Water, health and the Sustainable Development Goals

In September 2015, heads of state from all around the world gathered in New York and adopted the Sustainable Development Goals (SDGs), an ambitious “plan of action for people, planet and prosperity”, with 17 goals and 169 targets, aimed at “transforming our world”.

The 2030 Agenda builds on the eight Millennium Development Goals (MDGs) of 2000-2015, to now cover all aspects of sustainable development in all countries of the world.

The SDGs cover a wide range of drivers across the three pillars of sustainable development, with one goal solely dedicated to water and sanitation (SDG 6) that sets out to “ensure availability and sustainable management of water and sanitation for all”.

 SDG 6 thus expands the MDG’s focus on drinking water and basic sanitation to cover the entire water cycle, including the management of water, wastewater and ecosystem resources. 

With water at the very core of sustainable development, SDG 6 has strong linkages to all of the other SDGs, and also has the ability to underpin them, therefore, realising SDG 6 would go a long way towards achieving much of the 2030 Agenda.

It contains six targets on outcomes across the entire water cycle, and two on the means of implementing those outcome targets. Those two build on the MDG targets on drinking water and basic sanitation, while expanding their scope and refining definitions.

 Two other targets address the broader water context that was not explicitly included in the MDG framework, but was acknowledged at the Rio+20 Conference as important, such as water quality and wastewater management, water scarcity and water use efficiency, integrated water resources management, and the protection and restoration of water-related ecosystems. 

The last two targets also acknowledge the importance of an enabling environment, addressing the means of implementation and aiming for international cooperation, capacity building and the participation of local communities in water and sanitation management.   

The two targets on drinking water by extension include household water treatment and safe storage (HWTS) which is critical because it is the most effective intervention for reducing morbidity from diarrhoeal diseases, when used correctly and consistently over the long term.

Statistics from WHO - 2005 - have it that unsafe drinking water, poor sanitation and hygiene are the main contributors to an estimated four billion cases of diarrhoeal disease annually, causing more than 1.5 million deaths, mostly among children under five years of age.

 It also leads to their impaired physical growth and cognitive function, reduced resistance to infection and potentially long-term gastrointestinal disorders. 

Contaminated drinking water is also a major source of hepatitis, typhoid and opportunistic infections that attack the immuno-compromised, especially persons living with HIV/AIDS.

Outbreaks of acute watery diarrhoea add to the disease burden and require costly diversion of scarce health and other resources to minimise fatalities.

 Diseases associated with contaminated water also exact a heavy economic load in most developing countries, both on the public health care system for treatment and on persons affected for medicines and lost productivity. 

They also adversely impact school attendance and performance, particularly for girls and young women who must care for and assume the duties of ill parents and siblings.

Studies in six pilot countries found that 31 per cent of drinking water samples from boreholes exceeded WHO guideline values and national drinking water standards in the pilot countries for faecal contamination, which is the leading source of infection and disease. 

At the household level, contamination of stored water is even more common. In one of the pilot countries, only 43.6 per cent of samples from stored water were in compliance with the WHO guideline value and national standards, and more than half of household samples showed post-source contamination. 

This is consistent with a large body of research worldwide that has shown that even drinking water which is safe at the source is subject to frequent and extensive faecal contamination during collection, storage and use in the home.

Treating water at the household level has thus been shown to be one of the most effective and cost-effective means of preventing waterborne diseases in development and emergency settings. Promoting household water treatment and safe storage, therefore, helps vulnerable populations to take charge of their own water security by providing them with the knowledge and tools to treat their own drinking water. 

Since treating water at the household level prevents recontamination of water in the home, it is more effective than conventional improvements in water supplies in ensuring the microbiological quality of drinking water at the point of consumption. This translates into improved health outcomes. 

Studies have also established that household-based water treatment and safe storage was associated with a 35 per cent reduction in diarrhoeal disease compared to a statistically insignificant 11 per cent for conventional source-based interventions.

A more recent and comprehensive review covering more than 38 randomised, controlled trials and 53,000 people in 19 countries also found that household-based interventions were about twice as effective in preventing diarrhoeal disease than improved wells, boreholes and communal standpipes.

While household water treatment offers superior health gains, the economic advantages over conventional improvements in water supplies are equally compelling. Yet ensuring sustainable supply of access to water is an increasingly critical challenge. 

As a matter of fact, from its collection, through various uses to its ultimate return to the natural environment, good access to drinking water and sanitation promote an educated and healthy workforce, which constitutes an essential factor for sustained economic growth. Furthermore, it is an understatement that water is a key factor in the development of and opportunities either directly related to its management that is, supply, infrastructure, wastewater treatment, among others or in economic sectors that are heavily water-dependent such as agriculture, fishing, power, industry and health. 

In conclusion, tackling increasing global water stress calls for action to be taken across the value chain to encourage good water stewardship in the sourcing, storage and handling of the resource and to help people gain access to and enjoy the benefits of clean water, toilets and hygiene.

In doing so, people will be contributing to the United Nations Sustainable Development Goal framework which brings together, for the first time, the economic, social and environmental aspects of the water cycle under one overarching ambition of sustainable water and sanitation access for all (SDG6).