Half of the world’s population still does not have adequate access to safe drinking water, sanitation, and hygiene (WASH) which could have prevented at least 1.4 million deaths and 74 million disability-adjusted life years in 2019, this is according to the latest report by the World Health Organization (WHO) and an accompanying article published in a medical journal, The Lancet.
“With growing WASH-related health risks seen already today through conflicts, the emergence of antimicrobial resistance, the re-emergence of cholera hotspots, and the long-term threats from climate change, the imperative to invest is stronger than ever,” said Dr. Maria Neira, Director, WHO Department of Environment, Climate Change, and Health. “We have seen improvements in WASH service levels over the last 10 years, but progress is uneven and insufficient”
The burden of disease attributable to unsafe drinking water, sanitation, and hygiene: 2019 update presents estimates of the burden of disease attributable to unsafe drinking water, sanitation, and hygiene for 183 WHO Member States dis-aggregated by region, age, and sex for the year 2019.
The estimates are based on four health outcomes – diarrhea, acute respiratory infections, under-nutrition, and soil-transmitted helminthiases.
Diarrhoeal disease accounted for most of the attributable burden, with over one million deaths and 55 million DALYs. The second largest contributor was acute respiratory infections from inadequate hand hygiene, which was linked to 356 000 deaths and 17 million DALYs.
Among children under five, unsafe WASH was responsible for 395,000 deaths and 37 million DALYs, representing 7.6% of all deaths and 7.5% of all DALYs in this age group.
This included 273,000 deaths from diarrhea and 112 000 deaths from acute respiratory infections. These diseases are the top two infectious causes of death for children under five globally.
Important disparities were noted between regions and income groups. More than three-quarters of all WASH-attributable deaths occurred in the WHO African and South-East Asia regions, while 89% of attributable deaths were from low- and lower-middle-income countries.
However, even high-income countries are at risk, as 18% of their diarrhoeal disease burden could be prevented through improved hand hygiene practices.
While these estimates included four health outcomes for which data were available to quantify the impact, the true burden is likely to be much higher. The impacts of unsafe WASH on health are wide-ranging and go beyond disease by affecting social and mental well-being.
In addition, climate change is likely to exacerbate many WASH-related diseases and risks which are not fully captured in the present estimates.
To reduce the WASH-attributable burden of disease, WHO urges governments to focus access efforts on the poorest and most disadvantaged as the burden of disease is largely driven by inadequate access in low- and middle-income countries.
Although, this report notes that even in high-income countries, where access to safely managed drinking water and sanitation services is generally high, certain marginalized communities are under-served and face higher risks.
“It is clear that inadequate access to safe water, sanitation, and hygiene services continues to pose a significant, and preventable, health risk, particularly to the most vulnerable populations,” said Mr. Bruce Gordon, Head, of WHO Water, Sanitation, Hygiene, and Health Unit.
“The health benefits, as quantified in the report, are immense. Prioritizing those most in need is not just a moral imperative; it is key to addressing the disproportionate disease burden in low and middle-income countries and among marginalized groups in high-income countries.”
The organization also urges countries to adopt national monitoring systems to improve data on population exposure to safely managed services.