Blog 'Water, Health and Ecosystems: inextricably linked for a sustainable future'

Billions of people around the world still live in conditions that deprive them of safe drinking water and adequate sanitation facilities. The absence of both translates into the prevalence of disease. In addition, one in four health facilities lack basic water services, critical to people's recovery and a functional health system. 

Children looking for safe drinking water, East Nusa Tenggara, Indonesia

In January 2020, the World Health Organisation (WHO) released a ‘List of Most Urgent, Global Health Challenges’ for the decade ahead. Dr Tedros Adhanom Ghebreyesus, WHO Director-General, wrote: "We need to realize that health is an investment in the future. Countries invest heavily in protecting their people from terrorist attacks, but not against the attack of a virus, which could be far more deadly and far more damaging economically and socially. A pandemic could bring economies and nations to their knees."

These words sounded ominous in January, yet they were the planet’s reality just a few weeks later with the spread of the COVID-19 virus. We were warned this could happen. Scientists, historians, security advisors, epidemiologists and many others have raised the alarm bell of a global pandemic for decades (We Were Warned, The Atlantic). In 2015, Bill Gates foretold an outbreak of the coronavirus as we are living it today: ‘The next outbreak: We’re Not Ready’.

There are many similarities with the warning signals raised on the impacts of climate change. A global body of scientists and intellectuals warning of a severe threat, yet answered by a slow response and general sense of apathy, inaction or worse, denial. The major difference is that the impacts of climate change are nuanced whereas the impact of a pandemic is instant. Whilst it may be too late to reverse the spread of COVID-19, it is not too late to reverse the trajectory of the climate crisis. The next ten years are crucial and actions now will define our common future.

COVID-19 is primarily a health crisis and there are many lessons to draw as to how we respond to these rapid onset crises. Climate change will impact the spread of diseases that peak in the warmer months. In the heat wave of summer 2003 in Europe for example, more than 70 000 excess deaths were recorded. A number of diseases well known to be climate-sensitive, such as malaria, dengue fever, West Nile virus, cholera and Lyme disease, are expected to worsen as climate change results in higher temperatures and more extreme weather events (WHO). In addition, we do not know yet what the melting of permafrost and other impacts of temperature rise and changes in rainfall will have on the release and spread of pathogens. 

Water is an economic and social good everyone needs for survival - fundamental to human health and well-being.  Without good quality water, our health systems fail. Without reliable water availability our food security fades, and our energy and industrial production struggles.  An estimated 896 million people globally still have no water services and 1.5 billion no sanitation services (WHO/UNICEF).

Could a broader perspective help to better understand how delivery of sustainable water and sanitation help to protect the ecosystems that provide the water, absorb pollution, and future-proof the health of our societies?

Going back to the WHO List of Most Urgent, Global Health Challenges, water features amongst the most urgent challenges, along with harnessing new technologies and investing in medical staff. Similarly, water is repeatedly ranked as one of the biggest risks to business and economic development according to the World Economic Forum.  A significant amount of diseases could be prevented through access to safe water supply, adequate sanitation services and better hygiene practices. The WHO report ‘Safer Water, Better Health’ estimates that in developing countries an investment of US$1 in improved water supply, quality and access to sanitation leads to a return of US$5–6. That is a five to six-fold return on investment[1].

As often when we seek understanding, we look back at history. A quick such review (IWA ‘Environmental History of Water’) will teach us that for early civilisations to thrive, access to healthy river basins and consequently, investment in good water and sanitation facilities, were key for survival and prosperity. In New York, investment upstream in the Catskills watershed has saved more than $10 billion dollars through investing in water source protection, and not in wastewater treatment, recycling and additional infrastructure costs that would ultimately have been passed on to the consumer. This has also improved the overall state of the watershed, including water and soil quality. 

A vital link between a healthy supply of safe drinking water accessible to people is the broader river basin system. For all the investments in water supply, sanitation and hygiene services, if maintenance and environmental sustainability aren’t factored in, then you get failing systems.

According to UNICEF data, four countries in sub-Saharan African have an average sustainability rate for water points of only 6% after ten years (Tincani et al, 2015). This means that for any new water points developed in these countries this year, on average only 6% will be working by 2030, the year the world assesses the success of the Sustainable Development Goals. Clearly funding and campaigns are important, but more so is the connecting of interventions, socially, economically, and environmentally, with sustainability as the primary goal. As international agencies, governments, and donors look to supplement interventions with investment from private finance, sustainability has to be a primary focus if investors and companies are going to be convinced to support SDG6 and see corporate water stewardship improved. 

The current COVID-19 pandemic is exposing challenges which go well beyond the health care system, including food supply chains and international cooperation. It starkly brings to mind that if we do not look at the broader picture of any system, we will be unlikely to deliver on a post-2020 policy agenda and fine-tune our actions to truly achieve the targets set under the SDGs.

WASH - the collective term for Water, Sanitation and Hygiene - is regularly distanced from water resource management, water source protection, and pollution control. Yet a strong, resilient WASH system needs to include not just the policies, processes, infrastructure, resourcing, behaviour and leadership, it needs to better integrate with water management agencies – those who protect and manage the sources they need, including groundwater. Equally, pollution downstream of sanitation interventions needs to be factored in all WASH interventions. 

The context of water resources needs to be better understood, as well as the very practical elements such as can soap be consistently provided, do local health centres have adequate facilities – and soap? As the COVID-19 pandemic is causing grief, loss and hardship at levels not seen in recent decades, some solace can be found in the social resilience and innovation that is taking place.

Looking ahead, let us consider the fragile state of water, sanitation and hygiene delivery globally, and the number of people consistently ill and losing their lives to waterborne diseases due to polluted water, daily. How countries respond and improve WASH for marginalised people in rural areas, slums and peri-urban environments, unable to self-isolate or receive support during economic downturns, will be an indicator as to how lessons were learned and how committed we really are to all the indicators under SDG6.

Now is the time to lean-in on sustainable water management, for people, and for nature. Companies able to weather the financial storm during the lockdown period are those able to adapt, diversify, innovate, and reflect.  A large part of that is culture – institutionally ensuring resilience is a part of the ‘thinking’ internally, developing new foundations for working and delivering differently.  Economic stimulus packages that can drive resilience, and focus on low carbon approaches as we better understand that climate change is not just a physical risk, but a human health and economic risk of a scale we do not fully grasp yet.


Blog by the IUCN Water Programme team in HQ.

For the IUCN statement on the COVID-19 pandemic, please click here

[1] The cost-effectiveness of each intervention was assessed in terms of US dollars per disability adjusted life year (DALY) averted. The disability-adjusted life year (DALY) is a measure of overall disease burden, expressed as the number of years lost due to ill-health, disability or early death. It was developed in the 1990s as a way of comparing the overall health and life expectancy of different countries.



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