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Water, Sanitation and Health: the Millennium Development Goals and Reducing the Global Burden of Disease. Jamie Bartram With adaptations by Mark Sobsey, UNC-Chapel Hill. Overview. Water, poverty and prosperity Water: a health concern? Disability adjusted life years (DALYs)

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jamie bartram with adaptations by mark sobsey unc chapel hill

Water, Sanitation and Health: the Millennium Development Goalsand Reducing the Global Burden of Disease

Jamie Bartram

With adaptations by

Mark Sobsey, UNC-Chapel Hill

overview
Overview
  • Water, poverty and prosperity
  • Water: a health concern?
    • Disability adjusted life years (DALYs)
  • Who and where are the disadvantaged?
  • Perspectives / trends
  • Why invest in water and sanitation?
wsh disease and poverty
WSH = disease and poverty ?
  • Inadequate water supply
  • Unsafe water resources
  • Inequitable access
  • Time, financial cost
  • Disease burden
  • Health care costs

POVERTY

wsh a motor for development
WSH = a motor for development
  • Improved water supply
  • Safe water resources
  • Universal access
  • Time, financial savings
  • Averted disease costs
  • Healthy populations

Development

non fatal health effects
Non-fatal health effects
  • Mortality numbers can dominate conversations about health
  • Also concerned about non-fatal health conditions
  • A metric was needed to quantify non-fatal health outcomes, make informed policy decisions and allocate health resources
  • WHO introduced Disability Adjusted Life Years (DALYs) in 1994
  • Used to assess risks and benefits associated with various diseases, threats to health and interventions
disability adjusted life years
Disability Adjusted Life Years
  • DALY = YLL + YLD
    • YLL – years of life lost due to early death
    • YLD – years of life lost to disability
  • YLL = N x L
    • N = number of deaths
    • L = standard life expectancy at age of death in years
  • YLD = I x DW x L
    • I = number of incident cases
    • DW = disability weight
    • L = average duration of the case until remission or death (years)
how much disease could be prevented by modifying the environment
How much disease could be prevented by modifying the environment?

Prüss-Ustün and Corvalán (2007)How Much Disease Burden can be Prevented by Environmental Interventions?, Epidemiology, 18:1, p. 167-178.

.

diarrhoeal disease reduction from drinking water and sanitation improvements
Diarrhoeal disease reduction from drinking water and sanitation improvements

Reduction (%)

Source: Fewtrell L et al. Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: a systematic review and meta-analysis.Lancet Infectious Diseases, 2005

Intervention

gbd selected water related diseases
GBD – Selected water-related diseases
  • Diarrhoea:1.8 million people, mostly children, die of diarrhoea every year Malaria:1 million people, mostly children, die of malaria every yearBetter management of water resources reduces transmission
  • Schistosomiasis:200 million are infected, 20 million suffer severe consequencesBasic sanitation reduces the diseases by up to 77%
  • Trachoma6 million visually impaired, 146 million threatened by blindnessImproved sanitary conditions and hygiene practices preventstrachoma
the more we know the more environment matters
The more we know, the more environment matters

In addition (2010?)

Water hardness and heart disease, hepatitis A and E, fluorosis, arsenicosis, typhoid fever etc.

2005

Also WSH-caused malnutrition

Total disease

5%

2002

WSH caused diarrhoea and parasitic diseases

?

4%

3%

slide18

Improved Drinking Water:

Status in 2002

Meeting the MDG Drinking Water and Sanitation Target: Mid-term Assessment of Progress

WHO and UNICEF, 2004

WHO/OMS

slide20

Improved Sanitation:

Status in 2002

WHO/OMS

Meeting the MDG Drinking Water and Sanitation Target: Mid-term Assessment of Progress

WHO and UNICEF, 2004

slide21

Improved Sanitation:

Unserved population by region, 2002 (millions)

Meeting the MDG Drinking Water and Sanitation Target: Mid-term Assessment of Progress WHO and UNICEF, 2004

slide22

Disparities Masked by National Averages:

Rural versus urban sanitation (2002)

Meeting the MDG Drinking Water and Sanitation Target: Mid-term Assessment of Progress WHO and UNICEF, 2004

slide24

Reaching the MD Goals from 2002:

What does it mean for Goal 7 Target 10?

To halve, between 1990 and 2015, the proportion of the population without improved drinking water and sanitation now means means:

Enabling an additional 260,000 people a day up to 2015 to use improved drinking water sources

Enabling an additional 370,000 people a day up to 2015 to use improved sanitation

Ensuring continuation of services to an unprecedented population and maintenance and renewal of infrastructure

slide25

Reaching the MD Goals from 2002:

Focusing G7 T10 on the wider goals

  • Reaching the target would:
  • Reduce disease and death
  • Improve nutrition and food security
  • Reduce poverty (avert health care costs, time savings)

Unserved, children and women likely to benefit most (health and education)

Studies show WS&S to be cost effective

slide26

Improved Drinking Water:

Trends in service levels

Un-served

Meeting the MDG Drinking Water and Sanitation Target: Mid-term Assessment of Progress WHO and UNICEF, 2004

Other 'improved drinking water source'

Piped water at home

slide27

Improved Sanitation:

Perspectives

Meeting the MDG Drinking Water and Sanitation Target: Mid-term Assessment of Progress WHO and UNICEF, 2004

slide28

Change 1990-2002

Global: 18%

Urban: 31%

Rural: 8%

Change 1990-2015

Global: 37%

Urban: 70%

Rural: 12%

slide29

Reaching the MD Goals from 2002:

Focusing G7 T10 on the wider goals

  • Reaching the target would:
  • Reduce disease and death
  • Improve nutrition and food security
  • Reduce poverty (avert health care costs, time savings)

Unserved, children and women likely to benefit most (health and education)

Studies show WS&S to be cost effective

1 billion urban dwellers to keep up with urban population growth – targetting slums

900 million rural dwellers to start to deal with the rural backlog

annual cost of not dealing with water and sanitation
Annual cost of not dealing with water and sanitation

Lives lost

  • 1.8 million annually due to diarrhoea alone

Health care costs:

  • USD7 billion per year to health agencies
  • USD340 million to individuals

Value of time lost

  • USD 63 billion per year
cost benefit analysis cba
Cost-benefit analysis (CBA)

The aim of the study was to estimate:

  • the costs (capital and recurrent)
  • the health benefits (diarrhoea cases and deaths)
  • the additional benefits (costs averted, time saved)
  • Results presented as US$ per year, per capita , per intervention.
  • Note that these methods are highly dependent upon assumptions and that there are numerous data gaps
interventions
Interventions

5 interventions were modelled:

  • Halving population w/o improved WS by 2015 (through low-tech services).
  • Halving population w/o improved WS&S by 2015 (through low-tech services) (MDG 7).
  • Increasing access to improved WS&S services (low-tech) for all by 2015.
  • Increasing access to improved WS&S services (low-tech) plus disinfection at point of use, for all by 2015.
  • Increasing access to in-house piped water and sewer connection for all by 2015.
slide37

Macro relevance?

  • High malaria versus low malaria countries: 1% difference in annual GDP growth
  • Cholera in Latin America in 1990’s
  • 3.7% average annual growth by poor countries with improved W&S (as opposed to 0.1% for those without)
further topic details at

Suggested Reading:

Pruss-Ustun, A. and C. Corvalan (2007) How much disease burden can be prevented by environmental interventions? Epidemiology. 18(1):167-78.

Further Topic Details at:

www.who.int/water_sanitation_health/