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7 The Social Pillar of Sustainable Water: Health Research Gaps
Pages 77-92

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From page 77...
... Each year, there are 4–8 billion episodes of diarrheal disease. It is particularly tragic due to its preventable nature given that 80 percent of diarrheal disease is attributed to unsafe water supply, inadequate sanitation, and lack of hygiene.
From page 78...
... A WHO analysis looked at relative risks of disease given six different water and sanitation paradigms, from the ideal situation to one without access to clean water or improved sanitation. WHO found that risk increased as fewer had access to services, without piped water, without sanitation services, and little management of the water supply.
From page 79...
... III Piped water in-house and improved sanitation 2.5 4.5 services in countries where less than 98% of the population is served by water supply and sanitation services, and where water supply is likely not to be routinely controlled. IV Population having access to improved water 3.8 6.9 supply and improved sanitation in countries where less than 98% of the population is served by water supply and sanitation services and where water supply is likely not to be routinely controlled.
From page 80...
... Examples of this kind of problem are fishermen wading in a stream filled with drainage from the local dump, an unprotected pile of trash washing unknown concentrations of dioxin and household wastes into the water that people drink and eat from. Again, the need to use these clearly sullied water sources is greater among the most disenfranchised and poor populations, leading to increasing health disparities.
From page 81...
... Preliminary Overview of Current Research and Possible Research Priorities: Small Community Drinking Water Supplies John Cooper, Ph.D., Director Water, Air and Climate Change Bureau, Health Canada Boil water advisories are an effective mechanism to reduce burden of illness as long as the people in the affected communities abide by them. In Canada, there are approximately 1,200 to 1,500 boil water advisories in place at any one time across the country, impacting approximately 200,000 to 300,000 people.
From page 82...
... The WHO Small Community Water Supply Management Network was established in 2003 as a coordinated global response for the safety of drinking water in developed and developing countries. Its target was to help meet the Millennium Development Goal of reducing the number of people without access to safe drinking water by a half by 2015.
From page 83...
... The focus for the WHO Small Community Network is to identify areas where more research would contribute to the goal of safe drinking water by identifying gaps and priorities and strategically implementing mechanisms to direct and guide research, and deliver and/or fund projects. As a starting point, the research that has been done in the drinking water, defined broadly, can be used to identify the research needs for small community water supplies, while recognizing the unique challenges in the small community.
From page 84...
... The research to better understand the health risks related to both pathogens and chemicals in drinking water is not directly linked to the size of the water system. Significant advances in the understanding of the range of health effects have been made: There is a growing body of information on acute and chronic illnesses, an increased focus on disinfection byproducts, and risks to reproductive and developmental health effects, to name a few.
From page 85...
... Socio-Economics and Capacity Socio-economic factors in both developed and developing countries need to be considered in small community systems. As discussed earlier, there is sufficient evidence that safe drinking water protects health, reduces burden of illness, avoids boil water advisories; yet it's very difficult to get communities to actually invest and value water as a resource.
From page 86...
... Even if the regulations are for small systems, they cannot be met because of the following: • The treatment is inadequate or lacking • Operation and maintenance are not supported •  onitoring and testing can be particularly onerous for small communities M •  nadequate laboratory access affects ability to receive timely sampling I results Recognizing this inherent problem in small systems, there is a need for evaluation of best approaches to ensuring safe drinking water in small water systems that is country or regionally based. Conclusion This has been a very preliminary and limited overview of research priorities related to improving the safety of small community water supplies.
From page 87...
... In other words, they do not know if emphasizing drinking water is more important than sanitation to ensuring health outcomes, or vice versa. Learning from Hurricane Mitch Hurricane Mitch made landfall in Central America in October 1988 and affected four countries: Nicaragua, Honduras, El Salvador, and Guatemala.
From page 88...
... A qualitative evaluation of the Chiquimula area in Guatemala found that the community met the goals for access to water, access to sanitation, and hygiene education, and there was a corresponding decrease in childhood diarrhea. Conversely, in Las Pozas, El Salvador, there was a good water intervention with a drilled well that used gravity to provide water to the community.
From page 89...
... From a qualitative analysis, it appeared that hygiene practice had the largest impact in these projects, followed by sanitation, and then water interventions. With further data acquisition, quantitative and univariate analysis was possible.
From page 90...
... What Is Culture? From a sociological perspective, one can define culture a number of ways, and each definition helps to define various borders for what can appear to be a borderless discipline.
From page 91...
... Culture and Public Health Interventions Often culture can be seen as a barrier in the process of implementing public health interventions; however, culture does not have to be a barrier. Individuals in the community do not see themselves as a barrier.
From page 92...
... Researchers should not see culture as a barrier, but rather as an opportunity to ensure the sustainability of their interventions. Recognizing the importance of water and culture and their intersection opens opportunities to begin to address the Millennium Development Goals.


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