Water Supply and Health
Citation: Hunter PR, MacDonald AM, Carter RC (
Water Supply and Health
Paul R. Hunter 0 1 2
Alan M. MacDonald 0 1 2
Richard C. Carter 0 1 2
0 Abbreviations: DALY, disability-adjusted life year; GDP, gross domestic product; JMP, WHO/UNICEF Joint Monitoring Programme for Water-supply and Sanitation; MDG, Millennium Development Goal; NGO , nongovernmental organization; WSP , Water Safety Plan
1 Competing Interests: PRH is chair of the board of directors of the Institute of Public Health and Water Research, Texas A & M University; chairs the science advisory council for Suez Environment; and has done consultancy work for Danone bevarages. Neither of the other two authors have any competing interests to declare
2 1 School of Medicine , Health Policy and Practice , University of East Anglia , Norwich , United Kingdom , 2 British Geological Survey, Edinburgh , United Kingdom , 3 WaterAid, London , United Kingdom
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A safe, reliable, affordable, and easily
accessible water supply is essential for good
health. Yet, for several decades, about a
billion people in developing countries have
not had a safe and sustainable water supply.
It has been estimated that a minimum of
7.5 litres of water per person per day is
required in the home for drinking,
preparing food, and personal hygiene, the most
basic requirements for water; at least
50 litres per person per day is needed to
ensure all personal hygiene, food hygiene,
domestic cleaning, and laundry needs [1].
This domestic water consumption is
dwarfed by the demands of agriculture
and ecosystems, even in wealthy countries
where per capita domestic water
consumption greatly exceeds these figures [2]. To
cover all these requirements and to avoid
water stress, experts generally agree that
about 1,000 cubic metres of freshwater per
capita per year is needed [3].
A key target of Millennium Development
Goal (MDG) 7, which aims to ensure
environmental sustainability, is to reduce
by half the proportion of people without
sustainable access to safe drinking water and
basic sanitation by 2015 [4]. This water
supply target underpins several other
MDGs, including those relating to poverty
(MDG1), education (MDG2), and gender
equality (MDG3). In particular, it underpins
MDG4, the reduction of child mortality,
because many deaths in young children in
developing countries are due to diarrhoeal
disease, and unsafe water is a key risk factor
for diarrhoeal disease in this age group [5].
The WHO/UNICEF Joint Monitoring
Programme for Water-supply and
Sanitation (JMP), which monitors progress on
the MDG water supply target, identifies
The Policy Forum allows health policy makers
around the world to discuss challenges and
opportunities for improving health care in their
societies.
three categories of drinking water supply:
(a) water piped into the dwelling, plot, or
yard; (b) other improved sources (including
public taps, protected springs, hand
pumps, and rainwater harvesting); and (c)
unimproved sources (open water,
unprotected from contamination) [6]. JMP
assumes that improved water should be
available not only for drinking but also for
food preparation and personal and home
hygiene, but it provides no official
definition of how near a water source should
be to a dwelling to be called improved.
However, a distance of ,1,000 m has been
suggested as an appropriate distance for
meeting the MDG targets [7].
In poorly served countries, achieving the
MDG water supply target will involve
increasing water availability for domestic
uses, improving water quality, and
bringing about changed water-use and
watermanagement habits. In the wealthy
countries where adequate quantities of domestic
water are already available on demand, the
main task over the next few years will be to
sustain water quality given the increasing
pressures of pollution. However, global
water supply targets need to be tempered
by a recognition of the real demand (as
expressed in user willingness and ability to
pay), which may be less ambitious than the
internationally agreed target. Furthermore,
account needs to be taken of the realities
of frequently poor levels of functionality.
It is relatively easy to increase coverage
through construction of water supply
systems, but it is much more difficult to
ensure that such systems continue to
provide service over the long term.
We therefore argue in this paper for a
serious commitment by national
governments and their partners to ensure
adequate water supply services for all (the
MDG target, if met, would still leave 672
million people with an unimproved supply
[6,8]). In addition, we call for increased
attention to be paid to ensuring continuing
service provision. This will mean finding
new ways to enhance public demand for
improved services (that might translate
into a willingness to pay), and a public and
private sector ethos that puts high value on
the quality of construction and ongoing
service delivery.
Water Supply and Health
Inadequacies in water supply affect
health (...truncated)