Running head: ACCESS TO CLEAN WATER: A GLOBAL ISSUE

Access to Clean Water: A Global issue

Kurt Fadden
Santa Fe College
Global Health
HSC4624
Nancy Wood
April 16, 2015
Access to Clean Water: A Global issue
Global health is defined as the health of populations in a global context, and places a
priority on improving the health for everyone worldwide. Keeping this in mind, there are number
of pressing global health issues that exist today. Among these many issues is access to clean
water and sanitary conditions, which remains a pressing global health issue even in the 20th
century. Due to the global implications of inaccessibility to clean water and sanitary conditions
there are a number of factors one must consider, such as why it is a issue globally and what are
its social determinants. As well as, what is being done to combat the issue, who is working to
combat the issue, and what are the ethical issues that may be involved in addressing the issue.

In today's global arena there are an endless amount of individual health issues driven by a
vast array of social determinants. These issues range from child mortality rates to the transfer of
communicable diseases such as HIV/AIDs. However, the issue of access to clean and sanitary
water conditions is a global health issues that touches every facet of societies health status and
stems from seemingly simplistic sources. One of the main issues facing the global community is
the provision of easy access to clean water, sanitation, and hygiene to all people. The failure to
provide safe drinking water and adequate sanitation services to all people is perhaps the greatest
development failure of the 20th century (Gleick, 2002, p. 1) . A wide range of water problems
faces nations and individuals around the world including disputes over water, water scarcity,
water contamination, and even the transfer of disease through unsanitary water (Gleick, 2002, p.
1) However, at the heart of the issue is the failure to provide the most basic of water services for
billions of people and the devastating human health problems that come along with that failure
(Gleick, 2002, p. 2).
It is estimated that if no action is taken to address unmet basic human needs for water, as
many as 135 million people will die from these diseases by 2020 (Gleick, 2002, p. 2).The lack of
access to safe drinking water and sanitary water conditions has led to considerable unnecessary
and preventable human suffering . In fact unsafe water, sanitation, and hygiene is an important
determinant in a number of diseases , such as malaria, yellow fever, filariasis, dengue, hepatitis A
and E, and typhoid fever (Pruss-Uston, Kay, Fewtrell, & Bartram, n.d., p. 1322). Some of these
present a very high disease burden at the global level (Pruss-Uston et al., n.d., p. 1333). Although
water related diseases have largely been eliminated in wealthier nations, they remain a major
concern in much of the developing world (Gleick, 2002, p. 3).There are a number of different
ways that diseases can affect global health outcomes. Water related diseases are typically placed

ACCESS TO CLEAN WATER: A GLOBAL ISSUE

in four classes: waterborne, water-washed, water-based, and water-related insect vectors. The
first three are heavily related to lack of improved domestic water supply which is depicted in
Table 1 below (Gleick, 2002, p. 3).
Table 1: Water-Related Diseases
Waterborne diseases: caused by the ingestion of water contaminated by
human or
animal faeces or urine containing pathogenic bacteria or viruses; include
cholera,
typhoid, amoebic and bacillary dysentery and other diarrheal diseases.
Water-washed diseases: caused by poor personal hygiene and skin or eye
contact with
contaminated water; include scabies, trachoma and flea, lice and tick-borne
diseases.
Water-based diseases: caused by parasites found in intermediate
organisms living in
contaminated water; include dracunculiasis, schistosomiasis, and other
helminths.
Water-related diseases: caused by insect vectors, especially mosquitoes,
that breed in
water; include dengue, filariasis, malaria, onchocerciasis, trypanosomiasis
and yellow fever.
By looking at Table 1 we are able to see that the first three classes of water
related diseases all have to some form of human contact with contaminated

ACCESS TO CLEAN WATER: A GLOBAL ISSUE

water. All of which result in health risks such as viruses, disease, or exposed
to parasitic organisms.
Unfortunately, direct disease transfer isn't the only global issue that comes with
inaccessibility to sanitary water. For example, hand washing practices of mothers and availability
of water and sanitary latrine can have a very unfavorable effect on under-five morbidity rates. In
a recent study in India by the Indian Journal of Medical Specialties it was found that under-five
children belonging to households having bore well water supply suffered less from diarrhoea,
skin infections, and any morbidity (Datta, 2010, p. 2). However, it was also found in the study
that only 58.9% of the households had a source of water in their house (Datta, 2010, p. 4). That
means that 41.1% of the households studied did not have access to clean water, resulting in
mothers being less likely to practice proper hygiene and passing on the health risks to their
children. Sadly this simple issue has a major effect of under-five morbidity rates. The less access
to clean water these mothers have the less likely they are willing or able to practice proper
sanitation after being around fecal matter or when preparing food for their children. In this case
something as simple as easy accessibility to a water source and hand soap could significantly
decrease childhood morbidity rates in developing countries. yet this issue has remained a hard
one to set straight in a global context. This is just one example of how a lack of access to water
can have detrimental effects on global health.
Knowing that access to clean water and sanitary conditions is a serious global heath issue
it is important to understand who is most at risk and why. The social determinants of health, or
the underlying social and economic conditions that shape people's health, provide a conceptual
framework useful for illuminating how historical, political, and socioeconomic factors can lead.
In order to understand who inaccessibility to clean water most affects we need to first make a

ACCESS TO CLEAN WATER: A GLOBAL ISSUE

clear correlation between hygiene practices and access to clean water. Although there have been
relatively few studies on the impact of hygiene promotion on actual health behaviors and
reductions in the burden of disease, the studies that have been done showed that investing in
hygiene promotion led to 35 percent decrease in diarrhea , with diarrhea remaining to be one of
the leading causes of childhood death in low income countries(Skolnik, 2012, p. 151). Based on
this it would seem that public promotion of hygiene would be a very cost effective way to
address the issue of water related diseases(Skolnik, 2012, p. 151). But in order to practice proper
hygiene and hand washing techniques it comes back to these families needing access to the water
in their home in the first place.
This is where we are able to see who is primarily affected by the issue of access to clean
water. The cost of hookups to clean and sanitary water in individual homes seems above the
cutoff of what public funds will support in most countries (Skolnik, 2012, p. 150). Creating
access to clean water so people can live under sanitary conditions would be very expensive to
implement globally. This is why the majority of people effected by inaccessibility to clean water
are from low and middle income countries where much of their water is contaminated or hard to
access. These same low and middle income people also live under the veil of governments that
either refuse to help or lack the means to help them. Furthermore these groups lack education,
sometimes even due to their inability to attend school due to poor health, and inherently become
part of a lower socioeconomic standing in society. People who have poor governments, low
socioeconomic status, and little education are not the only ones without access to clean water, but
they are by far the largest group affected.
Despite the ongoing issue of access to clean water and sanitary conditions there an array
of studies and intervention practices in place to try and combat the ongoing global health

ACCESS TO CLEAN WATER: A GLOBAL ISSUE

concerns associated with it. In developing communities there is still a daily struggle to consume
safe drinking water. The World Health Organization (WHO) estimates show progress towards the
reduction of those at risk from 1.1 billion people in 2006 to the current estimate of 768 million
people, showing a large problem still exists (Barstow, Dotson, & Linden, 2014, p. 663). One
such intervention that is working to address this issue is Ultraviolet (UV) point of use (POU)
disinfection systems that are primarily being installed in urban developing communities. The
implementation of UV POU disinfection systems have the ability to provide safe drinking water
to the millions who lack access to clean water in urban communities (Barstow et al., 2014, p.
663).
There are a number of "improved source" interventions including household connections,
public standpipes, protected springs, and rain water collection systems (Barstow et al., 2014, p.
664). However, these water sources being improved alone leaves no guarantee of safe drinking
water at the time of consumption (Barstow et al., 2014, p. 664). Many of these community-level
sources can be contaminated and be re contaminated after water collection (Barstow et al., 2014,
p. 665). This is where the UV POU system comes into play, essentially providing treatment of
the water directly prior to its consumption. This has been very effective in combating diarrhea
globally. There are a number of existing POU systems such as chlorination and ceramic
filtration, but most of these lead to environmental degradation. Over the past decade, several UV
disinfection systems have been developed, tested, and deployed in developing communities
yielding results that demonstrate feasibility of UV based technologies in a global context
(Barstow et al., 2014, p. 666). Even though the UV POU system has demonstrated effectiveness
and feasibility on a global scale it has its problems. The two main concerns with the system are
cost of production and implementation as well recontamination after collection. It still

ACCESS TO CLEAN WATER: A GLOBAL ISSUE

successfully sanitizes water at the time of collection opposed to other POU systems, having
reported most re contamination cases as resulting in improper storage, which is a post treatment
issue. As far as cost is concerned the UV reactors are not inexpensive and the technology is
complex, making production costly at this stage in its development.
Another example of an intervention globally to provide access to clean water is one that
was carried out by University of Virginia students in a community in the rural South Africa. The
students were there to implement a pre-designed slow sand filtration system in the community in
order to provide clean drinking water, and water in general, to most households in the
community (Hashfield, Jemec, Makhando, & Ramarumo, 2009, p. 1)Slow sand filtration systems
are used to treat and purify raw water into a potable water product. Slow sand filtration systems
are different than its counterparts such as UV sanitation in that it utilizes a complex biological
film that grows naturally on the surface of the sand, the sand itself does not provide the filtration.
Throughout the study the students surveyed 46 of the households and found that throughout the
community 83% of the heads of the households believed that their water was not safe to drink
(Hashfield et al., 2009, p. 4). The intervention essentially consisted of using existing piping
leading from the mountains to the community, purifying the water, and then storing it in a central
location for all of the community members (Hashfield et al., 2009, p. 5). Although the students
came across some ethical and logistical issues, they achieved their goal in the end. This is a great
example of one of the many University based efforts to provide clean water in a rural
community.
When interventions such as the two discussed in the above paragraphs take place there
are a number of ethical concerns that come along with them. In most of the developing rural and
urban communities that serious interventions are required to provide access to clean water there

ACCESS TO CLEAN WATER: A GLOBAL ISSUE

are cultural, political, and financial considerations that can lead to a number of ethical concerns.
A good example of multiple culturally driven ethical concerns come from the second
intervention we talked about in Africa. The article stated that because the project was going to
benefit the entire community, there was an understanding that volunteers would not be paid
(Hashfield et al., 2009, p. 10). However, the students and researchers provided lunch to the
volunteers everyday, which culturally they took as they could afford to pay them and were
choosing not to. Another ethical concern stemming from that project was that the neighboring
community tried to start a feud over the water, placing a concern that if we provide water to
some and not others in certain communities it could cause violence, and in a global sense it could
cause war between governments. Politically there is also an ethical concern as to whether the
public or private sector should take on the majority of the responsibility for providing access to
clean water. Some activists are concerned about the corporate agenda in water privatization .
While others are concerned about if governments are allocating enough efforts and resources on
providing clean water to their people. Furthermore, in almost all instances of clean water
intervention there is one major question, who does the financial responsibility fall on? This can
be a source of great tension and ethical prowess. These are just few examples of the many
ethical concerns that arise when providing trying to provide people access to clean and sanitary
water sources in a global context.
Gaining access to clean water remains a major health concern globally, that requires
creativity and careful consideration when addressing it worldwide. As a result there are many
organizations involved in trying to implement solutions and combat the issue. There are both
public and private sector institutions that work together in this effort. Many non-profit
organizations work in numerous locations globally to provide clean water to those who dont have

ACCESS TO CLEAN WATER: A GLOBAL ISSUE

the resources to help themselves. Some of these nonprofit organizations include Charity:water,
water.org, and the Columbia water Center (CWC). One of the common ways these organizations
contribute is by raising money to implement and then implementing the building of wells and
costly water filtration systems in developing communities. A lot of these non profits are trying to
make up for what the governments in there prospective areas could not or have not addressed.
Some major national agencies that works to combat the issue is the World Health Organization
and the National Association of Clean Water (NACWA). The NACWA is vital in providing legal
advocacy, education, research, and funding in the name of providing clean water to all people.
Both public and private intervention groups play a major role in supplementing what
governments will not or cannot provide. Access to clean water is seen as a human right and
therefore it should lie on those who govern the well being of their people to allow for provisions
of clean water to all people. Unfortunately this is not a reality in many places across the globe. It
is for this reasons these agencies are so vital in helping to fight against the human injustice that
currently exists.
Access to clean water, and inherently sanitary conditions, continues to be a global issue
with roughly 768 million people still affected by inaccessibility to clean water as of 2006. If the
issue goes unaddressed roughly 135 million people will die due to the health risks that come with
this continuing global issue. For many in low and middle income countries the issues are far
from being eradicated. Governments are either not willing or unable to address the issues and the
people are uneducated as well as lacking in the resources needed to address the issue themselves.
it is for this reason we must continue to work together across public and private sectors to reach
out and help provide our global community with interventions that offer real solutions to gaining
access to clean water. Taking into consideration the serious political and ethical concerns that are

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at hand we must strive to make carefully planned executions to help people gain back what
should be considered a basic human right of all people, The success of such programs and efforts
is essential in combating global health concerns such as the spread of disease, child morbidity
rates, and many others. This is an issue that is not going away and must be addressed together as
a global community.

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References
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disinfection for safe water in urban developing communities. Journal of Water and
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%2BbwOLCmr02ep7ZSrqy4S7GWxWXS&ContentCustomer=dGJyMPHc4Xu549%2B
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Datta, D. S. (2010). Improving Hand Washing Practices through Apllication nof BEHAVE
framework: Experience fromRural Wardha, Maharashtra. Indian Journal of Maternal and
Child Health, 12(3), 1-8. Retrieved from
http://www.researchgate.net/publication/215538626_Improving_Hand_washing_Practice
s_through_Application_of_BEHAVE_Framework_Experience_from_Rural_Wardha_Ma
harashtra
Gleick, P. H. (2002, August, 15 2002). Dirty Water: Estimated Deaths from Water-Related
Diseases 2000-2020. Pacific Institute for Studies, Environment, and Security, 1-12.
Retrieved from http://agecon.nmsu.edu/fward/age384/spring-2010/Dirty_Water_Peter_H
%20_Gleick_2002.pdf
Hashfield, E., Jemec, A., Makhando, O., & Ramarumo, E. (2009). Water Purification in Rural
South Africa: Ethical Analysis and Reflections on Collaborative Community Engagement
Projects in Engineering. International Journal for Service Learning in Engineering, 4(1),
1-14. Retrieved from
http://www.virginia.edu/jpc/docs/WaterPurificationSouthAfrica2010.pdf

ACCESS TO CLEAN WATER: A GLOBAL ISSUE

Pruss-Uston, A., Kay, D., Fewtrell, L., & Bartram, J. (n.d.). Unsafe Water, Sanitation, and
Hygiene. World Health Organization, 1321-1352. Retrieved from
http://www.who.int/publications/cra/chapters/volume2/1321-1352.pdf
Skolnik, R. (2012). Global Health 101 (Second ed.). Burlington, MA: Jones and Bartlett
Learning.

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