutrition9. Key elements of ensuring awareness and understanding of the benefits to health associated with improved water and sanitation include education, communication, applied research and development of the evidence base. This Priority for Action sets out targets to achieve these key elements through a focus on: · Developing modular education programmes for a variety of stakeholders; · Promoting national implementation of water safety frameworks; · Rolling out water safety plans and sanitation safety plans at the local scale; · Ensuring reporting of expenditures and funding flows within the WaSH sector; · Undertaking applied research to support evidence-based decision-making; · Facilitating uptake of household water treatment and storage through national policies; and, · Developing an integrated approach for cholera prevention. 1 Prüss-Üstün A., Bos R., Gore F. and Bartram J. 2008. Safer Water, Better Health: Costs, Benefits and Sustainability of Interventions to Protect and Promote Health. World Health Organization: Geneva. Available from: http://www.who.int/quantifying_ehimpacts/publications/saferwater/en/index.html (Accessed May 2011) 2 UNICEF and WHO. 2009. Diarrhoea: Why children are still dying and what can be done. Available from: http://whqlibdoc.who.int/publications/2009/9789241598415_eng.pdf (Accessed May 2011). 3 UNEP. 2010. Clearing the Waters. Available from: http://www.unep.org/PDF/Clearing_the_Waters.pdf (Accessed May, 2011). 4 Esrey S.A., Andersson I., Hillers A. and Sawyer R. 2001. Closing the Loop. Ecological Sanitation for Food Security. Publications on Water Resources No. 18, SIDA: Stockholm. Available from: http://www.energyandenvironment.undp.org/undp/indexAction.cfm?module=Library&action=GetFile&DocumentAttachmentID=1044 (Accessed April 2009) 5 Bartram J., Lewis K., Lenton R. and Wright A. 2005. Focusing on improved water and sanitation for health. Lancet, 365(9461): 810 – 812 6 Fewtrell L., Kaufmann R.B., Kay D., Enanoria W., Haller L. and Colford J.M. 2005. Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: a systematic review and meta-analysis.” Lancet Infectious Diseases 5(1):42–52 7 Zwane A.P. and Kremer M. 2007. What Works In Fighting Diarrheal Diseases In Developing Countries? A Critical Review. The World Bank Research Observer Advance Access (May 4) 8 Rabie T. and Curtis V. 2006. Handwashing and risk of respiratory infections: a quantitative systematic review. Tropical Medicine and International Health. 11(3):258–267 9 Bartram J. and Cairncross J. 2010. Hygiene, Sanitation, and Water: Forgotten Foundations of Health. PLoS Med 7(11): e1000367. doi:10.1371/journal.pmed.1000367