Director-General

WHO Director-General addresses Budapest Water Summit

Dr Margaret Chan
Director-General of the World Health Organization

Universal access to water and sanitation: the lifeblood of good health
Keynote address at Budapest Water Summit
Budapest, Hungary

9 October 2013

Excellencies, honourable Ministers, distinguished delegates, heads of sister UN agencies, members of civil society, ladies and gentlemen,

Let me thank everyone in this room for applying the science of your disciplines, and the passion of your civil society organizations, to the multiple problems facing efforts to improve water, sanitation, and hygiene.

The multidisciplinary nature of the summit is deeply appreciated. For the many diseases associated with poor water and sanitation, a health agency like WHO can issue international guidelines for water quality and provide numerous practical instruments for improving water and sanitation services. But the health sector cannot implement these tools and instruments on its own. We depend on you.

The health sector can launch campaigns to promote hygiene, treat the sick, and count the cases and deaths. But the true root causes of these diseases reside in non-health sectors and must be tackled there. We depend on you for prevention.

The outcome of this summit has universal relevance. Every country in the world has communities, large or small, that suffer from inadequate water and sanitation services.

The summit also has relevance for vulnerable groups. The special needs of women and adolescent girls for hygiene and privacy are often neglected in plans for improving service provision.

Women and girls are also the ones who can spend up to four hours each day fetching water. The limited political and personal power of women in many developing countries means that some of the most powerful advocates for sanitation have no voice.

I thank those who drafted the Budapest Water Summit Declaration for underscoring the importance of gender equality and for keeping a strong and consistent focus on the unmet needs of the poor.

I have four main messages to convey.

First, the health consequences of poor water, sanitation, and hygiene services are enormous. I can think of no other environmental determinant that causes such profound, debilitating, and dehumanizing misery.

These health consequences can be measured, and the costs can be calculated. Doing so provides a powerful evidence base for commanding international attention.

The returns on investment can also be calculated. For sanitation, WHO estimates that every dollar spent brings a return of $5.50 by keeping people healthy and productive, and keeping children in school.

Second, poverty can never be eradicated, or even greatly reduced, as long as so many millions of people cannot access safe water and so many billions are living in environments contaminated by faeces. Efforts to improve water, sanitation, and hygiene should be viewed as a pro-poor strategy on a massive scale. If poverty eradication is central to the post-2015 development agenda, then water and sanitation must be included.

Third, progress has been made, but it is insufficient and, above all, uneven, within and between countries. The world, as a whole, met the MDG target for access to water last year, but in sub-Saharan Africa, for example, only 61% of the population is covered.

Worldwide, nearly 800 million people still do not have access to an improved water source. Progress towards the target set for sanitation coverage is the most off-track of all the MDGs.

Finally, sound water governance is urgently needed. The world is changing in ways that put unprecedented pressure on finite resources, and most especially on water. Adequate water is needed to sustain health, agriculture, and ecosystems, but also to fuel industrial development and economic growth.

The trends behind these changes are powerful, universal, and not easily reversed. They increase challenges that were already vast. They bring the need for sound water governance to the fore.

In the run-up to last month’s session of the UN General Assembly, the Lancet medical journal featured an editorial, by the economist Jeffrey Sachs, that looked at the need for sustainable development goals. That editorial drew attention to a stark reality.

As stated, “The gains in fighting poverty, and indeed generations of economic gains, are at serious threat of reversal unless deep structural crises of rising social inequality and rapid environmental degradation are finally addressed.”

Many others will discuss the significance of environmental degradation during this summit. I will concentrate on the vast, and growing, social inequalities that are so strongly demonstrated by differences in access to water and sanitation, and the related sharp differences in health outcomes.

Ladies and gentlemen,

At any given time, nearly half the population of the developing world will be affected by an illness or disease directly linked to unsafe or too little water, poor or no sanitation, or faulty management of water resources.

In 2010, the United Nations General Assembly recognized the right to safe and clean drinking-water and sanitation as a human right essential to the full enjoyment of life and all other human rights. In my view, having easy access to clean water and living in environments free of human waste ought to be part of the very definition of a decent life in the 21st century.

The interactions of water, sanitation, and hygiene with health are multiple. On the most direct level, water can be the vehicle for the transmission of a large number of pathogens. Human faeces is a frequent source of pathogens in the water and the environment, with the risk especially high when contamination occurs in areas where children play or food is prepared.

Improved sanitation, especially by ending open defecation, is a critical way to reduce the burden of diseases spread by water. In fact, it is virtually impossible to have a safe water supply in the absence of good sanitation.

Of all the waterborne diseases, the multiple pathogens and parasites that cause diarrhoea are the biggest killers. No vaccine will ever be able to prevent all of these causes. Good water and sanitation services cut them off at their roots.

Many waterborne diseases are prone to explosive outbreaks. Outbreaks of cholera, for example, are reported in more than 50 countries every year.

Having too little water also harms health. Blinding trachoma is probably the most vivid expression of the misery of living in filth and its debilitating consequences for health. When households do not have enough water to keep themselves clean, flies are attracted to dirty faces, especially to discharge around the eyes, spreading bacterial infection as they feed.

After repeated infections, the eyelid turns inward and the lashes scratch the cornea. Left untreated, the condition progresses, in agonizing pain, to permanent visual impairment and blindness. Worldwide, an estimated 1.5 million people are blind because of trachoma, the biggest single cause of preventable blindness. Think about what this means for the economies of poor rural communities and countries.

I use these examples to make a point. The impact on socioeconomic development of diseases associated with unsafe water and poor sanitation needs to be measured by many metrics other than the number of deaths. League tables of top killers cannot capture the contribution these diseases make to stubborn poverty and human misery.

And there are other diseases, including those spread by insects and other vectors that depend on water for part of their lifecycle. Major diseases like malaria and schistosomiasis are highly sensitive to changes in aquatic ecosystems, which can be introduced by schemes for irrigation and water impoundment. Such schemes, if not well-managed, can lead to explosive increases in cases of disease.

In just the past decade, the significance of dengue as a threat to health and economies has increased dramatically. More countries are reporting their first cases and more outbreaks are explosive.

Crippling urban outbreaks are of particular concern, as the mosquito that transmits dengue has adapted to breed in water stored near homes or in articles of urban garbage no bigger than a plastic cup.

Ladies and gentlemen,

Let me draw a contrast. Nearly all of the diseases I have described vanished from wealthy countries long ago as standards of living improved. Not so in the developing world.

As I said, improving water and sanitation services is a pro-poor strategy on a grand scale. Any future agenda for sustainable development that aims to eradicate or alleviate poverty must include water and sanitation.

Water scarcity, poor water quality, and inadequate sanitation have a negative impact on food security, livelihoods, and educational opportunities for poor families across the developing world.

Compared with wealthy households using network services, many poor households pay a much higher proportion of their income for water and sanitation services delivered by informal vendors and service providers.

The poor also pay much higher rates for these informal services, despite the poor quality and small quantity of the water and vastly inferior sanitation services.

Progress has been made, as demonstrated by regular reports from the joint monitoring programme undertaken by WHO and UNICEF. As I said, the goal for water has been met. More than half of the world population now enjoys the health benefits of a piped water supply in homes or in yards. Deaths from diarrhoeal disease are steadily falling.

But the joint monitoring reports reveal great gaps in coverage and, in some regions, stalled progress and setbacks. The state of sanitation needs to be regarded as one of the greatest crises facing socioeconomic development.

The developing world is littered with the remains of failed sanitation projects. For sanitation, vast experience tells us that improvements will not be sustained if technology is too expensive or too complex for communities to maintain or if it is ill-suited to their preferences or customs.

Hardware alone, in the absence of community demand and acceptance, will not improve sanitation. As an executive at the World Toilet Organization has noted, efforts to market toilets must find the right emotional trigger. In this regard, research on the effectiveness of community-led total sanitation should be warmly welcomed.

Ladies and gentlemen,

The world has changed dramatically just since the start of this century.

The climate is changing. Records for extreme weather events are being broken a record number of times. Issues of water scarcity and food security are now of global concern. Like agriculture, many major diseases are exquisitely sensitive to changes in temperature, rainfall, and humidity.

Rapid urbanization is a global trend. For the first time in history, more people live in cities than in rural areas. Poverty that was previously scattered in rural areas is increasingly concentrated in urban slums and shantytowns. This trend is outstripping the capacity of services and infrastructures to meet basic human needs, including for water and sanitation.

Rapidly growing economies and rising incomes have prompted a shift in food consumption patterns towards more meat and highly processed foods.This shift, in turn, has boosted the economic importance of intensive farming, confined animal feeding operations, and food processing plants that depend on water and produce large amounts of waste.

In the last decades of the previous century, health concerns were the principal driver of efforts to improve water supply and sanitation. This, too, has changed.

Water sustains life and health, but it also fuels industrial development and economic growth. In a world of growing water scarcity, this situation pits health concerns against the business interests of powerful economic operators. Again, this underscores the importance of the governance issues being discussed during this summit.

Ladies and gentlemen,

As I conclude, let me again thank everyone in this room for the work you are doing. The diseases linked to unsafe water and poor sanitation are truly horrific. Our joint efforts can do much to prevent them.

Thank you.

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