29 January 1998
3 BILLION PEOPLE WORLDWIDE LACK SANITATION FACILITIES:WHO STRATEGY ON SANITATION FOR HIGH-RISK COMMUNITIES
According to WHO, "the poorest 1000 million people on Earth are seven times more likely to die from infectious diseases and maternal and perinatal conditions - most of which are directly related to bad sanitation - than are the least poor 1000 million".
The WHO Executive Board has sent out a call for action to help those most in need of improved sanitation. "Concerned about the vast and increasing number of people in the world who lack sanitation, living in communities that should receive the highest priority for sanitation because of the particularly high risk of disease related to unsanitary conditions," the Board at its current session adopted a resolution urging Member States "to reorient and strengthen their sanitary programmes to ensure that priority is given to communities at high risk from insanitary conditions".
The actual number of people at high risk is difficult to estimate. In most developing countries half of all urban residents and an even larger proportion of rural communities may fall into the high-risk category.
For decades sanitation has been given extremely low priority in comparison with other general development needs. As a result, sanitation coverage in developing countries has remained constant at about one-third of the total population since 1970. Based on current trends, the total unserved world population is expected to increase to 3300 million by the year 2000. Various factors complicate the task of improving sanitation in developing countries. Recent urbanization has been very rapid, often leading to the mushrooming of informal settlements at the periphery of principal settlements. These areas are usually densely populated, suffer from poor-quality housing, and frequently are not covered by municipal waste management services.
In its broadest sense, environmental sanitation is about controlling or changing the physical environment in order to prevent the transmission of diseases to human beings. In real terms, environmental sanitation means access to safe and sufficient water supply, sanitary disposal of human excreta and household wastes as well as changing human behaviour through hygiene education.
The burden of disease directly linked to unsanitary conditions is horrifying: nearly 2.5 million deaths annually worldwide from diarrhoea diseases, including dysentery; 600,000 deaths from typhoid fever; 138,000 deaths from dengue and dengue haemorrhagic fever.
Exposure to faecal pollution may lead to a multitude of diseases, of which cholera, typhoid fever, paratyphoid fever, salmonella, shigella, giardiasis infection, hepatitis and poliomyelitis are of main concern. Inadequate sewage disposal was one of the main causes for the recent cholera epidemic in Latin America.
In developed countries nearly all human excreta is collected safely by means of sewerage, septic and other systems. However, considerable amounts of sewage are nevertheless discharged without adequate treatment into the environment in these countries. In developing countries, the sanitation coverage picture is very different. A small proportion of the total population, very roughly 10% and mainly urban, has access to sewerage systems and a slightly larger proportion, very roughly 20%, has some type of on-site sanitation facility. But the vast majority - about 65% - of people in developing countries do not have sanitary excreta disposal systems.
Of the unserved population in developing countries (2900 million), 80% live in rural areas. Most of the faeces are recycled for use in agriculture or deposited on land without prior destruction of pathogens, most of which eventually enter surface and ground waters, sometimes surviving for considerable lengths of time. Not surprisingly, infectious diseases such as diarrhoeal diseases, schistosomiasis and hepatitis are endemic in those areas. Most of this biodegradable organic material is disposed of with very little or no treatment at all, thus polluting the environment with organisms that are highly dangerous to human health.
The state of existing sewerage systems presents further problems. Many of the sewerage networks in developing countries were constructed a century or more ago. Most of these systems have not been maintained adequately. Increases in population density and water consumption have caused the systems to become overloaded. In most cases sewerage systems in developing countries rarely connect to effective treatment facilities.
Environmental sanitation can reduce the incidence of infectious diseases by 20% to 80% by inhibiting disease generation and interrupting disease transmission. Sustainable health, especially for children, is not possible without good environmental sanitation. Countries with the highest rates of infant and child mortality and the lowest figures for income and life expectancy tend to have the poorest environmental sanitation services.
The WHO resolution urges Member States to "give higher priority to sanitation in national planning for health and investment in infrastructure", and calls upon the United Nations and the international donor community to support efforts of individual Member States in this area. To this end, a Global Environmental Sanitation Initiative has been launched, supported by WHO, UNICEF and other agencies.
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For further information, please contact Mr Valery Abramov, Health Communications and Public Relations, WHO, Geneva. Telephone (41 22) 791 2543. Fax (41 22) 791 4858. E.mail email@example.com
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