Governments must speed up action to enable access to clean water for all, say UN bodies

Dear Editor
The report The Sanitary Conditions of the Labouring Population of Great Britain was a great landmark in public health when it was published in 1842.(1) It stressed the importance of the provision of pure water and effective sanitation and went on to revolutionise public health in Europe. The “sanitary revolution”— is one of the most important medical milestones(2) but the success has still not reached all corners of the globe.(3) Great inequalities exist that have recently been highlighted by Wise.(3)

Each year at least 1.4 million people die from preventable causes linked to unsafe water and poor sanitation.(4) A staggering 2 billion people do not have safe drinking water and approximately 3.6 billion people use sanitation services that leave human waste untreated.(4) Microbiologically contaminated drinking water can transmit diseases such as cholera, diarrhoea, dysentery, polio and typhoid. For example, this results in around 485,000 diarrhoeal deaths each year.(5)

In low- and middle-income countries almost 2 billion people depend on health care facilities lacking basic water services. In the world’s 47 most vulnerable countries one 1 in 2 health care facilities lacks basic drinking water, 1 in 4 has no hand hygiene at point of care and 3 in 5 lack basic sanitation services.(6) In many of which the impact of climate change on water supplies is increasing the challenges.

Safe drinking water and sanitation are crucial to health and well-being which is one reason why they have been made a Sustainable Development Goal (SDG6).(7) They are also linked to other important Development Goals such as poverty reduction. In some countries fetching water falls disproportionately on women and children, especially girls. So, providing water can free up time and have positive impacts on education and gender equality.

It is very positive that this month a historic United Nations Water Conference was held where the World Health Organization and the United Nations Children’s Fund called on all nations to radically accelerate action to make water, sanitation and hygiene a reality for all.(4) They urged governments to make investments and take decisive actions with support from UN agencies, multilateral partners, the private sector and civil society organisations.

Two organisations with a long history of working to provide safe water, effective sanitation and hygiene facilities are OXFAM and WaterAid.(8,9) Their websites have examples of successful case studies in diverse countries including, Bangladesh, Ghana, Malawi, Tanzania, Uganda, and Zimbabwe. However, as the global statistics above illustrate, far more still needs to be done.

Unfortunately, in many high-income countries many individuals are not aware of the current dire circumstances in some medium and low-income countries. Public health practitioners should use their advocacy skills to engage professionals, politicians and the public to ensure more rapid gains are achieved.

In the UK we have had recent examples of the importance of good sanitation for public health being ignored. A report published by the House of Lords stated that Ofwat and the Environment Agency must go further to hold water companies to account for pollution as the environmental performance of water companies was at its lowest ever level and most companies’ performance was declining.(10) In addition, the UK will run out of water in 20 years unless change is made.(10)

Globally, clean water, decent toilets and good hygiene are simply not prioritised highly enough and do not attract enough funding. This is causing unnecessary disease and death. Hopefully, the recent joint statement by the World Health Organization and the United Nations Children’s Fund will galvanise people into action in order to reach SDG6—universal access to drinking water, sanitation, and hygiene by 2030.(7)

References
1) Poor Law Commissioners. Sanitary Condition of the Labouring Population of Great Britain. London: House of Commons, 1842.
https://www.parliament.uk/about/living-heritage/transformingsociety/livi...

2) Chew M and Sharrock K (Eds). Medical Milestones. Celebrating key advances since 1840. British Medical Journal, 2007.
https://www.bmj.com/content/suppl/2007/01/18/334.suppl_1.DC2/milestones.pdf

3) Wise J. Governments must speed up action to enable access to clean water for all, say UN bodies BMJ 2023; 380 :p694 doi:10.1136/bmj.p694
https://www.bmj.com/content/380/bmj.p694

4) WHO/UNICEF. Our lifetime opportunity to enable water, sanitation and hygiene for all. Joint WHO/UNICEF statement. March 2023.
www.who.int/news/item/22-03-2023-our-lifetime-opportunity-to-enable-wate...
(Accessed 23 March 2023)

5) WHO. Drinking-water. Key facts. 21 March 2022
https://www.who.int/news-room/fact-sheets/detail/drinking-water
(Accessed 23 March 2023)

6) WHO/UNICEF. Almost 2 billion people depend on health care facilities without basic water services. Joint WHO/UNICEF statement. December 2020.
https://www.who.int/news/item/14-12-2020-almost-2-billion-people-depend-...
(Accessed 23 March 2023)

7) United Nations. The 17 Goals.
https://sdgs.un.org/goals
(Accessed 23 March 2023)

8) OXFAM. Safe Clean Water Saves Lives.
https://www.oxfam.org.uk/oxfam-in-action/water-for-all/
(Accessed 23 March 2023)

9) WaterAid
https://www.wateraid.org/uk/
(Accessed 23 March 2023)

10) Industry and Regulators Committee. The affluent and the effluent: cleaning up failures in water and sewage regulation. HL Paper 166. London: House of Lords, 2023.
https://publications.parliament.uk/pa/ld5803/ldselect/ldindreg/166/16602...