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microscopy. A general solution the to high rates of mortality and are Drinking water and infectious authors suggest is to develop an inte- associated with of diarrhoeal disease — establishing grated system for technical data on both diseases. For example, the incidence the links health and water. This approach would be of cholera is positively associated with facilitated by the water industry’s large poor housing and lack of clean water and Edited by Paul Raymond Hunter, and currently underutilized database. sanitation. Therefore, in developing Mike Waite & Elettra Ronchi Although the discussions on local countries, actions to improve hygiene Published by CRC Press & IWA Publishing, and national surveillance do provide a and sanitation, in addition to surveillance London, England general understanding of how important and investigation of waterborne infec- ISBN 1-84339-027-2, price US$ 129.95 a functional surveillance system is for tions, are needed to reduce preventing and reducing infectious from enteric pathogens. To reduce the In 1998, a workshop on safe drinking- diseases, not enough attention is given to global burden of diarrhoeal diseases, we water recommended ‘‘international surveillance of in have to tackle the whole set of under- coordination for improved surveillance the developing world. ‘‘If we are to lying causes of the disease. This is of and outbreak investigation’’. To start improve the quality of water-related course, a complex issue which requires putting this into effect, the UK Govern- surveillance,’’ say the authors of a wide range of collective efforts on the ment hosted an OECD expert group Chapter 6, ‘‘it is increasingly obvious that part of all sectors involved, and at each meeting in July 2000, entitled computers and sophisticated analytical level of planning and policy-making. ‘‘Approaches for Establishing Links algorithms will be needed to flag unusual In public health a vast body of between Drinking Water and Infectious events and supplement human judge- knowledge already exists on the links Disease’’. The book reviewed here is ment. It may also be useful to reconsider between drinking-water and infectious a product of that meeting. In the the choice of measures to be regularly diseases. The evidence has been accu- Foreword, the authors say that it collected and analysed, going beyond the mulating at least since 1848, when complements a WHO book on guide- traditional dependence on laboratory John Snow deduced that was lines and standards for drinking-water, isolates.’’ This may be feasible in most spread by the water supply, and helped waste-water reuse, and recreational industrialized countries but not in many to stop a cholera in London water. In fact, however, the present developing ones. There is a chapter by famously recommending the removal book is not about guidelines; it is about on international surveillance, which of the handle of the Broad Street how the link between drinking-water might eventually provide the beginning pump. Yet these authors strive to prove and infectious disease can be of a solution, but it is rather thin, the link as if it were still debatable. demonstrated. perhaps because this level of surveillance Evidently, decision-makers in other The 18 chapters, by authors from is underdeveloped. sectors such as industry and agriculture need more and more irrefutable a range of institutions in industrialized All together, the generic title of the evidence if they are to be convinced that countries, are organized into three book is misleading, as the focus is on they are damaging public health when sections: surveillance; investigation and problems of OECD countries, where they contaminate the water supply, and management of outbreaks of disease the of diarrhoeal diseases, for so must share the cost of protecting it. that may be linked to drinking-water; example, is incomparably lower than in Lack of coordination and collaboration and methods for determining the developing countries. The realities in between the health and other sectors contribution of drinking-water to developing countries are quite different then seems to be a major underlying sporadic disease incidence. Plentiful with regard to surveillance systems, problem. figures, tables and maps give life to the water sources and many of the other The global burden of disease caused pages and will help readers who find water-related diseases as well. For prac- by water, sanitation, and hygiene pro- visual information easier to take in titioners and decision-makers involved blems has recently been estimated with than words. Some chapters are better in public health and water utility sectors regard to various disease outcomes, written than others with regard to clarity in industrialized countries, however, principally diarrhoeal diseases. The dis- and logical flow, and nearly all have the book is readable and useful. ability-adjusted life years (DALY) a conclusion section. Throughout the Readers without specialized formula was used to combine numbers book, the authors use numerous knowledge of the topic would have of deaths and amounts of disability in examples to show what they mean, but benefited from an introductory para- a single index. This made it possible to these are limited mostly to three graph or two on enteric pathogens compare the burden attributable to countries: the US, the UK and Sweden. (bacteria, viruses and protozoa), the water, sanitation and hygiene problems Information on a country’s situation routes of exposure, and their similarities with those caused by other risk factors occasionally overlaps with that provided and differences. Also, a few words or diseases. The estimates were reported in the WHO book. on other water contaminants such as as summary measures of population A number of local, national and chemicals would have placed water in its health combining mortality and mor- international surveillance systems broader context. bidity, expressed as DALYs. The results currently in use are described, and their The authors of the last chapter say provide a useful contribution to the strengths and weaknesses are discussed. that ‘‘In many ways, the methods design and evaluation of multisectorial Their limitations include low probability described earlier in this book are all policies. They also help to put the of detecting waterborne outbreaks be- applicable in the setting of the develop- links between water and infectious cause of shared clinical syndromes and ing world’’, but this is not self-evident. disease in their global context. n underreporting, and lack of a system for In the developing world, problems of submitting specimens for diagnostic public and personal hygiene contribute Ramesh Shademani1

1 Papers Editor, Bulletin of the World Health Organization, Geneva, Switzerland.

916 Bulletin of the World Health Organization 2002, 80 (11)