World Water Day 2009: Sharing Waters–Sharing Opportunities

 

Each year on March 22, World Water Day attracts international attention to conservation and development of water resources. "Shared Waters–Shared Opportunities" is the theme for World Water Day 2009.

The Earth's Water

Although approximately three-quarters of the Earth is covered by water, only about 3% of all the water available on the planet is fresh water. Most of the fresh water is locked up in glaciers and icecaps or is located underground. Surface sources of fresh water, like lakes and rivers, contain less than 0.01% of the total amount of water on the planet, yet they continue to be the main sources of drinking water for people around the world [1].

During the last century, both global water usage and the global population have grown. However, water usage has increased at a rate more than twice that of the population. Although there is not yet a global water scarcity, a growing number of regions are facing chronic water shortages [2]. Furthermore, in many places the available water is unsafe for drinking because it is contaminated with bacteria, parasites, viruses, and chemicals from human and animal waste or various agricultural and industrial processes.

Sharing Waters: Transboundary Water

This year, World Water Day draws particular attention to the challenges of transboundary water, which refers to surface or ground water sources that cross shared borders. Worldwide, there are 263 transboundary lakes and river basins that include the territory of 145 countries. Close to one third of these 263 basins are shared by three or more countries, and 19 of them are shared by five or more countries [3]. Despite the complexity of these boundaries, there have been hundreds of successful international transboundary agreements. Organizations, such as The United Nations Educational, Scientific and Cultural Organization (UNESCO) and The United Nations Economic Commission for Europe (UNECE), are working to ensure the peaceful collaboration of countries who share water systems [3].

More information on sharing water resources, including facts and figures, may be found at UNESCO's Sharing Water Resources .

Water and Health

Many countries are challenged to provide safe drinking water and adequate sanitation for their entire populations. Today, hundreds of millions of people still do not have access to improved sources of drinking water [4], leaving people at risk for water, sanitation, and hygiene (WASH) related diseases. Worldwide, there are 1.6 million deaths per year that can be attributed to unsafe water, poor sanitation, and lack of hygiene [5]. The majority of these deaths occur among children younger than 5 years of age.  Devastating epidemics of cholera, such as the recent one in Zimbabwe responsible for more than 73,000 cases and 3,500 deaths. (See A Lion in Our Village --- The Unconscionable Tragedy of Cholera in Africa, New England Journal of Medicine, 12 March 2009.) Most of the cases and fatalities due to waterborne diseases are never reported [6]. Access to safe water, adequate sanitation, and proper hygiene education can reduce morbidity and mortality from disease, thereby leading to improved health, poverty reduction, and socio-economic development. Effective programs should include efforts to improve drinking water quality and access to safe water, to improve wastewater management processes, to increase access to sanitation facilities (e.g., toilets and latrines), and to promote personal hygiene.

In order to meet the United Nations' Millennium Development Goal to halve the proportion of people without sustainable access to improved drinking water* and basic sanitation by 2015, an estimated 1.1 billion people will need to gain access to an improved water supply and 1.6 billion people will need to gain access to basic sanitation (accounting for expected population growth). Even if this Millennium Development Goal is reached by 2015, it will still leave more than 790 million people (11% of the world's population) without access to an improved water supply and more than 1.8 billion people (25% of the world's population) without access to adequate sanitation [7].

* Improved water sources include household connections, public standpipes, boreholes, protected dug wells, protected springs, and rainwater collections. For more information, please see WHO's Access to Improved Drinking-Water Sources and to Improved Sanitation

Global Water, Sanitation and Hygiene Programs at CDC

Inadequate water, sanitation, and hygiene conditions exist in a range of settings, from temporary refugee camps to villages with distant water supplies and limited sanitation to permanent housing in large cities that have intermittent water service. CDC programs in global water, sanitation, and hygiene respond to needs across that spectrum.

CDC's International Emergency and Refugee Health Branch

A refugee camp housing internally displaced persons, Liberia. Photo Credit: Thomas Handzel

There are approximately 25 million refugees, internally displaced, or emergency affected persons worldwide today. Refugees and displaced persons often live in crowded conditions where access to safe drinking water and sanitary services are often extremely poor. Water and hygiene related diseases, including cholera and dysentery, are one of the primary causes of illness and death in such settings especially among young children.

CDC's International Emergency and Refugee Health Branch (IERHB) works with US Government, UN agencies, and NGO partners to reduce morbidity and mortality in emergency affected populations. IERHB provides technical assistance to the US office of Foreign Disaster Assistance in responding to acute emergencies, assists the Office of the United Nations High Commissioner for Refugees (UNHCR) in monitoring and evaluating water, sanitation, and hygiene programs in refugee camps, and the United Nations Children's Fund (UNICEF) in evaluating water, sanitation, and hygiene interventions.

CDC's Safe Water System

Household water storage -- changing ways water is stored and protected in homes. Photo credit: D. Lantagne.

In areas where access to safe water, appropriate wastewater management, and adequate sewerage systems are not feasible, certain programs, such as CDC's Safe Water System, can empower people to improve and protect the quality of their drinking water through simple, inexpensive technologies to treat and safely store water in their homes. The Safe Water System program consists of these steps:

• Point-of-use treatment of contaminated water
• Safe water storage
• Improved hygiene
• Behavior change techniques

More information on household water treatment is available from CDC at Safe Water System (SWS) and from the World Health Organization (WHO) at The International Network to Promote Household Water Treatment and Self Storage. For smaller community-based organizations, technical information on developing household water treatment and safe water storage programs can be found online at Safe Water for the Community: A Guide for Establishing a Community-Based Safe Water System Program or may be requested in hard-copy CD form by sending an email to safewater@cdc.gov [8].

CDC's WASH Away Neglected Tropical Diseases Program

Guinea worm extraction from a leg. Photo Credit: The Carter Center 2001.

CDC's WASH Away Neglected Tropical Diseases Program also works in communities burdened by diseases associated with inadequate access to safe water and appropriate sanitation and hygiene. For example, CDC is a partner in the global Guinea Worm Eradication Program. Guinea worm disease (GWD) is a preventable parasitic infection that affects poor communities in remote parts of Africa that lack safe drinking water.  One year after drinking contaminated water, Guinea worms up to one meter in length emerge from the skin of infected persons. Emergence of these worms can be very painful, slow, and disabling and prevents people from working in their fields, tending their animals, going to school, and caring for their families [9].

GWD is prevented through the use of simple interventions for providing safe drinking water, including using cloth filters and pipe filters to strain out water fleas carrying Guinea worm larvae, applying chemicals to the water supplies to kill the water fleas, and preventing infected people from entering and contaminating the water supplies as the worms emerge from their skin. Providing borehole wells and other supplies of safe drinking water in affected villages is another important component of the eradication efforts. Through these efforts, the Guinea Worm Eradication Program has reduced the number of cases of GWD from 3.5 million cases per year in 20 countries to fewer than 5,000 cases during 2008 from the 6 remaining endemic countries [10]. More information about GWD and the eradication program is available from CDC at Parasitic Disease Information – Dracunculiasis, from The Carter Center at Guinea Worm Eradication Program, and from the World Health Organization at Dracunculiasis Eradication.

CDC's Global Water, Sanitation, and Hygiene Program

Water storage tank for small community water system in Guatemala. Photo Credit: Richard Gelting.

In communities where community water and sanitation interventions and hygiene education are feasible, CDC's Global Water, Sanitation, and Hygiene Program works with partner organizations to improve the public health impact and sustainability of water, sanitation, and hygiene interventions, as well as providing technical assistance to support the development and implementation of these interventions.

Currently, the Global Water, Sanitation, and Hygiene Program works to:

• Evaluate the sustainability of water, sanitation, and hygiene interventions;
• Improve access to safe drinking water through the implementation of Water Safety Plans (WSPs); and
• Research the public health impacts of sanitation programs.

More information on community water systems and water safety plans is available from CDC's Community Water Systems and Water Safety Plans and from the World Health Organization (WHO) at WSPortal: Health through Water. Technical information on developing water safety plans can be found from WHO at Water Safety Plans: Managing Drinking-Water Quality from Catchment to Consumer.

Other CDC Activities in Water, Sanitation, and Hygiene

• Healthy Water
• Healthy Water: Global Water, Sanitation and Hygiene  
• Water-Related Environmental Public Health
• Chemical Contaminants in Drinking Water and Public Health
• Community Water Fluoridation
• Surveillance for Waterborne Disease and Outbreaks Associated with Drinking Water and Water not Intended for Drinking – United States, 2005-2006
  • Text
  • Appendix A
  • Appendix B

References

1. U.S. Geological Survey. Earth's Water Distribution. Available at http://ga.water.usgs.gov/edu/waterdistribution.html.
2. UN Water. Coping with water scarcity – challenge of the twenty-first century. World Water Day 2007. Available at: http://www.unwater.org/wwd07/downloads/documents/escarcity.pdf
3. Educational, Scientific and Cultural Organization. World Water Assessment Programme: Sharing water resources. Available at http://www.unesco.org/water/wwap/facts_figures/sharing_waters.shtml
4. World Health Organization and UNICEF. Progress on Drinking Water and Sanitation – Special Focus on Sanitation. Available at http://www.wssinfo.org/en/40_MDG2008.html
5. UN Millennium Project. Health, Dignity, and Development: What Will it Take? Available at http://www.unmillenniumproject.org/documents/WaterComplete-lowres.pdf.
6. Africa. N Engl J Med 2009;360:1060-1063.
7. WHO and UNICEF Joint Monitoring Programme. Meeting the MDG Drinking Water and Sanitation Target: The Urban and Rural Challenge of the Decade. 2006. Available at www.who.int/water_sanitation_health/monitoring/jmpfinal.pdf
8. Lantagne DS, Gallo W. Safe Water for the Community: A Guide for Establishing a Community-Based Safe Water System Program. CDC 2008; Edition 1. 
   • Ruiz-Tiben E, Hopkins DR. Dracunculiasis (Guinea worm disease) eradication. Adv Parasitol. 2006;61:275-309.
9. WHO Collaborative Center for Research, Training, and Eradication of Dracunculiasis. Guinea worm wrap-up #186. Available at http://cartercenter.org/resources/pdfs/news/health_publications/guinea_worm/gw186.pdf
10. WHO Collaborative Center for Research, Training, and Eradication of Dracunculiasis. Guinea worm wrap-up #186. Available at http://cartercenter.org/resources/pdfs/news/health_publications/guinea_worm/gw186.pdf