by A Prüss-Üstün · 2008 · Cited by 1186 — Prüss-Üstün A, Bos R, Gore F, Bartram J. Safer water, better health: costs, benefits and sustainability of interventions to protect and promote health. World Health

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SAFER WATER , BETTER HEALTH Costs, benefits and sustainability of interventions to protect and promote health Almost one tenth of the global disease burden could be prevented by improving water supply, sanitation, hygiene and management of water resources Annette Prüss-Üstün, Robert Bos, Fiona Gore, Jamie Bartram

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Almost one tenth of the global disease burden could be prevented by improving water supply, sanitation, hygiene and management of water resources Annette Prüss-Üstün, Robert Bos, Fiona Gore, Jamie Bartram SAFER WATER , BETTER HEALTH Costs, benefits and sustainability of interventions to protect and promote health

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© World Health Organization 2008 All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: Requests for permission to reproduce or translate WHO publications Œ whether for sale or for noncommercial distribution Œ should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; e-mail: The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. The named authors alone are responsible for the views expressed in this publication. Printed in Spain. WHO Library Cataloguing-in-Publication Data Annette Prüss-Üstün – [et al]. 1.Gastrointestinal diseases – prevention and control. 2.Diarrhea – prevention and control. 3.Parasitic diseases – 8.Life expectancy. I. Prüss-Üstün, Annette. II.World Health Organization. Suggested citation interventions to protect and promote health. World Health Organization, Geneva, 2008.

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5 and adequate sanitation and encouraging personal, domestic and community hygiene will improve the quality of life of millions of individuals. Better managing water resources to reduce the transmission of vector-borne diseases (such as viral diseases carried by mosquitoes) and to make water bodies safe for recreational and other users can save many lives and has extensive direct and indirect economic macro-perspective of national economies. The global importance of water, sanitation and hygiene for in the United Nations Millennium Declaration, in particular its eight Millennium Development Goals, in the reports of the United Nations Commission on Sustainable Development and at many international fora. Millennium Development Goal 7: Ensure environmental sustainability Target 10: Reduce by half the proportion of people without sustainable access to safe drinking water and basic sanitation Indicator 30: Proportion of the Population with Sustainable Access to an Improved Water Source Indicator 31: Proportion of the Population with Access to Improved Sanitation In 2002, the World Health Organization (WHO) the global burden of disease related to water, sanitation and hygiene (3,4) (UNICEF), in monitoring the status of and trends in access to both improved drinking-water sources and basic sanitation (5) . Subsequently, WHO continued to develop this evidence base for policy and good practice. This has included systematic work on developing an understanding of the impact of interventions on disease those interventions. The tools being developed by WHO as part of this work are suitable for application at different levels, from local to national to global. A clear understanding of the burden of disease and the effectiveness of alternative approaches to reduce this burden provides the basis for the development of effective intervention strategies. Estimating the costs and impacts of policy and technical options provides an objective basis from which to inform decision-makingŠespecially important in an area where many different sectors and actors are involved. This document summarizes the most recent water- (2) ; presents recent information on effective interventions (6) ; summarizes information from economic evaluations (7) (8) . The global health impacts presented are based on both rigorous assessments (for diarrhoea, trachoma, schistosomiasis and intestinal nematode infections) and reviews of expert opinion (all other addressed expert opinion is not at the same level as that of the estimates based on rigorous assessments; nevertheless, the opinion-based estimates are the best ones currently available. WHO™s mission in environmental health WHO™s mission in environmental health is to improve health by identifying, preventing and reducing environmental hazards and by assessing and managing associated risks. Health education, Bangladesh.

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7 7An important share of the total burden of disease worldwideŠaround 10%Šcould be prevented by improvements related to drinking-water, sanitation, hygiene and water resource management. The following are examples of global disease burdens that are known to be preventable in this manner. 1.4 million preventable child deaths per year Diarrhoea is caused mainly by the ingestion of pathogens, especially in unsafe drinking-water, in contaminated food or from unclean hands. Inadequate transmission of these pathogens. Eighty-eight per cent of cases of diarrhoea worldwide are attributable hygiene. These cases result in 1.5 million deaths each year, most being the deaths of children. The category fidiarrhoeafl includes some more severe diseases, such as cholera, typhoid and dysenteryŠall of which have related fifaecalŒoralfl transmission pathways. 860 000 preventable child deaths per year Childhood underweight causes about 35% of all deaths estimated 50% 1 of this underweight or malnutrition is associated with repeated diarrhoea or intestinal nematode infections as a result of unsafe water, underweight in children is directly responsible for some 70 000 deaths per year. Underweight children are also more vulnerable to almost all infectious diseases and have a lower prognosis for full recovery. The disease burden related to this indirect effect on deaths from infectious diseases is an order of magnitude higher than the disease burden related to the direct effects of malnutrition. The total number of deaths caused directly and indirectly by malnutrition induced hygiene is therefore 860 000 deaths per year in children 1(1)Food in generalHuman excretaHandsNon-waterbornesewageLatrinesWaterbornesewageSoilFliesGroundwaterSurface waterHumansFish and shellfishFruits and vegetablesDrinking waterAnimal excretaAnimal products (eggs)

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