I can't take credit for this provocative, catchy title - it is the that of a paper in the New England Journal of Medicine by Michele Barry and James M. Hughes.
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Here is their first paragraph:
In the wake of Cyclone Nargis, which devastated the Myanmar delta in early May, and the seismic earthquake that shook China shortly thereafter, access to safe drinking water and proper sanitation have become top priorities among those attempting to prevent epidemic diseases. But even without catastrophic disasters, the lack of access to clean water and basic sanitation represents a silent crisis affecting more than a third of the world's population. Some 443 million school days are lost annually to water-related illness, millions of women and girls spend up to 2 hours a day collecting water, and every day in Bangladesh alone 28 million to 35 million people consume drinking water containing dangerously elevated levels of arsenic. Given that the United Nations has declared 2008 the International Year of Sanitation — and that in the United States this year marks the 100th anniversary of the first chlorination of a public water supply — this seems an appropriate time to reengage in an ancient conversation about safe water and sanitation.
The Barry and Hughes article was brought to my attention by John Sauer's piece in The Huffington Post, in which he decries the lack of attention paid to diseases caused by poor sanitation. He compares the inattention to that "given" to HIV/AIDS in the "early days":
Another pandemic -- namely more than two dozen diseases associated with poor sanitation -- now faces the same kind of unresponsiveness. Every 20 seconds, a child dies of sanitation-related diseases, which kill five times as many children as HIV/AIDS. As an article in the New England Journal of Medicine documents, pathogens that cause diarrheal diseases, tracoma, and guinea-worm are among the culprits. You didn't think you can die of diarrhea did you? Well you probably can't but those living where open defecation is the norm can. Human excrement: it is the last taboo.
The last taboo. Recall that World Toilet Day was last week. Sauer's comments:
One US government official refused to release a statement on World Toilet Day because of objection to the word "toilet." Progress towards the Millennium Development Goal (MDG) target of halving the proportion of people without basic sanitation by 2015 will not be met, at current rates, until 2115. In fact, the original version of the MDGs didn't have a sanitation target.
Sauer and others have pointed out that sanitation needs a "rock star". But who's going to be the face of diarrhea or other waterborne diseases? Talk about a career-killer, or being the butt of late-night jokes.
Barry and Hughes' last paragraph is most telling:
Global health issues have captured the attention of governments, global funds, and foundations. Yet most of this attention and the consequent investment have focused on diseases such as malaria, tuberculosis, and AIDS, which kill a fraction of the number of people who die from water-related diseases. The necessary political will has not been mustered to address the water and sanitation crisis, among the most neglected of the United Nations' millennium development goals. A recent cost–benefit analysis reported by the World Health Organization makes a strong case for investment in this sector, and, at its Tokyo summit meeting in July, the Group of Eight reaffirmed its commitment to addressing concerns about water.5 Political support is urgently needed at all levels for the development and implementation of evidence-based recommendations to improve access to safe water, for the enhanced surveillance of water-related diseases, for the financial support of relevant epidemiologic and laboratory research, and for the development of accessible educational materials. Clearly, we need to start talking dirty water.
We need to start acting on sanitation and clean water. Problem is, they are not "sexy", like finding a new vaccine or drug. Nor are they profitable for the drug companies. Clean water and sanitation are not rocket science, folks, and they are not especially expensive. The political will is lacking, that's all.
"Despite 150 years of acceptance of the healthful effects of clean water, an estimated 1.1 billion people still lack access to it, and 2.6 billion people lack access to adequate sanitation. " -- Michele Barry and James. M. Hughes
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