Access to clean water is not enough

NEW YORK — The 19th annual World Water Day recently featured an abundance of events all over the world. This international day, to raise awareness about the importance of preserving freshwater resources, has gained wider attention in recent years as access to safe water has become a major modern development priority.

But the focus has not been as intense for the less sexy side of the water story: sanitation, toilets and hygiene. Together, they have the potential to save many more lives at a lower cost than just providing access to clean water.

The international community should grasp the opportunity to combat the preventable diseases of poverty — specifically diarrheal diseases and infections — through improving access to sanitation and hygiene. This is a holistic approach that embraces health-care systems as opposed to solely water-based strategies.

More than 780 million people worldwide do not have access to safe drinking water. This number is dwarfed by the approximately 2.5 billion people — 37 percent of the developing world’s population — for whom no suitable sanitation facilities are available, according the United Nations Children's Fund.

The 2011 census results for India released earlier this month disclosed a shocking picture: in this emerging economic power, only 47 percent of its citizens have any form of toilet (including pit latrines) available to them.

Lack of adequate water, sanitation, and hygiene are the root causes behind the overwhelming majority of the 1.8 million people who die every year from diarrheal diseases; 90 percent of these deaths are among children under five. More children die of diarrhea, a preventable and treatable condition, than of AIDS, malaria, and measles combined.

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While improving the water supply reduces by 21 percent the frequency of contracting diarrhea, improving sanitation facilities reduces diarrheal frequency by 37.5 percent. Studies show that washing hands at critical times, such as after going to the bathroom and before preparing or eating food, can reduce diarrheal cases by up to 35 percent. Hand washing has also been shown to significantly reduce upper respiratory infections, one of the top five causes of deaths globally among children under five.

Improving access to clean water in the developing world is key to directly averting illness and death from preventable diseases. Clean water is an increasingly popular cause. It draws ample international attention and has wide public support. The actress Jennifer Connelly, for example, appeared in a 2011 public service announcement for a charity devoted to increasing global access to clean water.

However, prominent public figures are not volunteering to promote awareness of the critical issue of sanitation and hygiene in the developing world. This underscores the reality that it is difficult to build support for improving access to toilets (especially pit latrines) and hygiene-related health education that encourages proper hand washing. These strategies are more important in disease prevention and they typically are less costly interventions.

Governments and international institutions working on global health issues have an obligation to raise awareness about the importance of hygiene and contribute significant resources toward these preventative efforts. Spending on health requires hard choices. Ideally, the international community can find effective ways to integrate hygiene in its imperative for providing clean water access for all.

Zoe Liberman is a research associate for the Global Health Program at the Council on Foreign Relations in New York.

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