Intended for healthcare professionals

Student Education

Water and sanitation: the targets and challenges

BMJ 2003; 326 doi: https://doi.org/10.1136/sbmj.030494 (Published 01 April 2003) Cite this as: BMJ 2003;326:030494
  1. Alex Vass, assistant editor1
  1. 1BMJ Unified, BMA House, London WC1H 9JR

Alex Vass discusses the inequality of access to clean water and what the world is doing about it

Almost two and a half billion people across the world do not have access to adequate sanitation, and over one billion have no adequate water supply. Nearly all of them (98%) live in the developing world.1 The consequences of poor water supply and sanitation make stark reading. Diarrhoeal diseases cause 2.2 million deaths a year,2 6-9 million people are estimated to be blind from trachoma, and intestinal worms infect a third of the population of the developing world.3 Children suffer disproportionately, with most of the ill health, impaired development, and death being in those under the age of 5 years.4

At the start of what was called the water supply and sanitation decade (1981-90), the international community set the ambitious target of universal access to safe water and affordable sanitation by 1990. When that date passed, the year 2000 was suggested. In 2001 “more realistic” targets were set. The date for achieving universal coverage is now 2025. Nevertheless, simply supplying water and sanitation technology will not greatly improve health. Education is needed to change hygiene behaviour. This article explores the extent of the problem, the health consequences of inadequate water and sanitation supply on health, and what needs to be done.

Global water supply and sanitation

The joint monitoring programme of the World Health Organization and Unicef has been monitoring trends in the coverage of water supply and sanitation across the globe since 1991. The fourth and latest assessment was done in 2000 and for the first time collected data from consumers through household surveys. …

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