Journal of Perinatology (2007) 27, 56–58 r 2007 Nature Publishing Group All rights reserved. 0743-8346/07 $30 www.nature.com/jp
SPECIAL FEATURE
Global minute: water and health – walking for water and water wars D Vidyasagar Department of Pediatrics, Division of Neonatology, University of Illinois at Chicago Medical Center, Chicago, IL, USA
Water is a precious commodity and needs to be conserved. Water plays an important role in daily life: in sustenance of life, sanitation and food production. Scarcity of water may lead to water wars among water-stressed nations. Therefore, there is a need for development of democratic principles among nations to assure free access to water to one and all. In view of the fact that lack of access to clean water affects health and infant mortality gap. Great importance is given to improve water resources in the communities (Millennium Development Goal # 7). As professionals entrusted with the health of mother and child, we must strive to improve access to potable clean water to communities in underdeveloped countries. Journal of Perinatology (2007) 27, 56–58. doi:10.1038/sj.jp.7211629
goes uncontrolled. ‘Do not spend money like water’ is an often used axiom. In fact, the axiom should be ‘Save water like money’. It is becoming increasingly apparent that water shortage is a global problem. Thirty-one countries, mostly in Africa and the Middle East, face water shortage. By 2025, an estimated another 17 countries may be added to the list covering more than one-third of the world population.1 International institutions are seriously engaged in discussions of these issues and development of plans that will conserve water, minimize wastage and enhance water access for the water deprived around the globe.
Keywords: water; health; IMR; water wars; sanitation
Water Water is essential to sustain life. Man can survive without food for a month but without water for only 7 days. Water, however, is a finite commodity on the globe. Only 2.8% of total water on earth is fresh water; rest is in the form of salt water. Majority (70%) of the fresh water is in the form of ice, river and lake water. Globally, 12.5 to 14 billion cubic meters of water (12 500 to 14 000 km3) are available for use annually (1 m3 is equal to 1000 l).2 Water is also required for agricultural purposes. It takes 3000 to 5000 l of water to grow 1 kg of rice; that is, water equivalent of two to three Olympic size water pools is needed to grow 1 t of rice. Similarly, it takes 1000 t of water to grow one ton of wheat.3 It is interesting to note that when water-scarce countries such as those in the Middle East, import grains, they are using not only the grains but also the water required to grow the grains and therefore using up the water resources. Except for few fortunate regions in the world, there is acute shortage of fresh water. Yet we pay little attention to how water is managed in our daily life. Water usage in general is uncontrolled, especially in countries with large resources. Water usage in the US Correspondence: Dr D Vidyasagar, Division of Neonatology, University of Illinois at Chicago Medical Center, 840 S. Wood Street, Chicago, IL 60612, USA. E-mail:
[email protected] Received 14 September 2006; accepted 19 September 2006
The Millennium Goal no. 7 Since the Mar del Plata Water conference was hosted by UN in 1977, the concept of sustainable water management has been high on the international agenda. In 1992, an International Conference on Water and the Environment (ICEW) developed the following principles:4 1. Fresh water is a finite and valuable resource that is essential for sustenance of life, the environment and development. 2. The development and management of our water resources should be based on a participatory approach involving users, planners and policy makers at all levels. 3. Women play a central role in the provision, management and safeguarding of water resources. 4. Water has an economic value and should therefore be seen as an economic good. These principles reflect the importance of water in our daily lives and the need for communication, gender equity and economic and policy incentives to manage the resources properly. The Millennium Developmental Goal no. 7 calls for ensuring environmental sustainability. Increasing accessibility to safe drinking water and basic sanitation is one of the major elements of this goal. Over a billion people in the world still do not have access to water. About 2.6 billion people lack toilets and other forms of sanitation. If the current trend continues, it is estimated that by 2015, 2.4 billion will be still without sanitation, mostly in
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Sub-Saharan countries and Asia. Shortage of water in the region affects quality of life as demonstrated below.
Correlation coefficient = −0.65
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Water and health Water quality affects health. Unclean water can lead to life-threatening illnesses.6 Clean water saves lives. There is a strong relationship between availability of clean water and infant mortality (Figures 1 and 2). About 2.3 billion people suffer from water-related diseases. They affect both adults and children. Some 60% of infant mortality is due to infections and parasitic diseases mostly related to unclean water. In Bangladesh, 75% of all illnesses are due to unsafe water and poor sanitation. In Pakistan, 25% of all people in hospitals are ill from water-related problems. Water related diseases include: water-borne (bacteria, feco-oral contamination), water-based (toxic material), water-related vectors and water-scarce diseases. Rain water can also bring water-borne diseases. Water-borne diseases include: dysentry, diarrhea, cholera, typhoid, hepatitis and polio. Water-based diseases include: ascariasis, clonorchiasis, schistosomiasis and guinea worm. Water-related vector diseases include: malaria, filaria and dengue. It is not only the bacterial contamination of water that affects health. There are other water-related health problems such as those caused by pollutants. Water pollution can be industrial, natural or man-made. In some regions, because of local geologic structure, water may be heavily loaded with minerals that are
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Figure 1 Correlation between IMR level and level of access to portable water services in Peru, 1996. Pan American Health Organization report – Health Analysis Situation, 2000 p. 12. Correlation coefficient = −0.66
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Infant mortality rate (deaths per 1,000 live births)
Walking for water For many people around the globe walking for water does not mean walking to the nearest water fountain in the office. Many countries suffer from lack of access to water for daily use. Water is not delivered through water pipes to homes; people have to walk distances in search of water for daily needs. How far you have to walk to fetch a pot of drinking water depends on where you liveFAsia or Africa. To get drinking water, the walking distances vary from 2 to 6 km. It is a daily chore for villages in India and Africa. Who walks the walk? Not the able bodied men of the family, but the women and children, who have the onerous responsibility of fetching the water, cooking and feeding the family. Women carry loads of 20 kg on their head and walk 1 to 2.5 h daily 300 days a year in Burkina Faso. In Nepal, women work 16 h a day and go to work walking long distances. In Uganda in a study of 715 water journeys, 75% were on foot, 22% by bicycle and only 2% by vehicle. In Mozambique, communal water standpipes reduced the collecting time to 25 min compared to 131 min in another village without water standpipes.5 Thus, there is a great need to improve access to clean water to sustain life. Water also plays a significant role in maintaining good health.
Infant mortality rate (deaths per 1,000 live births)
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Figure 2 Correlation between IMR level and level of access to portable water services in Brazil, 1996. Pan American Health Organization report – Health Analysis Situation, 2000 p. 12.
detrimental to the body. Natural water in some regions of the world has excess content of fluoride. These high levels lead to several bone defects leading to lifetime disabilities. In other areas, ground water is contaminated with arsenic; so also other areas are severely deficient in iodine content leading to thyroid deficiency, which affects brain growth. Industrial contamination can also be severely toxic. Lead, mercury and arsenic are some of the very toxic Journal of Perinatology
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substances that affect health. These problems, however, are not insurmountable. Through improved technologies and appropriate public health policies, water quality can be improved impacting overall health of the people. Water sanitation and IMR In terms of health, there is substantial evidence that purification of water plays a significant role in maintaining health. In the US and Europe, most of the water purification projects were initiated in late nineteenth and early twentieth century. Several researchers have shown the positive impact of water purification on health. Cutler7 studied the evolution of water purification in 15 different cities in the US during the early 1900s and its effect on health. He demonstrated that overall mortality, IMR and under-five child mortality rates in particular, decreased in all the fifteen major cities with each of the water purification interventions introduced since 1915. The empirical estimates suggest that between 35 to 56% mortality decline in Chicago during 1850 to 1925 was related to water purification and eradication of typhoid fever. Interestingly, providing clean water had diffuse health benefits. It not only reduced the death rate from diseases that were directly water-borne, for example, typhoid and diarrhea, but also reduced death rate from non-water-borne diseases such as influenza, pneumonia, heart disease and tuberculosis. This phenomenon is known as Mills–Reinckke effect.8 In Chicago and elsewhere, when steps were taken to assure water supply free of infections, death rate from non-water-borne diseases also fell along with typhoid. More recently, an analysis of the effects of federally supported clean water programs during 1960 to 1970 in Indian reservations showed remarkable decrease in IMR.9 These experiences of the past century indicate that improving water quality has high dividends in improving health and quality of life and thus increases human development index at a low cost. Water wars More recently, Serageldin, Vice President of World Bank expressed concerns that water scarcity may lead to wars between states. He said, ‘If the wars of this century (twentieth century) were fought over oil, the wars of the next century will be fought over water’. More than 50 countries in the five continents may be soon caught up in water disputes unless they move quickly to establish agreements on how to share reservoirs, rivers, and ground water.
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Vandana Shiva,10 a physicist turned renowned global environmental activist, studied the global politics of water quality and accessibility. She summarized her views in ‘The Principles of Water Democracy’ in her book Water Wars. The principles are as follows: (1) water is nature’s gift; (2) water is essential to life; (3) life is interconnected through water; (4) water must be free for sustenance needs; (5) water is limited and can be exhausted; (6) water must be conserved; (7) water is common; (8) no one holds the right to destroy and (9) water cannot be substituted.
Conclusion In summary, water is essential for life. Improving water quality brings about major dividends of health and quality of life. Based on the basic needs of water for sustaining life and health dividends of clean water, we should emulate ‘The Principles of Water Democracy’ so that no segment of society across the globe is deprived of its share of water, just as we would not allow anybody to suffer from lack of God-given air.
References 1 Abdel Darwish Geneva Conference on Environment and Quality of Life, 1994 June. http://www.mideastnews.com/waterware.htm##Number of water scarce countries in 1955, 7. In: 1990: 13 were added, another 10 by 2025, total of 18 will face severe shortage. 2 https://ga.water.usgs.gov/watercycle. 3 Bouman BAM, Tuong TP. Growing rice with less water, equivalent of 2 to three Olympic size water pools to grow one ton of rice. (5/23/06) www.iwmi.cgiar.org//assessment/FILES/pdf//publications/other/Issues.pdf. 4 The Dublin statement on water and sustainable development, 1992. www.cawater.info.net/library. 5 Rural woman walking the IFAD. International Fund for Agricultural Development. http://www.IFAD.org. 6 Water Partners International Fact Sheet. www.water.org. 7 David C, Grant M. The role of public health improvements in health advances: the twentieth-century United States. Demography 2005; 42(1): 1–22. 8 Harold G. McGree. Am J Public Health 1920; 10: 585–587. 9 Public Health Investments and the Infant Mortality Gap. Evidence from Federal Sanitation Interventions on US Indian Reservations. www.williams.edu/Economics/wp/watson0805san.pdf. 10 Water Wars. Privatization, Pollution, and Profit. South End Press: Cambridge MA, 2002.
