The Lancet
The UN recognizes access to water and sanitation as a human right, describing it as fundamental to the health, dignity and prosperity of all, but global water mismanagement endangers the planet and , consequently, all of us (1).
Water is essential for our existence. However, mismanagement and neglect of water resources have led to a dangerous situation, with access to clean water and sanitation inaccessible to many people. The world is a long way from achieving Sustainable Development Goal (SDG) 6 by 2030: ensure the availability and sustainable management of water and sanitation for all. In 2015, 70% of people had access to safely managed drinking water; by 2020 this had progressed to only 74%. Over the same period, people accessing safely managed restrooms increased from just 47% to 54%. The United Nations says efforts to provide water, sanitation and hygiene (water, sanitation and hygiene = WASH) would have to quadruple to meet the 2030 goals, a prospect that is likely to become increasingly difficult due to climate change. World Water Day, March 22, marks the first United Nations conference on fresh water in nearly 50 years and will serve as a mid-term review of the Decade of Action for Water (Water Action Decade), which runs from 2018 to 2028 and aims at the sustainable development of water resources. Failure to secure water for all would cause widespread harm across the SDGs and to human health in general. The stakes couldn’t be higher.
Access to water is already an emergency in many areas. A quarter of the world‘s population faces extremely high levels of water stress, where industry and agriculture use more than 80% of the available supply per year. Water scarcity is a matter of equity. It affects those with the lowest incomes, not only in low-income countries, but also those with the lowest incomes in high-income countries. A commentary in The Lancet highlights that access to safe water is gendered, with the burden of procuring and sustaining safe water falling primarily on women. The disease burden associated with WASH is significant and hampers economic development. Progress on nutrition, poverty, education and conflict is impossible without proper water management. The hygiene required for good infection control, including good pandemic prevention, relies on the availability of clean water and access to sanitation. A recent WHO report highlights that one billion people without access to adequate sanitation are at risk of a surge in cholera cases due to climate change.
The planetary dimension of access to water and sanitation has been underestimated by the global health community. The water we rely on for drinking, washing and cleaning is part of the global interconnected and interdependent water cycle. Human activities are damaging and stressing the whole system. Anthropogenic global warming alters evaporation and precipitation. Humans are causing ocean acidification, sea level rise, devastation of marine biodiversity and extreme weather events, such as floods and droughts. Safeguarding water for health requires attention in all of these areas, but the governance global water management is uncoordinated and often ineffective, ignores conservation standards and favors trade policies rather than addressing water scarcity. The Treaty on the High Seas (High Seas Treaty) recently signed, which establishes a framework that would cover 30% of international waters protected for conservation, is an extremely positive step. Transformation in water governance is the central call in a vital new report from the Global Commission on the Economy of Water (Global Commission on the Economics of Water). Named Turning the Tide (Reversing Course), the report calls for recognition of water as a global collective good and calls for it to be protected as such, with stabilization of the water cycle, investment in access to water in low- and middle-income countries and the end of underestimating the value of water. He also points out how $700 billion in subsidies to industry are actively damaging progress towards WASH delivery and proposes that these subsidies instead be used to promote water conservation and universal access to clean water. The forthcoming Lancet WASH Commission aims to deliver a shift in WASH interventions, to emphasize state accountability over the individual, and to address an international architecture of WASH policies hitherto shaped by colonial legacies.
The UN recognizes access to water and sanitation as a human right, describing it as fundamental to health, dignity and prosperity for all, but global water mismanagement endangers the planet and, consequently, all of us. This World Water Day must mark a turning point. It must spur action on water cycle protection, better targeted and smarter funding for WASH delivery, and closing gaps and inefficiencies in governance of clean water. Above all, it must lead to a wider awareness that achieving sustainable access for all cannot succeed without addressing the deeply intertwined nature of water’s health, economics, environmental and ecological aspects.
Editorial, Water and health: think bigger, Lancet: 2023; 401: 971. Published: March 22, 2023. The translation is ours as well as the subtitles and bolds.