Global Water Sanitation and Health: What this Course is aboutKofi Annan United Nations Secretary-GeneralSlide 3Global Burden of Poor Water, Sanitation and Hygiene (WSH)Slide 5Slide 6Slide 7Slide 8What a lot of this Course will be about: Five F’s of WSHHuman Sanitation: Fundamental but Often LackingSanitation: Our Biggest FailureSlide 12Water, Disease and HealthThe Microbial World: Types and Sizes of MicrobesSlide 15Issues in Water and HealthAnalyzing the Role of WSH in Reducing DiseaseComparison of Impacts of WSH Interventions: Fewtrell et al. 2005 vs. Previous StudiesHandwashing Hygiene to Prevent DiseasePiped and Non-Piped Water SuppliesBarriers against Microbial Contamination and Waterborne DiseaseBehavioral and Educational Components of WSH InterventionsSlide 23WSH, Addressing the Global Burden of Disease by Working towards Meeting the MDGs: Still Plenty to DoCelebrating Water for Life The International Decade for Action 2005 to 2015Global Water Sanitation and Health: What this Course is aboutMark D. SobseyUniversity of North CarolinaDepartment of Environmental Sciences and [email protected] 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.”Percent of total burden (within region)1% -5% -Water, sanitation and hygiene (5.5%)LeadUnderweightIndoor air (3.7 %)Ambient airOccupational injuriesDeveloping countries(high mortality)Developed countriesOccupational risksAlcohol Tobacco Overweight LeadUnsafe sexTobacco Climate changeAlcohol Ambient airWater, sanitation and hygieneOverweight Unsafe sexPhysical inactivityZinc deficiencyGlobal Burden of Disease Attributable to Selected Major Risk FactorsGlobal Burden of Poor Water, Sanitation and Hygiene (WSH)•1.1 billion people (~17% of the population) lack access to improved water–tap water in the house or yard from public distribution systems, protected wells and springs, public stand posts, rain water collection; 17% of world population •2.6 billion (42% of population) lack access to basic sanitation–sewerage, on-site septic waste treatment system, latrine•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 earthLack of WSH = Disease and Poverty• Inadequate water supply• Unsafe water resources• Inequitable access• Time, financial cost• Disease burden• Health care costsPOVERTYWSH = An Engine for Development and Productivity• Improved water supply• Safe water resources• Universal access• Time, financial savings• Averted disease costs• Healthy populationsDevelopmentUN Millennium DeclarationOverall Goal: Poverty ReductionMillennium Development GoalsGoal 1 Eradicate extreme poverty and hungerGoal 2 Achieve universal primary educationGoal 3 Promote gender equality and empower womenGoal 4 Reduce child mortalityGoal 5 Improve maternal healthGoal 6 Combat HIV/AIDS, malaria, and other diseasesGoal 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 dwellersGoal 8 Develop a global partnership for developmentWhat a lot of this Course will be about:Five F’s of WSH•Feces•Fingers•Flies•Fields/Food•Fluids•FomitesWater TreatmentHuman Sanitation:Fundamental but Often Lacking•Excreta management and disposal•Hygiene behaviors–Handwashing•Safe waterSanitation: Our Biggest Failure•Our sanitation systems don’t 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 resultRoman latrineLatrineVIP latrineInferior/No Community Wastewater Treatment SystemsUntreated/poorly treated wastewater is discharged to land or natural watersWater, 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" diseasesHelminth (Worm)(eggs shed in feces)>30 micronsBACTERIUM~ 1 µMThe Microbial World: Types and Sizes of MicrobesNorovirusHepatitis A&ERotavirusesPolio-/enterovirusesCholeraDiarrheaTyphoid feverDysenteryAmebic dysenteryGiardiasis ( bever fever)(Ascaris lumbricoides)Waterborne Pathogens Come Primarily from Feces by Various Routes of ExposureExcreta from humans and animalsExcreta from humans and animalsHumanHumanShellfishShellfishCropsCropsAerosolsAerosolsOceans andEstuariesOceans andEstuariesRivers andLakesRivers andLakesIrrigationIrrigationSolid WasteLandfillsSolid WasteLandfillsSewageSewageLandRunoffLandRunoffRecreationRecreationWaterSupplyWaterSupplyGroundwaterGroundwaterAdapted from Charles P. Gerba et al. 1975Spinach!E. coliIssues in Water and Health•Quality•Quantity•Access•Habitat and Ecology•Resources and Management•Economics•Behavior and BeliefsAnalyzing the Role of WSH in Reducing DiseaseRecent meta-analysis shows major impacts by•Hygiene•Sanitation•Water quality•Water supplyComparison of Impacts of WSH Interventions: Fewtrell et al. 2005 vs. Previous StudiesAll StudiesGood Studies• Water quality interventions (POU water Rx) was more effective than previously thought• Multiple interventions (combined WSH) were not more effective than single interventions (?)Handwashing Hygiene to Prevent Disease•Handwashing with soap and water after contact with fecal material can reduce diarrheal diseases by 35% or moreSource: Almedom et al. 1997Piped and Non-Piped Water Supplies•Most people lack piped
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