This month I am thrilled to be travelling to Africa with our School’s benefactors Dana and David Dornsife. As part of a trip coordinated by World Vision, we will be visiting Burundi, Kenya, and Tanzania and learning about various community-based projects aimed at increasing access to safe water and sanitation throughout the region. Our School has been deeply engaged in many of these projects through the many students who have visited and worked in these countries as Dornsife Global Development Scholars. We are also actively involved in training the local water, sanitation, and hygiene (WASH) workforce through our Global Health Certificate program.

More than 40 years ago, the World Health Organization (WHO) formally recognized access to water as a fundamental human right, noting that “All people, whatever their stage of development and social and economic condition, have the right to have access to drinking water in quantities and of a quality equal to their basic needs.” (Declaration of Mar del Plata, 1977). Yet despite all our advances, the United Nations (UN) estimates that 3 in 10 people worldwide, or 2.1 billion, lack access to safe, readily available water, and 6 in 10, or 4.5 billion, lack safely managed sanitation. Of the 2.1 billion people who do not have safely managed water, 844 million do not have even a basic drinking water service. Of the 4.5 billion people who do not have safely managed sanitation, 2.3 billion still do not have basic sanitation services.

There are so many ways in which access to water affects our lives, some obvious and some more subtle, but all fundamental to quality of life. It is easy to forget how reliant we are on water when all we have to do is turn on the faucet to obtain plentiful, clean water that is free of contaminants and safe to drink.

Water is obviously critical to life and lack of access to clean water and sanitation is a major driver of infectious diseases, associated child malnutrition, and child mortality in many countries. Water quality influences health through water-borne diseases (such as cholera) and water-washed diseases (such as trachoma linked to lack of water). High levels of lead and arsenic in water may also contribute to disability and poor health.

But there are many other ways in which access to water shapes our opportunities and our health. The time spent obtaining clean water in communities without access to running water is a major economic factor and especially affects women who are often responsible for obtaining water for their families.  For example, the UN estimates that 263 million people spend more than 30 minutes per trip collecting water from sources outside the home. Access to sanitation has also been shown to be a major factor influencing whether young girls stay in school after puberty.

Although lack of access to water and sanitation is a much larger problem in rural than in urban areas, ensuring environmentally sustainable access to water is a major challenge in growing cities all over the world. Many urban areas lack the infrastructure needed to provide clean water and adequate sanitation. An estimated 700 million city residents live without improved sanitation and 156 million live without improved water sources. Yet, cities offer many opportunities for the development of integrated, sustainable, and equitable water systems.

Just a few weeks ago, as a result of a prolonged drought, combined with other factors, Cape Town, South Africa, was on the verge of becoming the first major city to run out of water.  Thanks to a dramatic and rapid reduction in water consumption by about half, “Day Zero” (the day in which the city is estimated to run out of water) was pushed to 2019.

Water availability and use has implications for the economy and the environment, as well as health. According to the UN, 90 percent of all natural disasters are water-related and 80 percent of wastewater flows back into the ecosystem without being treated or reused. There are many competing pressures on the use of water: agriculture accounts for 70 percent of global water withdrawal, and roughly 75 percent of all industrial water withdrawals are used to produce energy. Addressing water access, use, and reuse in the context of broader environmental and sustainability issues is therefore a major challenge.

Preparing for my trip to Africa brought back memories of other trips. Many years ago, as a medical student, I spent a summer in remote rural areas of southern Argentina working with local residents, many of them descendants of Mapuches, the original inhabitants of the area. Among other health education activities, we tried to promote better access to water and sanitation. I say we tried because in all honesty we did not do much. We learned much more from our hosts than they learned from us, but that was the one time I lived for a few weeks without easy access to water. Of course our experience was trivial compared to what these families experienced throughout their lives. As soon as we returned to our homes we went quickly back to taking showers, using a flushing toilet, and drinking all the water we wanted straight out of the tap.

As I travel this month to Burundi, Tanzania, and Kenya, I am sure I will see many differences, but also issues that are similar to those in the rural villages I worked in so many years ago. It is within these similarities, these common problems, but also common strengths, that we need to find opportunities to create change, whether it be improving access to water and sanitation, or the other social conditions necessary to ensure health and fulfilling lives for all.

Ana V. Diez Roux, MD, PhD, MPH
Dean and Distinguished Professor, Epidemiology, Dornsife School of Public Health