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Water, Sanitation, and Hygiene

    PAHO/CDC/EPA Partnership Consultations at the Spanish Town Treatment Plant with Jamaican officials from the National Water Commission.
    PAHO/CDC/EPA Partnership Consultations at the Spanish Town
    Treatment Plant with Jamaican officials from the National Water
    Commission. (August 2006, Richard Davis)

    Many households in developing countries lack adequate sanitation facilities, water sources that are protected from microbial and chemical contamination, and sufficient water supply to enable good hygiene practices. Worldwide, deaths from preventable waterborne diseases are estimated at 5 to 10 million per year. Diarrheal diseases are the second leading cause of death among children, killing an estimated 1.6 million each year, and roughly 90% of these cases are related to environmental conditions. Further, naturally-occurring arsenic and fluoride contamination of groundwater used for drinking can cause cancer, bone malformations, and other diseases. Poor management of standing water is linked to mosquito-borne diseases such as dengue and malaria. Agricultural and industrial run-offs containing fertilizers, pesticides, herbicides, and other chemicals can contaminate water sources, and the long-term health effects of many of these chemicals is as yet unclear. Finally, when water supplies are insufficient for personal hygiene, diseases such as louse-borne typhus are more prevalent.

    The World Health Organization estimates that 20% of the developing world lacks adequate drinking water and 50% lacks improved sanitation facilities. Although providing sustainable water supply and sanitation systems has long been a global public health priority, large ongoing efforts are needed for new construction to outpace population growth and decay of existing infrastructure. A Millennium Development Goal calls for the percentage of the population without sustainable access to safe water and sanitation to be halved by the year 2015.

    In addition to provision of water and sanitation, other interventions are known to be effective in protecting health. For example, educating individuals to wash hands with soap and water at critical times during the day can reduce diarrhea rates by more than one-third. Treating impure drinking water in the home to remove pathogens (through boiling, chemical disinfection, or solar disinfection) has a similar impact. In fact, based on a recent meta-analysis of studies on the topic, these two interventions may be even more effective than simply improving water supply systems.

    NCEH/ATSDR EXPERTISE AND EXPERIENCE

    With public health partners, CDC promotes, designs, participates in, and evaluates environmental public health service programs to prevent and control diseases related to water supplies, sanitation, and poor hygiene practices. The NCEH/ATSDR approach to water, sanitation, and hygiene programs, known as WaterPlus / Agua y Más, focuses on Water Safety Plans (an approach to protecting water supplies through proactively assessing and preventing risks from catchment to consumer); integration of water supply with point-of-use water purification, sanitation, and hygiene elements as needed; and program evaluation.

    Click here for a list of current NCEH/ATSDR projects related to this topic.

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