WWDR Chapter 06c (F) 15/2/06 15:34 Page 202 By means of water we give life to everything The Koran, Book of The Prophets 21:30 WWDR Chapter 06c (F) 15/2/06 15:35 Page 203 Part 1. Human Health in Water Part 3. Progress towards the MDG Targets on Development.....................................................205 Water, Sanitation and Health...................221 Box 6.1: The emergence of malaria in India’s 3a. Status of MDG 7: Drinking water and sanitation Thar Desert targets...............................................................221 Table 6.1: The relationship between the MDGs and Fig. 6.1: Projected population without access to water, sanitation and hygiene improved sanitation Map 6.1: Coverage with improved drinking water Part 2. Update of the Burden of Water- sources, 2002 Map 6.2: Coverage with improved sanitation, 2002 related Diseases..............................................208 3b. Status of the other MDG targets with respect Table 6.2: Global burden of disease: Deaths by age, to water-related health issues ..........................221 gender, region and cause for the year 2002 CHAPTER 6 Table 6.3: Global burden of disease: DALYs by age, gender, region and cause for the year 2002 Part 4. Indicators ...................................................224 Protecting and 2a. Diseases related to lack of access to safe 4a. Burden of water-related diseases......................224 drinking water, poor sanitation and 4b. Access to improved drinking water and Promoting insufficient hygiene...........................................210 sanitation: Standards and definitions................224 Human Health Diarrhoeal diseases .............................................210 Table 6.7: Classification of improved and unimproved Box 6.2: Control of diarrhoeal diseases drinking water sources Intestinal helminth infections ...............................212 Table 6.8: Classification of improved and unimproved Table 6.4: Estimated global burden of disease sanitation facilities associated with soil-transmitted intestinal helminth Box 6.7: User-based versus provider-based data Requirements for water service levels and infections, 1990 Table 6.9: By Table 6.5: Global estimates of prevalence and the health implications 4c. Water quality.....................................................226 6WHO number of cases of soil-transmitted helminth infections by region and age group, 2003 Drinking water quality .........................................227 (World Health Skin and eye infections........................................212 Box 6.8: Water safety plans (WSPs) Organization) 2b. Vector-borne diseases associated with water....213 Wastewater use in agriculture and aquaculture.....228 Table 6.6: Global estimates of people at risk of 4d. Child mortality ...................................................229 four vector-borne diseases 4e. Nutritional status ..............................................229 UNICEF Malaria ...............................................................214 (United Nations Water management for malaria control ................215 Part 5. Comparative Risk Assessment ........229 Children’s Fund) Box 6.3: Malaria control through stream water Box 6.9: Benefits of improved sanitation management Filarial infections .................................................216 Part 6. Governance................................................231 Schistosomiasis ...................................................217 6a. Economic evaluation of interventions................231 Arboviral infections..............................................217 6b. Water scarcity: Bridging the gaps between the Box 6.4: A new strategy against Aedes aegypti different sectors ................................................232 in Viet Nam 6c. Multiple uses of water ......................................233 2c. Non-communicable water-associated health Box 6.10: Domestic use of irrigation water issues ................................................................218 6d. Falling groundwater levels.................................233 Box 6.5: Recreational water use, pollution and health 6e. Poverty Reduction Strategy Papers....................233 Box 6.6: Availability and quality of drinking water in Box 6.11: Successful water supply in Phnom Penh, the Ruhuna Basins, Sri Lanka Cambodia Part 7. Water for Life: Making it Happen ..235 References and Websites..................................237 WWDR Chapter 06c (F) 15/2/06 15:35 Page 204 204 . WATER: A SHARED RESPONSIBILITY Key messages: Water-related diseases, including diarrhoea, are a leading cause of death in children of developing countries. However, they can be prevented and controlled by improving access to safe drinking water and sanitation, as well as domestic and personal hygiene. Yet progress remains very slow, especially in the provision of adequate sanitation in sub- Saharan Africa and South-East Asia. An integrated approach to human health and water resources management is urgently required. This should be characterized by flexible planning and implementation, analysis of the cost- effectiveness of local options, a significant reallocation of resources to drinking water, sanitation and hygiene, and attention to the most vulnerable groups in urban and rural settings. This is essential to save the lives of millions and ensure considerable long-term economic benefits. ■ Infectious diseases, especially diarrhoea followed by ■ Understanding of drinking water quality as it relates to malaria, continue to dominate the global burden of health has evolved from rigid standards applied at the water-related disease. Substantial progress has been treatment facility to a process of risk assessment and made in reducing the mortality associated with management from catchment to consumer. diarrhoeal disease but morbidity remains essentially unchanged, while the burden of malaria is increasing. ■ The importance of both accelerated access to safe water and adequate sanitation, and better Integrated Above: Exterior and ■ Globally, the drinking water target set by MDG 7 is on Water Resources Management (IWRM) practices to interior of a toilet block schedule, but the sanitation target will not be met by achieving most MDG targets, need a higher profile. in Dar es Salaam, 2015 without extra inputs and efforts. In sub-Saharan This can be achieved by refining and publicizing the Tanzania Africa, the trends observed since 1990 indicate that correlations between water indicators and the neither of the targets will be met by 2015. indicators for childhood illness/mortality and nutritional status. ■ The water-related disease burden and the relative Below: A teacher assists a young girl to wash her hands & DEVELOPMENT CHALLENGES FOR WELL-BEING CHALLENGES FOR efficiency of water interventions are key criteria in with soap and clean water after using a sanitary latrine water/health decision-making. Disability-Adjusted Life in a school in North Khway Ye village in Myanmar. Some Section 3: Years (DALYs) and cost and effectiveness of 3,800 children die every day from diseases associated interventions should be put upfront as key decision- with lack of access to safe drinking water, inadequate making criteria. sanitation and poor hygiene WWDR Chapter 06c (F) 15/2/06 15:35 Page 205 PROTECTING AND PROMOTING HUMAN HEALTH . 205 Part 1. Human Health in Water Development A range of water conditions and parameters essentially determine the health status of communities. Human health, therefore, cuts across all sectors responsible for water resources development, management and use. In water for domestic uses, the focus is on the lack of In water for ecosystems, the evidence base for associations access to sufficient supplies of safe drinking water, between natural ecologies, biodiversity conservation and adequate sanitation, and the promotion of hygiene human health still requires substantial development. It may ...there may be practices, all in relation to diarrhoeal and other water- be safely assumed that many of the environmental services related diseases. While infectious diseases are of principal provided by wetlands, for example, are important to vulnerable concern, other health risks may be important under sustaining the health of communities that depend on these groups whose specific circumstances. ecosystems for their livelihood. Yet, in specific settings, such as wetlands, there may also be health risks related to water- nutritional In water for food and energy, the focus is on the associated vector-borne diseases, sanitation-related diseases hydrological changes caused by dam construction (see and impaired access to health services. However, health can status declines Chapter 5) and irrigation development (see Chapter 7) and be a key motivator in mobilizing communities to participate with the the ensuing transmission risks of vector-borne diseases, in nature conservation and environmental management. such as malaria, schistosomiasis, filariasis and Japanese introduction of encephalitis. The impact of irrigated crop production on the Improvements in access to safe drinking water, adequate nutritional status of communities varies. On the whole, it is sanitation and hygiene have an impact on wider development irrigation... positive, but there may be vulnerable groups whose issues, a fact that has been summarized by the Water Supply nutritional status declines with the introduction of irrigation, and Sanitation Collaborative Council (WSSCC, 2004) for the which shifts the economic balance from subsistence to cash