The United States is engaged in international assistance programs that aim to provide individuals with cleaner drinking water and, by so doing, improve health. These efforts strive to involve local communities in making decisions about their water use, promoting democracy, and improving environmental resource management at the same time.

Jonathan A. Margolis is special representative for sustainable development at the U.S. Department of State.

The United States is at the forefront of efforts to help developing countries address their fundamental needs for access to clean water, sanitation, modern energy services, and better health. Promoting such development, which balances economic freedom and growth with social advancement and environmental stewardship, is a hallmark of U.S. foreign policy. Indeed, as President Bush has said, combating poverty is a "moral imperative."

Expanding the circle of development builds prosperity. Healthier individuals with access to basic services are better able to engage in economically productive activities, take care of their families, and pursue their dreams. Furthermore, when done right, the process of enhancing these services can strengthen participatory decision making-strengthening the very fabric of democracy by empowering individuals and making institutions accountable to their constituents. The steady alleviation of poverty in turn enhances security, breaking the cycle of hopelessness and despair that can breed instability.

Water and health are two of humanity's most fundamental needs. More than 1 billion people lack access to safe drinking water, and more than 2 billion lack access to adequate sanitation. Every year approximately 3 million people, mostly children, die from water-related disease, principally diarrhea. Many more become ill or disabled as a result of water-related infections, mostly due to an unsafe water supply, inadequate sanitation, and poor hygiene. In these areas, the United States is supporting activities that are improving peoples' lives and transforming societies.

Lessons From Our Backyard

Integrated water resources management (IWRM) is a process of managing water resources while taking into account the multiple competing uses for water. Truly integrated water management also enables the adequate provision of food, urban infrastructure, energy, and other valuable services while maintaining a healthy environment. In the United States, such activities take place at the local, state, and federal level, in cooperation with a wide range of agencies, nongovernmental organizations, the private sector, and individual citizens.

New York City provides one of the best demonstrations of the value of this integrated approach. The New York City water supply delivers 1.4 billion gallons of high-quality drinking water to more than 9 million people every day. This water originates in the Catskill/Delaware watershed. To meet the requirements of the federal Safe Drinking Water Act, the city would have to spend an estimated $8 billion to build the necessary filtration plants.

The city proposed a different approach for purifying the water for drinking. Rather than build infrastructure, city leaders suggested a comprehensive long-range watershed protection program. Key elements of the program include land acquisition and stewardship, partnership programs, wastewater management, policy and regulatory changes, and environmental education and outreach programs. Working with upstream communities, the city designed projects to maintain and manage the forested and agricultural landscape to protect water quality and to enhance local economic opportunities. The cost: approximately $507 million. By managing the watershed in a sustainable way, New York City was able to dramatically reduce the need for costly filtration and still maintain a long-term supply of high-quality drinking water. Another benefit was preservation of ecosystem values and the upstream economy that depends on the watershed resources.

Promoting Development and Democracy

IWRM is based on stakeholder participation. At its core are processes for participatory decision making at local, national, and regional levels to identify shared interests and define courses of action. Through a U.S. Agency for International Development (USAID) project in El Salvador, for example, the community of Puente Arce recently elected an administrative board to oversee its newly expanded water service. This board now provides high-quality, efficient service rivaling systems in the United States. In some cases, the selection of these local administrative boards represents the first time citizens have been involved in electoral processes. IWRM nurtures a culture of democracy by making participatory decision making a reality and empowering stakeholders to demand greater transparency and accountability from public and private institutions.

The United States has placed a priority on IWRM, devoting a significant amount of USAID's three-year, $970 million Water for the Poor Initiative to these efforts. Above and beyond our bilateral projects, the U.S. government has also worked to raise the profile of IWRM in multilateral discussions and to engage other donors. For example, we recently began working through the Global Water Partnership (GWP) to fund additional IWRM assistance for El Salvador, Ethiopia, and Indonesia. With these funds, the GWP will encourage more discussion among stakeholders on water management to implement an IWRM plan. These new U.S. contributions have given rise to further contributions from other donors; in total, more than 18 developing countries will receive additional support for their IWRM efforts through the GWP.

Reducing Water-Related Disease

Water-related diseases cause human suffering and impose heavy costs on families, communities, and nations. Through traditional bilateral aid as well as private investment and public-private partnerships and multilateral initiatives, the United States is working to reduce these diseases, saving lives and boosting prosperity by allowing people to engage more fully in creative, civic, educational, and entrepreneurial activities.

For example, the United States has joined with the World Health Organization, the United Nations Children's Fund (UNICEF), and others in launching the Partnership to Improve Health through Water (PHW). Growing out of the U.N. Commission on Sustainable Development's recent focus on water and sanitation issues, the PHW brings together several global programs and initiatives dedicated to reducing the incidence of water-related disease. This partnership is working to raise awareness of the health implications of unsafe water and to put in place programs that encourage clean water at the household and community levels.

In one part of this program, the United States is working with the partnership to support "point-of-use" water disinfection programs using locally manufactured products in more than 20 countries in Asia, Africa, and Latin America. These programs empower individuals to take control of their own health by disinfecting their water at the household level. The Safe Water System initiative has already distributed more than 12 million bottles of disinfectant solution to improve the quality of drinking water at the household level. Each bottle typically provides one household with enough disinfectant to produce drinking water for up to two months.

While these point-of-use programs enable people to take responsibility for their well-being in the short term, they also have a broader effect. By demonstrating the linkage between cleaner water and better health, these programs empower communities to work with their governments for safer, more sustainable water services over the longer term.

Role of Local Financing

Clean water and other essential services often require significant flows of local financial resources. To address this need, USAID has developed innovative financing tools that strengthen local capital markets and mobilize domestic capital, empowering communities to take action. One such tool, the Development Credit Authority (DCA), stimulates lending by offering partial loan guarantees to local banks and financial institutions. In the Indian state of Tamil Nadu, a DCA project facilitated the issuing of a municipal bond to mobilize up to $6.4 million for local infrastructure projects. The township of Valasaravakkam (population 26,260), for example, is using newly available funds to upgrade its water system, increasing the water supply from two liters to 35 liters per person per day.

Promoting IWRM, reducing the burden of water-related illness, and unleashing domestic capital are some of the many ways in which the United States is helping developing countries improve the quality of their citizens' lives and develop a culture of accountability and participation. In so doing, we are fulfilling the mission to create a more secure, democratic, and prosperous world.