Curing the Developing World's Water Woes

It's often said that the worst job in the world is being the "before guy" in weight-loss ads: pasty, flabby, and balding. The "before guy" picture in the developing world is far more photogenic. It is a photograph of an elegant Asian or African woman wrapped in a vivid sari or kente cloth, gracefully carrying a brass kettle of drinking water on her head under a warm tropical sun.

As popular and romanticized as such photos are, the way that woman spends many of her waking hours is precisely what many governments and international donors are working to change. With a body weight of perhaps 90 to 100 pounds, she has to haul 5 gallons of water (45 pounds) on her head for a daily average of over three miles. Often she must return to that unsafe forest or jungle path to gather the firewood with which to boil that water to make it potable for her children. Hers is indeed a thankless job. Worse, her children in many cases must join her, risking injury, rape, and wild animal attacks while missing the chance to attend school or enjoy any semblance of childhood.

In the early 21st century we have an unprecedented opportunity to solve this problem by prioritizing safe drinking water and sanitation investments throughout the developing world. Achieving the "after" picture, a less photogenic but more straightforward shot of a borehole and latrine, will have profoundly positive impacts on the entire planet.

Currently 1.1 billion people face daily struggles for safe drinking water around the planet -- mostly in Asia, Africa, and Latin America. Few of the 5.5 billion with water recognize how world-changing this reality is. There are 2.6 billion people suffering from a lack of improved sanitation and hygiene. Essentially they have no place at home to go to the bathroom. Imagine competing outdoors for your spot with the 700 million Indians, or the 750 million Chinese who also lack the luxury of a hole in the ground. There is no ground devoid of human waste. Thus is reborn the diarrheal disease transmission cycle as your played-out and thirsty children track feces back to your dinner table.

This lack of water and sanitation prevents young girls from going to school or from staying in school once they start menstruating because of a lack of private sanitation facilities. One half of the world's primary schools, estimates UNICEF, lack safe drinking water for their students, and 75 percent of those schools lack adequate sanitation facilities.

The amalgamation of these dry statistics and underreported but plain realities leads to unfathomable but very tangible rates of mortality and morbidity. Waterborne diarrheal diseases alone, including cholera and dysentery, kill approximately 2 million each year. The Economist pondered in a recent article on globalization and health: "Stalin said a single death is a tragedy, a million deaths, a statistic. But millions of avoidable deaths are millions of tragedies." Over 90 percent of these deaths are of children under 5 and are for the most part indeed avoidable. Diarrheal diseases combine with trachoma, Guinea Worm, schistosomiasis, and other water-related illnesses to fill over 50 percent of hospital beds in the developing world.

Addressing such concerns, the world agreed to the Millennium Development Goals (MDGs) with great fanfare in 2000. The water MDG commits the world community to halving by 2015 the proportion of people without access to safe drinking water and sanitation. As things now stand, we are on track to meet the global water MDG thanks to the impressive efforts of India and China (which, however, mask the ongoing severity of the problem in Africa). But we stand little chance of meeting the sanitation MDG. Importantly, safe water contributes, on average, 30 percent to other MDG goals in child and maternal health, education, poverty alleviation, and environmental sustainability.

The U.S. donor community, as well, is becoming increasingly aware of the enormity, urgency, and solvability of the water challenge. A heightened awareness of safe water as the foundation of sustainable development has manifested itself recently in a quantitative and qualitative increase in the amount of financial resources flowing to the sector: Uncle Sam has appropriated $300 million for long-term safe drinking water and sanitation initiatives in developing countries in 2008. These taxpayer dollars are to be aligned with the 2005 Senator Paul Simon Water for the Poor Act whose strategy is to "focus water and sanitation assistance toward the countries, locales, and people with the greatest need." A compelling corporate initiative is the United Nations Foundation's Global Water Challenge, designed to coordinate the financial and technical contributions of the corporate and foundation sectors, and to improve how these resources are made available to U.S. and international nonprofits.

We are not embracing the opportunity we have to combat unsafe water and inadequate sanitation. The solutions -- technical, political, and sociocultural -- are within our grasp. The money is there. This cure simply needs to be made available to hundreds of millions in the developing world as it has to the developed countries.

On the one hand, the cure is uncomplicated: pipes, valves, UV and chemical water purification systems, pit latrines, hygiene training programs. On the other hand, arriving at more holistic behavior-changing solutions is harder than rocket science: Think about how long it took to potty train your toddler or to get your kids to wash their hands before every meal and brush their teeth every night. There is no silver bullet.

One current line of attack is to confront the lack of water and sanitation specifically at schools. UNICEF has pursued this approach for years, joined now by Water Advocates, the Global Water Challenge, and myriad others. Ensuring that schools have safe drinking water and sanitation brings distinct health and education benefits, giving children the opportunity to attend -- and in many cases, especially for girls, to stay in -- school.

Development work in water is no longer about simply poking holes in the ground and pumping out safe water. Sustainability -- technical, financial, environmental, and sociocultural -- must remain front and center. Interventions should address the need, desire, and management capacity of the recipient community, not the ambition of the donors. The sector should continue to explore and expand innovative business and financial models to make cost recovery more feasible for water and sanitation services. The end game of preventing unnecessary mortality and morbidity should remain fixed in the crosshairs.

Matthew Arnold was right when he said in 1875 that the freethinking of one age is the common sense of the next. So let's skip to that common sense dictating that there should be universal safe drinking water. Having more than 1 billion people without this basic human necessity is an embarrassment. There should not be a poster child for unsafe water. There should be a billion "after" pictures of healthy girls in school. Of children with childhoods. Of women with safe water and sanitation spending time on income-generating activities, protecting their environment, and perhaps participating freely in democratic processes.