The development of rural water supplies and water user groups in Tanzania has significantly reduced time spent fetching water, a task falling mainly on women, and has reduced the prevalence of water-borne disease.
Stuart Batterman
Graham Environmental Sustainability Institute
Water and disease-related issues represent major roadblocks on the path to sustainable development (Toepfer in Shiffries & Brewster 2004). As examples: 80% of illness and death in the developing world is water-related; half the world's hospital beds are occupied by people with water-related diseases; water-related illness (diarrhea and malaria alone) are by far the largest cause of under-five mortality (34%) in Africa in the 2000-03 period; preventable deaths from water-related disease are estimated to range up to 5 million people per year, most of them children; and infant mortality in low-income countries is more than 13 times higher than in wealthier countries. Roughly 1.1 billion people worldwide are without access to safe and reliable drinking water, and 2.4 billion people are without access to sanitation services. The Millennium Development Goals (MDG) adopted at the 2002 World Summit on Sustainable Development commit to halving the proportions without clean water or sanitation by the year 2015, with an estimated annual cost of $30 billion, representing at least a doubling of current expenditures. (Also see footnote 4 for issues associated with the MDGs). Many factors exacerbate the water crisis and represent stressors that increase the prevalence of water-associated diseases, e.g., diarrheal disease, malaria, dengue fever, schistosomiasis, hookworm, filariasis, and guinea worm. Key stressors include: (1) Population growth and urbanization, increasing population densities in areas that typically lack infrastructure including housing, water supply and sanitation, e.g., the sub-Saharan Africa (SSA) rate of urbanization was 4.6% between 1990 and 2001, while the slum population expanded by 4.5% annually; (2) Climate variability and change with pernicious impacts on human welfare due to the erosion of food production capacity, impacts on water availability and quality, and increased flooding and drought due to inadequate drainage and storage (in part due to the increased episodic nature of rainfall); (3) Growing water demand by cities, industry and agriculture, often with very limited opportunities for reservoir development or aquifer utilization; (4) Increased vulnerability of populations to disease, a result of crowding, poverty, inadequate education, resources, greater mobility, etc.; and (5) other factors including changes in agriculture, housing, deforestation, species diversity and migration, etc. These factors are interactive and synergistic in ways that have increased the vulnerability of many communities and the likelihood of adverse health outcomes.