- by Baroness Kinnock of Holyhead
This article was originally published in the December 2013 issue of Public Health Today, FPH’s members’ magazine. It is reproduced here to mark World Water Day tomorrow, 22 March 2014.
When, in 2007, readers of the British Medical Journal were polled to discover what they believed to be the greatest medical advance since 1840, many people were surprised that they chose ‘sanitation’.
They shouldn’t have been. History emphatically demonstrates that clean water, functioning sewers and public hygiene are basic to health and wellbeing. That truth is plain – but may be so simple that it invites complacency.
In 1854, when Dr John Snow recognised the connection between a communal hand pump on Broad Street in Soho and a raging cholera epidemic, he isolated the pump, saved countless lives, helped to found the new science of epidemiology and swept aside the previous conventions that attributed cholera and several other diseases to ‘foul air’. The implications of this breakthrough seized the whole of society. The rich and powerful were almost as grievously affected by filth-generated disease as slum dwellers.
In addition, the economic benefits of protecting the workforce against a mass killer like cholera were evident even to those usually reluctant to support improvements in living conditions. Public investment in sewers, water filtration and chlorination became prodigious and rapid. Victorian civic modernisers, engineers and entrepreneurs laid a sewerage system through most of urbanised Britain, much of which is still in use today.
Progress on a proportionately huge scale and at rapid pace is needed now in large parts of the world. For at least 2.6 billion people in the ‘developing’ world lack of sanitation is the prime cause of ill-health and premature death, especially among under-fives.Great improvements have been secured since the 1980s when cholera killed an estimated three million people a year globally – but the annual mortality level is still around 100,000.
Incompetence or malice can have devastating effects. In Zimbabwe, Mugabe’s government took funds away from water treatment plants and refused replacement international aid until the cholera crisis became acute. In South Africa, privatisation of water programmes resulted in disease for the poor who couldn’t afford clean water, but not for the relatively prosperous who could.
The economic and social penalties of bad or non-existent sanitation are monstrous and the advantages of good sanitation huge. The World Bank has calculated that for every £1 spent on sanitation, £3 is returned in increased productivity. The association between cleanliness and Godliness is not proven. The link between hygiene and efficiency is.
However, the compelling evidence for the multiple benefits of good sanitation is still not enough to attract the high priority it deserves. Lack of money, pressure to pursue other objectives, packed and expanding cities, industrialisation and desperate water shortages all impede improvement. But these challenges must not be allowed to stall progress.
Let those who decide policies and funding make just one visit to a place where a two-year old girl is dying in agony and exhaustion from diarrhoea that could have been prevented if her district had access to clean water and a safe means of disposing of sewage. I have seen too much of such avoidable tragedy. It’s why I plead for more reporting, recognition and determination to cure this scourge by stopping its cause.