What is our biggest global health challenge?
October 15, 2017
Jamie Bartram, PhD
Don and Jennifer Holzworth Distinguished Professor of environmental sciences and engineering
Director, The Water Institute at UNC
Water, no doubt about it.
Globally, water problems go hand in hand with poverty, inequality and injustice. Whether contamination of ground water, inaccessibility to water sources or outdated infrastructure, those who can and do invest in taking care of this limited resource are those willing to invest in the future.
At The Water Institute, we work worldwide, especially with low- and middle-income countries and communities, to steer efforts and investments – to improve health, reduce poverty, erode inequalities and right injustices. Transitioning to infrastructures that deliver what communities want and need to achieve these benefits is key. The village hand pump, for example, is outdated now – it often fails and does little to prevent disease or reduce the burden of collecting water. Recent innovations offer opportunities for radical improvements. For example, we should turn to solar pumping and disinfection – with the potential to deliver safe water, household by household. These are key demands under the Sustainable Development Goals. (See www.who.int/sdg/en.)
Collecting water can require more than 20 percent of a woman’s day (yes, overwhelmingly women) in some low-income countries. Imagine, instead, investing these hours in business-building, leading community efforts, caring for children or growing nutritious crops. It is not so hard to locate, transport and deliver potable water – for all, and not just for us privileged few.
Hand in hand with the water crisis loom the massive but unpredictable consequences of climate change. Those involved in extending the benefits of safe drinking-water cannot afford to be believers or deniers of climate change. The water crisis is immediate and demands adaptation. It is doubly challenging because we cannot predict precisely what to plan for in any one place – more frequent or more extreme droughts; more frequent or more extreme floods, storms and cyclones. At the same time, the investments are long-term. Hand pumps may last 20 years; buried water distribution networks, a half-century. Developments – in technologies, in management, in policy and financing – are evolving rapidly. This is no time for posturing around denial or belief. Adaptation is an immediate and urgent need.
Q: How will the U.S. fare in all this?
A: As elsewhere, without central (federal and state) policy, planning and investment, the poorest will be hit hardest – poor communities and poor households in ordinary communities. For decades, we’ve under-invested across the U.S., reaping the benefits of investments by previous generations. Each year of recent decades, we have not paid our share of the cost of renewing basic drinking water and sewerage infrastructure, pushing those costs onto the next generation. Not dealing with water pollution and conservation increases costs and makes the best solutions increasingly unaffordable.
First, I hope we do not see a splurge of business-as-usual. The challenges of the past are not those of the future, and long-term infrastructures may not be fit for purpose in a half-century’s time. We need simple, effective legislation that gives utilities incentives and flexibility to adapt creatively to climate change, whether through financing or hardware.
Second, I hope we improve the way we do business. There are win-win options that deliver greater benefits for similar costs. Water Safety Plans have improved water quality, compliance and health at little cost.
Third, incentives must deliver improvements for small communities – where safety is lowest and reliability least – as well as big population centers. That means extending utility services to marginalized adjacent settlements and delivering oversight and support to smaller rural communities. Otherwise, these communities will bear the greatest adverse impact and hold back overall benefits.
Finally, we are wedded to two costly and contaminating approaches – municipal sewers demanding costly treatment and septic systems that are also costly, haphazard and under-regulated. In this country of innovation, we should be able to do far better – cheaper, less-polluting systems ought to be conceivable.
Q: Are you hopeful that we can solve our water problems – or not?
A: When I came to UNC in 2010 to launch The Water Institute, water already was understood as the defining health challenge of the 21st century. How we now navigate our waters over the next decade or two will signal our ability to determine our own future.
Some signs are positive, such as the massive gains in drinking water and sanitation access in poorer countries. Some are negative, including stagnation in developed nations like the U.S. New factors also challenge us, such as managing the consequences of migration, encumbered international scientific exchange and discourse, and uncertainty about how specific places will experience climate change.
I believe we’re smart enough to develop and implement the solutions for the water crisis, but we’re very slow coming to the table and slow to make informed important decisions. There’s little time to make the urgent changes we need.
Carolina Public Health is a publication of the University of North Carolina at Chapel Hill Gillings School of Global Public Health. To view previous issues, please visit sph.unc.edu/cph.