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UNC-Chapel Hill ENVR 890 - LECTURE NOTES

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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: The “F”s of WSHA Lot of What Else this Course is AboutHuman Sanitation: Fundamental but Often LackingSanitation: Our Biggest FailureSlide 13Water, Disease and HealthThe Microbial World: Types and Sizes of MicrobesSlide 16Issues in Water and HealthAnalyzing the Role of WSH in Reducing DiseaseComparison of Impacts of WSH Interventions: Fewtrell et al. 2005 vs. Previous StudiesPiped and Non-Piped Water SuppliesSlide 21Barriers against Microbial Contamination and Waterborne DiseaseBehavioral and Educational Components of WSH InterventionsSlide 24WSH, 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 FactorsMore recent estimate even higher!Global 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, latrineGlobal 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!Lack of WSH = Disease and Poverty• Inadequate water supply• Unsafe water resources• Inequitable access• Time, financial cost• Disease burden• Health care costsPOVERTYThe Older Conventional View:WSH = An Engine for Development and Productivity• Improved water supply• Safe water resources• Universal access• Time, financial savings• Averted disease costs• Healthy populationsDevelopmentThe Newer Optimistic View!Millennium 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 developmentWhat a lot of this course will be about:The “F”s of WSH•Feces•Fingers•Flies•Fields/Food•Fluids•FomitesWater TreatmentA Lot of What Else this Course is About•Air pollution•Solid waste management•Vectors & vector-borne diseases•Disasters and emergencies•Climate change health effectsHuman 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/Absent Community Wastewater Treatment SystemsUntreated/poorly treated wastewater is discharged to land or natural watersNo Rx.Rx.Rx. Often Absent!Water, 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-/enterovirusesCholeraDiarrheaDysenteryTyphoid feverAmebic dysenteryGiardiasis(Ascaris lumbricoides)SOME BAD ONES!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. 1975E. coli from Spinach Lettuce & Tomatoes!Issues in Water and Health•Quality•Quantity•Access•Habitat and Ecology•Resources and Management•Economics•Behavior and Beliefs•Enabling Environment and PoliciesAnalyzing 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


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UNC-Chapel Hill ENVR 890 - LECTURE NOTES

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