1 Water and Health: A Global Perspective Jim Shine Dept. Environmental Health, Harvard School of Public Health

2 Outline: Global Water Cycle - How much water is out there? - How much is accessible for human use? - How fast is it replaced? Water and Sanitation in Developing Nations - What are the problems with water quality and quantity in developing nations? -What is the magnitude of the problem? -What can be done?

3 Global Water Resources

4 Anthropocentric View of the Global Water Cycle

5 Global Water Cycle: Reservoir % of Total Residence Time Oceans97.33,100 yrs Snow and Ice2.116,000 yrs Groundwater yrs Lakes yrs Soil days Rivers days Atmosphere days Biota

6 Annual Precipitation

7 Spatial and Temporal Variability of Water Monthly Runoff as Fraction of Annual Runoff:

How Much Water Do We Consume? Note: 2500 m 3 /capita/yr = 6,850 Liters/day

Water Footprint of Agricultural Products

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12 Geographic distribution and water stress

13 Water and Sanitation in Developing Nations:

Reported Cases of Waterborne Infectious Disease in the United States (1920 – 1992) CDC

Milwaukee Cryptosporidiosis Outbreak 1993  Spring rains and filtration adjustments produce sharp increases in turbidity  400,000 cases of disease 4,000 hospitalizations >100 deaths  Water quality did not violate existing standards  Almost missed causal agent

Water and Health: The Global Perspective: Not Encouraging - Worldwide… billion people lack access to safe drinking water billion lack access to adequate sanitation - Estimate: 1.8 million deaths per year attributable to inadequate water and sanitation. - 3% of all deaths - 11% of deaths in children less than 4 yrs. - Millennium Development Goals: Halve these numbers by 2015

Water and Health: The Global Perspective:2012 Data - Not Encouraging - Worldwide… million people lack access to safe drinking water billion lack access to adequate sanitation - Estimate: 1.8 million deaths per year attributable to inadequate water and sanitation. - 3% of all deaths - 11% of deaths in children less than 4 yrs. - Millennium Development Goals: Halve these numbers by 2015

Percentage of population with access to safe water by country, 2000 Source: Pacific Institute

How much is enough water? By contrast, acceptable water quantities in developed countries range from liters per person per day (direct consumption)

How far is too far? UNICEF estimates that every year in developing countries, 10 million person-years are spent fetching water

Population with No Access to Improved Sanitation (2004)

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23 Predominant Means in Developing Countries Not improved  Service or bucket latrines (where excreta are manually removed)  Public latrines  Open latrine Improved  Connection to a public sewer  Connection to septic system  Pour-flush latrine  Simple pit latrine  Ventilated improved pit latrine

Improved WATSAN & Infant Death EgyptUgandaPeruCameroon UN Human Development Report 2006 Improved Water Improved Sanitation Reduction in risk of mortality (%)

 At the Millennium Summit in 2000 adopted the Millennium Development Goals (MDGs).  Water & Health Goal: “Halving the proportion of people without access to safe drinking water or adequate sanitation by 2015”.  In concrete terms: Delivering improved water services to almost 700,000 people every day for the next 15 years Goal 1Eradicate extreme poverty and hunger Goal 2Achieve universal primary education Goal 3Promote gender equality and empower women Goal 4Reduce child mortality Goal 5Improve maternal health Goal 6Combat HIV/AIDS, malaria and other diseases Goal 7Ensure environmental sustainability Goal 8Develop a Global Partnership for Development MDGs Millennium Development Goals

March 2012 Report

The MDG Drinking Water Target Has Been Met!

- 11% of world’s population (783 million) still lack access to safe water billion people still lack access to basic sanitation -Drinking water quality & reliability not assessed - only access to improved sources - testing at national level too costly - Increases in drinking water access primarily in China and India - 40% of those lacking drinking water from sub-Saharan Africa - Some countries falling back to pre-1990 rates of coverage Other Observations……

Progress in Drinking Water Coverage: Sub-Saharan Africa not on target to reach goal

The Sanitation Goal Will Not Be Met

Progress on Sanitation: Sanitation Trend: Target to be missed by ~800 Million people

Sanitation Improvement by Region:

Urban vs. Rural Situation

Environmental Risks: Unsafe water, sanitation, and hygiene Urban air pollution Indoor smoke from solid fuels Lead exposure Climate change WHO Global Burden of Disease Report (2004, 2010 Data) Available at:

35 Global Burden of Disease from Unsafe Water, Sanitation and Hygiene: Results (Year 2004) Diarrheal disease - Estimated 1.9 million deaths (64.2 million DALYs) attributable to unsafe WSH - 81% of WSH deaths occur in children (0 – 4 years) Total burden of Unsafe WSH: - 4.4% of all deaths and 8.1% of DALYs - 23% of deaths and 19% of DALYs in children (0 – 4 years) - 98% of deaths and 99% of DALYs occur in developing countries - “low income” and “low middle income” Note: Other ‘Water’ Diseases in Other Risk Categories - Example: schistosomiasis, trachoma, ascariasis, trichuriasis and hookworm disease examined in ‘Underweight’ category

Deaths attributed to 19 leading factors, by country income level, 2004 WHO 2008

Percentage of disability-adjusted life years (DALYs) attributed to 19 leading risk factors, by country income level, 2004 WHO 2008

38 Leading Causes of Death,

39 Leading Causes of DALY’s,

40 Unsafe Water, Sanitation and Hygiene: Attributable Deaths by Age and WHO Region for the Year 2004 WHO Total Africa Americas East. Med Europe SE Asia W. Pacific

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