Intended for healthcare professionals

Opinion

Water matters: we must end the pollution of our rivers with sewage

BMJ 2023; 381 doi: https://doi.org/10.1136/bmj.p1481 (Published 28 June 2023) Cite this as: BMJ 2023;381:p1481
  1. Julian Sheather, consultant ethicist

Keeping open waters clean is a public health and environmental priority, writes Julian Sheather

I was born on a houseboat on the upper reaches of the river Thames. Summer was spent in the river. Home from school I would tear off my uniform—torture wearing it in those hot, sunstruck classrooms—and hurl myself into the cool water. This was the Seventies. Although the river ran green or brown according to the day, it was clean. Despite the disbelief of onlookers, it was, biologically at least, safe to swim in. My father marvelled at the comparison with the London Thames he knew in the Forties and Fifties: a dead river, little more than a toxic, anaerobic sluice, foul with human and industrial waste. But as a kid I swam in water that trout were rumoured to haunt. It was so obviously progress, such a hands down win for the world—for the environment, for the liberty of summer, for the joy of being alive—that I took its continuance for granted.

Recently I was walking the river Wandle. It rises in south Croydon and winds its beguiling way to the Thames at Wandsworth. Despite meandering through a deal of exurbia, suburbia, and light industry, it is that rarest of things, a chalk stream—there are only 200 in the world, almost all in southern England. As I edged a new housing development, I saw a pipe leaking effluent into the river. It was awful stuff: ashen, grainy, smothering. Like death itself being dribbled into the water. A few hundred yards downstream, a couple of guys were fishing. Kayaking near Victoria Bridge after a spot of rain, I paddled through a shoal of what Scousers dub Mersey otters’, brown and buoyant, fresh from a toilet. And this is just the visible tip of a vast polluting. In 2022 alone, raw sewage was pumped into UK rivers over 800 times a day.1 There is almost no open water in the UK that is biologically safe to swim in. We have turned it toxic.

In a slightly laconic opinion piece on Gov.UK, Chris Witty, along with the Chairs of Ofwat and the Environment Agency, restate public health orthodoxy: “One of the greatest public health triumphs of the last 200 years was separating human faeces from drinking water.”2 Only vaccination can compete with it for impact. The Thames is not drinking water, accepted, but it is tough to swim ebulliently without taking a little water onboard. And this is where the health threat gets serious. Witty et al again: “When bacteria from human faeces (coliforms) are ingested, it increases the risk of significant infections including antibiotic resistant bacteria. Keeping human faeces out of water people might ingest remains a public health priority.”

Responsibility for pollution on the current scale, along with the release of viable coliforms into rivers as part of “business as usual” sewage management rests squarely with the water companies. It looks like their approach has been woefully short term and extractive, prioritising shareholder return and lower bills over public health and the environmental integrity of our open water. But the politics are tricky. Investment in infrastructure is expensive. Absent serious government investment, some of the cost will be passed directly to consumers. Eliminating storm overflows would cost between £350bn and £600bn, hiking household bills by between £569 and £999 a year. It would also be “highly disruptive and complex to deliver.”3 Open water swimming is still—despite the best efforts of The Guardian—a niche enthusiasm. With the cost-of-living skyrocketing, many consumers are tightly focused on their household bills. Why fret over the cleanliness of water they would not dream of swimming in?

There are inevitable—and plausible—calls to take water back into public ownership. I have some sympathy. The combination of private profit and poisoned public goods is galling. As ever, the degradation of the environment is seen as an “externality”—not priced into the costs of the goods we consume. But nationalised industries also have their Achilles heel: inefficiency. If regulation and price controls are effective without nationalisation, this could be sidestepped. Sarah Hendry has an interesting blog over at the LSE that nicely untangles some of the policy issues.4 And if there were any doubt that this is politics, remember there are only two stretches of river in the UK certified to swim in. France has five hundred.

I admit though that my interest in good water is personal, biographical. It started in childhood, but a decade or so ago, slightly mauled by depression, I returned to outdoor swimming. It was an Indian summer—long, still autumn days, mist in the morning, shadows lengthening early afternoon. For me depression is, among other woes, a disorder of temperature. My body and mind start to overheat, gradually broiling in the oven of themselves. That autumn, as September slowly tilted over into October, the cold water began its quiet magic. Joy crept back into the day. I knew I had found a lifelong ally. Then lockdown closed everything, including my local lido. Bereft, I took to cycling to Teddington to get my morning hit of cold water. Dawn dips in the last of the non-tidal Thames. But this is no longer the Thames of my youth. I eye it suspiciously. If it’s been raining at all, I keep my head up—the water as much threat as restorative. What microscopic menace lurks invisible in its flow?

So I can’t help it. When I look at the stark calculus of water policy, at the pros and cons of investment and public ownership, of cost and benefit, something in me refuses. I have skin in this game. Water matters. It is a primary good, just like our health—to which it is linked in a thousand supersubtle ways. And to move beyond public health, beyond the irrefutable science: water is surely originary. It is a mythic substance, foundational to life. And rational as I try to be, I cannot accept a trade-off that poisons our wells, that corrupts the sources, mythological and otherwise. We cannot swim with Mersey otters. We must end the fouling of our water.

Footnotes

  • Competing interests: none declared.

  • Provenance and peer review: commissioned, not externally peer reviewed.

References