Water for health

Clean water is needed for good health.

Credit: WaterAid / Alex Macro

10,000 dead in London cholera outbreak

We all know we won't be reading this in our newspaper headlines any time soon. But why not? After all it's only 150 years since the 1853/4 London cholera outbreak did indeed kill 10,675 people. It was September of that second year that a further outbreak, having killed some 616 people, was famously traced by Dr John Snow to its source, the sewage-polluted water from Soho's Broad Street pump.

Part of the evidence was the case of a woman living in Hampstead who, having previously lived in Soho, had grown so attached to the taste of the Broad Street water that she still sent her servant to collect water there. And so she alone among the residents of Hampstead died from the Soho cholera outbreak.

Prior to this the received wisdom was that cholera was caused by 'miasma', bad air, but by demonstrating that the Broad Street water was contaminated by a sewer which ran underground close to the pump Dr Snow revolutionised the understanding of cholera and the importance of safe water for public health.

Although pressure mounted for a better sanitation system in London it took the Great Stink of 1857 - when the smell of unremoved and untreated excrement in the streets and the River Thames was so great that members of Parliament had to clutch handkerchiefs across their noses - before the Government acted decisively and funded £3 million worth of sewers.

These were designed and built by Joseph Bazalgette whose memorial can still be seen on The Embankment in London. Part of his design was the Albert Embankment on which, appropriately enough, the London offices of WaterAid now stand.

Elsewhere in the UK sanitation continued to be very poor. Leeds for example was visited on five occasions between 1858 and 1875 by the Medical Department of the Privy Council which was concerned at the repeated cholera outbreaks.

Even in 1914 construction of the necessary water and sanitation systems was taking one-third of Leeds' capital budget, far more than schools or hospitals. And it was not until hygiene practices became widespread between the two World Wars some 80 years ago that epidemics of diarrhoeal diseases were finally prevented.

But what is history for us in the UK is, as WaterAid supporters know well, still the present reality for billions of people in developing countries.

The World Health Organisation asserts that 65% of infant deaths from diarrhoeal diseases, like cholera, in developing countries could be prevented by providing safe water and sanitation.

The British medical journal The Lancet recently estimated that diarrhoea is the biggest single killer of children in the world's poorest countries. And we are all too familiar with the grim statistic that a child dies every 15 seconds from bad water and sanitation.

It was therefore not surprising when in 2000 the world's nations pledged to reduce by 2015 the number of children who die before their fifth birthday by two-thirds as one of the Millennium Development Goals (MDGs).

What is surprising however is how little water features in the plans to deliver this Goal. Recent work by WaterAid and other non governmental organisations for the Commission for Sustainable Development in New York found that only two out of 30 developing countries had fully prioritised water in their national plans. And, despite the fact that these 30 countries are home to nearly 90% of the world's 1.1 billion people without safe water donors target less than 40% of their aid for water towards them.

The focus of donors is often placed on more expensive medical treatments instead. For example many more resources are being directed for HIV/AIDS drugs even though the World Health Organisation (WHO) report four - and in some countries up to twenty - times as many children die from diarrhoeal diseases as from HIV.

Guidance co-written for the British Department for International Development (DFID) by one of WaterAid's trustees, Dr Sandy Cairncross of the London School of Hygiene and Tropical Medicine, notes that environmental improvements like sanitation have bigger impacts and lower costs than curative medicines.

Given these links it is disappointing that DFID has not been placing more emphasis on water, and is in fact reducing the share of its budget on this essential need. DFID had previously stated that countries receiving the most aid for health had to demonstrate that they were increasing access to water and sanitation.

This target has now been dropped. Its annual report identifies failures, especially in Africa, on the infant mortality MDG but apparently without any understanding that lack of access to safe water and sanitation might be behind this problem.

WaterAid's Flush out poverty campaign has therefore been calling on DFID to put water back at the heart of its development assistance programmes.

Elsewhere this message seems to be being heard more clearly. The UN Millennium Project which is assessing the finance needed to reach the MDGs is calculating the costs of health based on the assumption that better water and sanitation will cut diarrhoeal diseases by up to 65%.

Meanwhile WaterAid and its partners' work in Madagascar has convinced the government that it must prioritise sanitation in its national poverty reduction plan. Otherwise it will continue to lose five million working days and 3.5 million schooldays every year as workers and children fall sick from bad water.

The WHO has recently estimated that globally six billion working days are lost each year due to unsafe water and sanitation.

Behind all of these statistics are millions of individual human stories. People like Seshumarie, Jeanine and Mr Machangwa whose words can be read here.

The links between water and good health range from simple well being on a day to day basis through to matters of life and death in developing countries. It is these links that underscore WaterAid's simple message that water is life.

Decision makers throughout the world need to hear that message clearly if the goals of poverty reduction are to be realised for the poorest people.

David Redhouse is one of WaterAid's Policy Officers.