Public Health, Water and Sanitation

Despite massive outlay for the improvement of both sanitation and clean water in the world, access to clean water has remained to be a bigger challenge in the rural and urban areas of the developing countries. The main drivers of public health are water and sanitation. Public health is the advancement and protection of health on a worldwide and local scale. Everywhere throughout the world, public health entities significantly focus on keeping the world healthy, however, their mission is not accomplished because of some illnesses, social, behavioural and environmental factors. Across the globe, health variations have been hard to control and have transformed into serious epidemics throughout the year. The Center for Disease Control characterizes public health as the science of safeguarding and refining families’ health and community through health promotion; research and illness control and additionally prevent injury¹. It is along these lines that public health is dependably proven and some level of prediction is seen in specific cases.

There exist a relationship between access to clean water, sanitation and health. Over time, poor hygiene, lack of sanitation as well as inadequate access to quantity and quality clean water have caused million’s of the poorest individual to die from preventable diseases each year. The main victims involved in this menace are women and children. There are numerous ways that water, sanitation, and health are connected. Inadequate water and sanitation represent a major percentage of the disease burden and death in most developing nations.

There are three adverse health outcomes that result from poor access to water and access as well as sanitation. Diarrhoea, paratyphoid fever and typhoid fever are the health risks associated with poor sanitation. This paper discusses improvement of access to both clean sanitation and water. It also seeks to reveal that how improved clean water as well as sanitation access work enhances people’s health when they are considered as drivers of change by health professionals and the community as a whole. The paper further discusses strategies to enhance the effect of sanitation by outlining the public health roles.

Adequate sanitation is fundamental for individuals as well as population health. However, unsafe sanitation is defined by the country’s population percentage that is exposed to health risks which emanate from sanitation and water, characterized by the use of toilets in various households. Concerning sanitation, Menstrual Hygiene Management (MHM) is also an important issue to be discussed. Poor MHM has affected the health and education of most girls in developing countries. For instance, it is approximated that menstrual cleanliness causes around 70 per cent of reproductive infections in India². It further jeopardizes the chances of girls to acquire education. Sanitation and clean water are vital in the management of menstrual in a hygienic way.

 Improvement in sanitation facilities has shown a significant a decrease in water-borne diseases such as typhoid and diarrhea. In this case, an improved sanitation source must meet some particular requirements of hygienically separating human excreta from human contact. As much as the MDGs for clean water were achieved on a worldwide scale in 2010, almost 663 million people in the world still have no access to improved drinking water sources³.

Clean Water and Sanitation

Then again, access to clean water is estimated by the percentage of the population of the country that is exposed to health dangers that emanate from the access of clean water.  It is characterized by water source utilized by households as well as treatment at the point of collection. As much as there is deficient national information on clean water in numerous countries, clean water is the best accessible intermediary that is used for checking improved access to clean water. Although the MDGs have planned to decrease the percentage of individuals without access to sustainable water and sanitation, sanitation target have fallen below the mark by half as at 2015^{3, 4}.Improvement of access to clean water is one of the achievements of MDGs which have improved health among people. However, by 2012, 90 percent of the population was able to use improved drinking water sources as compared to 76 percent in early 1990s.

Improvement of access to safe drinking water and sanitation is useful for human growth, economy as well as the environment. It is estimated that over 2 billion individuals have limited or no access to sanitation, clean water and hygiene and out of this number 81 per cent of these people, are from rural areas. While 99 per cent of individuals that reside in developed nations can easily access water as well as sanitation, only 53 per cent of such individuals have access to such facilities in developing countries.  This has concealed regional inequalities. The systems have failed at addressing the monitoring progress and creating links with the relevant agencies and poor spending. Over the past years, water supply and sanitation provision have rarely kept pace with the rising populations and most of the services have been outpaced by population growth^{3, 4, and 15}. The poor quality of water and insufficient sanitation has numerous impacts on all life aspects.

In Sub-Saharan Africa, the increase in population and poverty are the most significant factors behind deteriorating water status⁵. The extensive poverty has been a limiting factor in the effort to provide safe and sufficient water and decent sanitation services.  Around the world, insufficient clean water access as well as poor sanitation sources has influenced reasonable development efforts. The slow progress of water and sanitation has been experienced because of subsidizing sewage as well as water supply to increase access.

Reducing health risks that emanate from poor sanitation and unsafe water is a crucial step in examining the ability of the country to maintain clean and safe water systems. This minimizes human contact with dangerous viruses and bacteria that are found in contaminated water.  Notably, contaminated water as well as sanitation is linked with the growth of sicknesses such as diarrhea, typhoid, and cholera. It is crucial for people to access clean water and sanitation to do away with preventable illnesses across the globe. Therefore, action is required to avail both water and sanitation in the world.

Over the past years, there have been substantial international efforts that seek to address poor sanitation, unsafe water and several issues that stem from it. With regard to health, poor sanitation as well as inadequate access to clean water is linked to many diseases. The diseases that are linked to poor sanitation and access to clean water particularly correlate with poverty and infancy. In Africa, Latin America and Asia almost half of the population is associated with the disease that originates from poor hygiene, water and sanitation.

Current Situation

Diarrhoeal diseases are the vital indicator of water and sanitation. Diarrhea is also the main cause children death across Sub-Saharan Africa.  Most researchers suggest that improvement of access to clean water as well as sanitation can minimize the rate of diarrhoea disease ranging between 32 per cent and 37 per cent^{3, 4}. It is estimated that around 2.2 million deaths from 4 billion diarrhoea cases occur every year. From this number, 1.7 million are children under the age of five and 15 per cent of the under 5 deaths is experienced in the developing world. It is worth noting that diarrhoea accounts for 4.3 percent of the global burden and 88 per cent of this burden are caused by contaminated water, hygiene and poverty⁴. Eradicating the risks that are associated with contaminated water as well as inadequate sanitation can aid children to have better health as well as improved school attendance^{6, 14}.

Additionally, insufficient sanitation and poor access to quality water limit economic development in many countries. For instance, the illnesses that emanate from unsafe water increases the costs of healthcare⁷.Therefore, achieving high levels of clean water will reduce health costs globally. According to Hutton and Varughese^{8, 19}, accomplishing widespread water and sanitation provision will only cost 28.4 billion dollars annually that will be incurred in global capital costs. Previously, most nations have cumulatively increased their water and sanitation budgets by considerable amounts although most of the countries find their budget to be inadequate to meet their national targets.

Evidently, adequate clean water is essential for the health of the ecosystem. Water pollution increases toxicity, eutrophication, as well as sanitization, which are dire environmental consequences that pose danger to the natural ecosystems. The introduction of a number of harmful substances in water by human being disrupts aquatic environments^{5, 20}. The large amounts of nutrients cause eutrophication which leads to oxygen depletion and minimizes ecosystem services.

Benefits associated with the access to clean water as well as sanitation on global health have been profound. However, it is difficult to overstate the benefits. In developing nations, most individuals prioritize access to clean water and sanitation as the most effective way of improving their lives. Besides, decent sanitation and hygiene are some of the ways that can minimize poverty. Access to clean and sanitation saves lives, improves economic growth, keeps children in school and broadens the opportunities women and girls. Firstly, both clean water and sanitation access save lives of individuals who die yearly from diseases that are directly associated with inadequate sanitation, poor hygiene practices and contaminated water. In addition to its impacts on health, a considerable access to clean water as well as sanitation could result in both economic as well as social benefits.  The householders do understand the benefits of sanitation as compared to scientists who have started to study people’s motivations for improving sanitation recently.

Concerning social benefits, householders scarcely adopt toilets use for health-related reasons but the main motivating factors to sanitation include privacy desire, desire to be modern and avoiding dangers of the bush²². Household sanitation provision minimizes the risk of attack that can occur when heading to the bush to defecate or public latrines. Furthermore, girls will be less likely to miss school when school sanitation facilities are provided during menstruation^{9, 13}.

Impacts of Improvement of Access to Clean Water and Sanitation on Health

  The economic benefits that come with sanitation and water include reduced costs in the health system, few days lost at school and work that result from the illness or care of sick relatives. The prevention of water-related as well as sanitation diseases can save a lot of money in the health sector and death can also be averted. According to the Disease Control Priorities Project by Cairncross and Valdmanis^{10, 21}, hygienic promotion is the best health intervention that can prevent diarrhoea followed by sanitation promotion.

In collaboration with other sectors, the public health sector can perform numerous things to ensure that investments in sanitation and water supply result in a significant health impact. To start with, public health promotion, as well as education strategies, is required to change people’s behavior so that they can easily realize improved water supplies benefits. Hill et al argue that programs that encourage hand washing behaviour are attainable and economical especially when they include traditional cleanliness practices and convictions^{11, 23}.

 However, there is minimal experience with the interventions that concentrate on faeces disposal behaviour change and in most cases, results appear to be mixed. Recently, new and better approaches to change the behaviour of people have been developed and have presented excellent results. Some of the behaviour change has been conducted through persuading the private sector to pass health information by publicizing soap and its appropriate use to avert diarrhoea. Besides, the public health can also introduce health programs in schools that offer an entry point for improved sanitation, water supply facilities as well as promoting community hygiene¹⁶. By introducing such programs, schools will reinforce health and hygienic messages hence transformed into action. To ensure that monitoring is carried out, the public health sector should work with responsible agencies to facilitate water quality and sanitation monitoring. Water, hygiene and sanitation interventions ought to be advocated so that they can be included in poverty reduction plans and strategies.

It is well known that the general public, as well as politicians, listen to doctors and this can enable health professionals to speak out essential health issues such as sanitation and water quality^{17, 21}. However, this has not happened in history. Although the health community has put a greater amount of human and financial resources on low health interventions, it is unfortunate that they have not realized that hygienic and sanitation promotions are among the best available interventions in developed countries. In addition to working with various agencies in monitoring the quality of water, the health professionals ought to apply surveillance skills to form clear links between water and sanitation planning.

There are numerous challenges that are associated with access to decent sanitation and safe water. The need of evaluation of the demand of water and sanitation services is one of the challenges that hinder access to water and sanitation. Individuals need to be made aware of the demand of water and sanitation services. Putting this challenge into consideration will spur the demand of consumers and as well provide effective market-based approaches.

Another challenge that hinders improved access to clean water and sanitation is accountability. Water and sanitation project should be monitored and evaluated from inception, implementation and follow up. For success in water and sanitation projects, there is need to reflect both the actual use and promote accountability to maintain the services in operation. The monitoring and evaluation results should be taken to the decision makers so that they can make appropriate decision on water and sanitation.

There is insufficient research to identify approaches that are sustainable environmentally, technically and financially. Technical sustainability involves breakage of pumps and equipments without repair. The problem often occurs on the scale of service from a pump at a wastewater treatment plant or borehole. On the other hand, financial sustainability results when the local capacity is not able recover water and sanitation system costs of operation and maintenance without depending on donors. It is of significance for these services to be valued because they protect the scarce natural resources. Environmental sustainability in this case involves putting into consideration the available water resource and how it can be developed for industrial, agricultural and drinking. In most developing countries, most cities and town have sewerage system but lack sewerage treatment plants which may affect the aquatic environment when the wastewater is directly discharged into water. Human capacity should be built in most countries to provide labour in construction, managing, operating and maintaining water and sanitation systems.

It is unfortunate that water quality and sanitation topics are complex in relations to health, economic and social development. It has affected many people but few of them champion for it. Political leadership is one major strategy that could achieve success in clean water and sanitation. This is because the position is manifested by the formation of clear institutional responsibility as well as the budget that is in line with access to clean water and sanitation¹⁸. The political leadership ensures that the public sector working in water resources, utility services and health, work together in harmony.

Secondly, the health sector should be fully involved in sanitation and water quality. In most cases, the health sector has a great inspiration for enhancing access to sanitation and clean water. This was evident in the 1978 Declaration of Alma Ata which focused on the primary health care importance¹². Sufficient provision of sanitation and safe water was one of the main elements that were noted. Since the declaration, many years have passed but sanitation has increased greatly. It is of paramount importance that the health sector reasserts its commitment and leadership to aid everybody prospers in a world that has access to clean water and adequate sanitation.

Finally, the services of sanitation and water provision should shift from centralised supply into decentralized supply²⁴. Adopting this kind of strategy will change water supply and sanitation from a minor service provider to a noteworthy area of economic activity that will address accessibility since it allows individuals to introduce whatever sanitation and water systems they can afford.

Conclusion:

Improvement of access to clean water is significant in eradicating preventable diseases. Improving access to clean water as well as decent sanitation has numerous recommendable benefits. To begin with, sanitation and access to clean water save lives from diseases that are associated with contaminated water. Secondly, it minimizes costs that are incurred as a result of health care and days lost at work and school. There is an urgent need to foster sanitation and water access services in the world. Specifically, improvements of access to safe water as well as sufficient sanitation services should be made in numerous places. Also, countries ought to remain committed to provide sustainable sanitation and clean water. Besides, effective policies should be established and implemented to reflect sustainable investment in clean drinking water and sanitation services. On the other hand, regional disparity issue in the access of water and sanitation should be addressed to reduce the gap that exists between developed as well as developing countries.

In promoting sanitation and clean water practices, the public health sector should plan as well as involve community members in the planning process. The public health sector should maximize the impact of sanitation promotion and education through participatory techniques. The public sector should also incorporate various programs that can change hygienic practices in health, water and sanitation projects. To achieve the health benefits, sanitation and hygienic components should be included. The health sector should not only provide water pipes and latrines but also provide community training on the sustenance of these services. More so, strategies should be put in place to achieve clean water and sanitation. One of the strategies that need to be involved is political leadership. Political leadership will ensure that the public sector working in water resources work together. Water supply should also shift from a centralized system to a decentralized system to ease accessibility.

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