The acronym “WASH” stands for water, sanitation, and hygiene. These basic necessities of life are not available to many people in developing countries all around the world. In fact, more than 780 million people (1 in 9) do not have access to clean, safe drinking water and 2.5 billion people (2 in 5) do not have access to adequate sanitation (like a bathroom).
Access to WASH is a basic human right, and lack of access is not only an injustice but is detrimental to economic productivity, childhood survival, public health, education, environmental conservation, climate resilience, and much more.
The United States Congress passed the Senator Paul Simon Water for the Poor Act in 2005, which established WASH as a priority in U.S. foreign and development policy and instructs the State Department and USAID in their work on WASH.
New legislation such as the Water for the World Act, which has been introduced in previous Congresses with bipartisan support and is soon to be introduced in the 113th Congress, could modify the Water for the Poor Act and improve the efficiency with which the U.S. gives foreign aid for WASH. This is especially important with looming budget cuts that are likely to affect these programs.
- Research has found that safe drinking water, sanitation and hygiene (WASH) programs offer a return of $4 in increased economic productivity for every $1 invested. The World Bank has estimated that hygiene is the most cost-effective health intervention available.
- Lack of access to WASH contributes to two of the three leading killers of children under five years old in the world. These diseases are pneumonia, which can be prevented by good handwashing and better hygiene; and diarrhea, which comes from drinking unsafe water and lack of sanitation around the world. With good quality water, sanitation and hygiene, many children’s lives could be saved.
- Many Neglected Tropical Diseases (NTDs) could be prevented if safe drinking water, sanitation and hygiene were available.
- Lack of access to WASH is estimated to contribute to up to half of all undernutrition in the world. Yet, WASH would not only help prevent poor nutrition, but stunting and cognitive delays, as well.
- Up to 40 billion working hours are lost every year due to water collection, mostly by women and girls who must walk long distances, sometimes in dangerous circumstances, to collect water. This, combined with water-borne diseases keeping people from school and work, costs countries in sub-Saharan Africa and South Asia 5-6% of their Gross Domestic Products each year. WASH access would help return lost income and productivity, contributing to financial stability and reducing poverty.
- Approximately half of the world’s population lives in areas that currently or will soon face physical water scarcity, or that lack the necessary infrastructure to take water from rivers and aquifers. Never has it been more important to protect the freshwater ecosystems that can supply clean drinking water in the face of these changes.
- 1.5 million people die every year from diarrheal diseases (including cholera); 90% are children under 14, mostly in developing countries.
- 88% of diarrheal disease is attributed to unsafe water supply, inadequate sanitation and hygiene.
- Improved water supply reduces diarrhea morbidity by 21%.
- Improved sanitation reduces diarrhea morbidity by 37.5%.
- The simple act of washing hands at critical times can reduce the number of diarrheal cases by up to 35%.
- Additional improvement of drinking-water quality, such as point of use disinfection, would lead to a reduction of diarrhea episodes of 45%.
- 42% of malaria cases across the world could be prevented by improved management of the environment.
- Over half a million people die of malaria each year, 90% of whom are children under 14.
- There are 219 million cases of malaria every year, most of the disease burden is in Africa south of the Sahara.
- An estimated 200 million people are infected with schistosomiasis.
- The disease causes tens of thousands of deaths every year, mainly in sub-Saharan Africa.
- It is strongly related to unsanitary excreta disposal and absence of nearby sources of safe water.
- Basic sanitation reduces the disease by up to 77%.
- Man-made reservoirs and poorly designed irrigation schemes are main drivers of schistosomiasis expansion and intensification.
- 320 million people are at risk from trachoma, and 146 million are threatened by blindness.
- Trachoma affects 21.4 million people of whom about 2.2 are visually impaired and 1.2 are blind.
- The disease is strongly related to lack of face washing, often due to absence of nearby sources of safe water.
- Improving access to safe water sources and better hygiene practices can reduce trachoma morbidity by 27%.
Other Neglected Tropical Diseases (NTDs)
- Sixty-six percent of the disease burden of lymphatic filariasis is attributed to inadequate WASH.
- Dengue, Japanese encephalitis, and onchoceriasis together cause 31,000 deaths worldwide
Intestinal helminths (Ascariasis, Trichuriasis, Hookworm disease)
- 2 billion people each year are infected with intestinal nematode infections – almost one third of the world.
- 20% of clinical cases of Japanese encephalitis die, and 35% suffer permanent brain damage.
- Improved management for irrigation of water resources reduces transmission of disease, in South, South East, and East Asia.
- Each year, 860,000 child deaths are caused by undernutrition as a result of poor sanitation and hygiene.
- There are 1.5 million cases of clinical hepatitis A every year.
- In Bangladesh, between 28 and 35 million people consume drinking-water with elevated levels of arsenic in their drinking-water.
- The number of cases of skin lesions related to arsenic in drinking-water in Bangladesh is estimated at 1.5 million.
- Arsenic contamination of ground water has been found in many countries, including Argentina, Bangladesh, Chile, China, India, Mexico, Thailand and the United States.
- The key to prevention is reducing consumption in drinking-water with elevated levels of arsenic, by identifying alternative low arsenic water sources or by using arsenic removal systems.
- Over 26 million people in China suffer from dental fluorosis due to elevated fluoride in their drinking water.
- In China, over 1 million cases of skeletal fluorosis are thought to be attributable to drinking-water.
- The principal mitigation strategies include exploitation of deep-seated water, use of river water, reservoir construction and defluoridation.
- 783 million people still lack access to safe drinking water. 80% of these live in rural areas.
- 2.5 billion people lack access to improved sanitation facilities. 72% of these live in rural areas.
- Only 30% of the population of Sub-Saharan Africa is served by sanitation services. In South Asia, 41% of the population is served by sanitation services.
- Improved access to safe WASH has the potential to prevent at least 9.1% of the world’s disease burden and 6.3% of all deaths.
- Over 20% of the total deaths or DALYs in children 0-14 are caused by lack of safe WASH.
The global response
Millennium Development Goals (MDGs)
By including water supply, sanitation and hygiene in the MDGs, the world community has acknowledged the importance of their promotion as development interventions and has set a series of goals and targets.
Goal 7: Ensure environmental sustainability
- Target 9: Integrate the principles of sustainable development into country policies and program and reverse the loss of environmental resources.
- Target 10:
- Halve by 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation.
- Integrate sanitation into water resources management strategies.
- Target 11: Have achieved by 2020, a significant improvement in the lives of at least 100 million slum dwellers.
Goal 4: Reduce child mortality
- Target 5: Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate.
Goal 6: Combat HIV/AIDS, malaria, and other diseases
- Target 8: Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases.
Water for Life Decade: 2005-2015
- UN Declares 2005-2015 “Water for Life” as the International Decade for Action and sets the world agenda on a greater focus on water-related issues.
“Water and Sanitation is one of the primary drivers of public health. I often refer to it as “Health 101”, which means that once we can secure access to clean water and to adequate sanitation facilities for all people, irrespective of the difference in their living conditions, a huge battle against all kinds of diseases will be won.”
Dr Lee Jong-wook, Director-General, World Health Organization.
World Health Organization, Safer Water, Better Health, (World Health Organization, 2008) http://www.who.int/quantifying_ehimpacts/publications/saferwater/en/index.html
The Carter Center, “Trachoma Control Program,” http://www.cartercenter.org/health/trachoma/index.html
World Health Organization, “Priority Eye Diseases,” http://www.who.int/blindness/causes/priority/en/index2.html
World Health Organization, “Malaria Fact Sheet No. 94,” http://www.who.int/mediacentre/factsheets/fs094/en/
World Health Organization, “Facts and Figures: Water, Sanitation and Hygiene Links to Health,” http://www.who.int/water_sanitation_health/publications/factsfigures04/en/