The Value of Water in Sanitation and Toilets

For those of us who are living in developed countries, water, sanitation, hygiene, and toilets may not be a big deal. However, approximately 3.6 billion people, mostly those who are living in developing countries, do not have access to water, sanitation, hygiene, and toilets. The fact is, toilets, and the sanitation systems that support them, are underfunded, poorly managed, or neglected in several parts of the world. Poor sanitation may lead to the contamination of drinking-water sources, recreational waters like rivers and beaches, and food crops. This contamination could then lead to the spreading of deadly diseases ultimately threatening public health. Poor sanitation affects more than just people’s health, it can have devastating consequences on economics and the environment. This is especially true in the poorest and most marginalized communities. It is therefore imperative that governments invest in sanitation systems. Studies have shown that for every dollar invested in basic sanitation systems, an average of five dollars is saved on medical costs and increased productivity. The issue regarding sanitation, washrooms, toilets, bathrooms, and restrooms is also a gender equality issue. Women and girls are disproportionately affected by the lack of water and sanitation due to the following reasons; first, they are often the ones tasked with fetching water for the entire family, and second, water and sanitation is of vital importance during menstruation and pregnancy.

Current Situation - Water Availability and Scarcity

It may appear that the Earth has an overabundance of water since 70% of its surface is covered in water. However, only 3% of all the world’s water is freshwater. On top of this, most of the world’s freshwater reserves are inaccessible to humans. In other words, they are locked up in polar ice caps or stored too deep beneath the earth’s surface that they can’t be extracted. To make matters worse, whatever freshwater is accessible has become unfit for use due to pollution. World Atlas estimates that only 0.4% of the Earth’s water is usable and drinkable, and it is to be shared among the 7 billion people living in it. Another problem with regards to the world’s water availability is that a huge portion of this 0.4% is not easy to access. Most of the world’s usable and drinkable water is present underground as groundwater. The rest is present in rivers and streams as surface water. There is about 1,330,000 million cubic miles of water that is usable and drinkable. If distributed evenly to the 7.9 billion people living on Earth, each person would be allocated about 185,000,000 gallons of water which is more than enough water for a person’s lifetime. However, water is not evenly distributed which is why the global population is hard-stricken having access to water.

To have a better understanding of water availability and scarcity, it is important to distinguish between surface water and groundwater. Surface waters are those that you can see easily such as lakes, rivers, streams, and reservoirs. This is the most common water resource that is used for irrigation and public supply. In fact, 80% of the world’s daily water usage comes from surface waters. Groundwater is not visible because it is found beneath the Earth’s surface. It is more plentiful than surface water because they constitute 98% of the Earth’s freshwater.

Depending on their temperature, water could take on various forms of liquid, gas, and solid. They can cycle through these forms through the hydrologic cycle. When their temperature is increased, water molecules could change from liquid to gas. When water changes from liquid to gas, it is said to have evaporated. In their gaseous form, water vapour could rise through the atmosphere. At this point, the water vapour would start to cool and condensation begins. The water vapour condenses into clouds. The clouds would turn into rain clouds when more water vapour reaches them. When the rain clouds are saturated with water vapour, the water vapour falls back to earth in the form of precipitation. The entire water cycle from evaporation, condensation, to precipitation, distills the water before it starts to fall. When the water hits the ground they replenish the aquifers, rivers, or lakes, ready to be used again. Some of the world’s fresh water is trapped in glaciers and icecaps which cover about 10% of the world’s mass.

The increasing frequency of droughts and the dwindling natural water resources are drawing more attention to the lack of access to fresh, potable water. This lack of sufficient water or not having access to safe water supplies is referred to as water scarcity.

Water scarcity is a reality for several areas of the world. This scarcity is exacerbated by the growing population and the increasing need for water for growing and processing food, and creating energy. What’s more, is that climate change worsens water shortage.

When there isn’t enough water to meet the needs of the general population, it is said that there is physical water scarcity. To be exact, physical water scarcity occurs when water withdrawals exceed 75% of river flows. Roughly 20% of the world’s population is currently living in physical water scarcity. Moreover, an additional 500 million people would soon suffer the same fate as they are currently living in areas “approaching physical scarcity”. The dwindling water resources could be the result of dry or arid local conditions, distribution also plays a role.

Water’s Role in Sanitation and Hygiene

Simply put, access to clean water and sanitation means being able to avoid diseases that are caused by poor sanitation and hygiene. Aside from that, access to water means being able to flush one’s toilet. The benefits of water, sanitation, and hygiene are amplified if made available to an entire community.

Studies and systematic reviews have shown that improved sanitation can significantly reduce rates of diarrhoeal diseases by 32% to 37%. Although these studies and systematic reviews did not investigate the effects of wider water, sanitation, and hygiene interventions individually, nonetheless, they are collectively effective in reducing diarrhoeal diseases. For instance, a longitudinal cohort study in Salvador, Brazil, revealed that a 26% to 80% increase in sewerage coverage resulted in a 22% reduction of diarrhea prevalence in children under the age of 3 years. A separate meta-analysis showed that the provision of sewerage reduced diarrhea prevalence by up to 60% in areas with poor baseline sanitation conditions. In yet another longitudinal study, this time conducted in urban Brazil, it was revealed that the major risk factors for diarrhea in the first three years of life were low socioeconomic status, poor sanitation conditions, presence of intestinal parasites, and absence of prenatal examination. This Brazilian study concluded that the diarrhoeal disease rates could be substantially decreased by interventions designed to improve the sanitary and general living conditions of households.

DALY or Disability-adjusted life year is an estimate of the years of life lost due to premature mortality and the years lived with a disability due to prevalent cases of the disease or health condition in a population. Neglected tropical diseases or NTDs cause significant DALY losses despite causing little mortality. Most NTDs are spread through the fecal-oral transmission pathway. With that said, improved sanitation and increased access to water could potentially reduce their prevalence.

Benefits of Sanitation Beyond Health

Besides promoting health, access to toilets, sanitation, and water has both social and economic benefits. In the household setting, the main motivation for adopting sanitation systems has less to do with health but more with social convention. Adopting sanitation systems in the household setting promotes privacy, prevents embarrassment, fulfills the desire to be modern, provides convenience, averts discomforts, promotes social acceptance, and instills a sense of status. Sanitation provides unique social benefits for females. Having sanitation systems at home reduces the risk of sexual assault when going to public latrines or the bush. The provision of sanitation systems in schools would improve school attendance as they no longer need to stay at home during menstruation. By promoting health, sanitation systems can reduce days lost at work or at school through illness or through caring for an ill family member. This ultimately leads to economic benefits.

Studies have estimated the financial gains that sanitation and the prevention of water-related diseases provide. In one of these studies, it is estimated that $7 billion per year in health system costs can be saved by promoting sanitation and preventing water-related diseases. An analysis on achieving universal sanitation access and the Millenium Development Goals reveals that sanitation alone could generate about ten dollars' worth of economic benefit, mainly by productive work time gained from not being ill.

The Effects of Water Scarcity on Sanitation and Hygiene

Diarrhea is the main cause of death in children under the age of 5 in places with inadequate water supply, sanitation, and hygiene. In fact, the Center for Disease Control estimates that diarrhea kills 2,195 children every day. Poor sanitation and unsafe and inadequate water cause nearly 20% of workplace deaths. These deaths would significantly reduce productivity which leads to an estimated 260 billion dollars in productivity losses every year.

Sanitation deficiencies, such as the lack of water, among vulnerable populations in low-income countries cause a heavy burden. These deficiencies in sanitation and water access put over one billion people at risk of soil-transmitted helminth infection, which leads to five million years of healthy life lost. Schistosomiasis, on the other hand, threatens an additional two million people. Trachoma has left 2.2 million people visually impaired and a total of 1.2 million irreversibly blind. The subsequent economic cost in terms of lost productivity from blindness and visual impairment is estimated at 2.9 to 5.3 billion dollars annually.

Causative agents of diarrhea include viruses, bacteria, and protozoans. These agents are primarily transmitted via human feces. Although, some of these causative agents are transmitted through animal vectors. Soil-transmitted helminth parasites are parasitic nematodes that live in the gut and are spread primarily through fecal contamination of the environment. Trachoma is a bacterial infection that causes scarring in the inner eyelid. Its causative agent is the bacteria Chlamydia trachomatis. Repeated infections and or lack of treatment can lead to corneal opacity and blindness. Schistosomiasis is caused by a parasitic trematode, whose eggs are expelled either in stool or urine. This stool or urine could contaminate waters and infect those who would come into contact with this contaminated water. Although treatable, reinfection can occur. The spread and transmission of these diseases can be prevented through sanitation, access to toilet facilities, and access to sufficient water. It is imperative that the spread and transmission of these diseases be prevented because they can cause poor nutrition in young children. Especially that subclinical conditions caused by these pathogens can lead to enteric dysfunction.

Water is important for sanitation, hygiene, and the prevention of diseases. With that said, the scarcity of water that is safe for drinking and domestic use could greatly hinder sanitation and hygiene. This could lead to the appearance of diseases and could lead to a public health burden.

Ensuring Water Availability

Toilets and other forms of sanitation systems require sufficient water to carry out their functions. Without water, they cannot effectively promote hygiene. Thus, the United Nations created the Sustainable Development Goal 6 or SDG 6 which is about "clean water and sanitation for all". One project that falls under UN’s SDG 6, is the boreholes project in Kenya.

A huge portion of Kenya’s population does not have access to clean water. Fortunately, there is freshwater underground. To address Kenya’s water shortage, over 60 boreholes have been constructed or upgraded. The boreholes are of good design where vertical pipe casings are utilized. This pipe casing protects and supports the well. Aside from that, a well screen is also utilized as a filtering device so that the well water is safer. This way, communities dependent on the boreholes for water, although highly recommended, no longer need to purify the water by boiling it. As mentioned, there are more than 60 boreholes that have been created or rehabilitated. These boreholes benefit about 37,000 people. Since those who collect water from the boreholes no longer have to boil the water, families no longer need to collect and burn firewood to do so. This saves time, reduces deforestation, and lowers carbon emissions.

The usage of boreholes works towards achieving Sustainable Development Goals 6 and 13. In other words, Kenya’s boreholes increase access to clean water for a large number of people and help combat climate change.

Since it addresses the shortage of clean water, this project promotes sanitation and hygiene. Repairing old boreholes and installing pipe casings and well screens promotes water safety. Aside from that, families no longer need to travel long distances just to get water or use water from the damaged borehole which is most likely unsafe. On average, a single borehole can provide approximately one million litres of safe drinking water per year. However, this number may vary depending on factors such as the number of people who are taking water from the borehole.

Final thoughts

Sanitation systems, including toilets, are heavily reliant on water. Improving access to water leads to functioning sanitation systems that would promote hygiene and health. Water scarcity, on the other hand, hinders communities from achieving sufficient sanitation and hygiene. This would ultimately lead to poor health. Aside from health, sanitation systems have a positive impact on an individual's social and economic welfare. The presence of a functioning toilet in one’s household provides a sense of social acceptance. In an economical sense, sanitation systems significantly reduce the cost associated with treating illnesses brought about by the lack of sanitation and the loss of income due to sickness.


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