Experts at the European Centre for Environment and Health in Rome describe the importance of water to health in the European Region of the World Health Organization (WHO). They highlight the challenges that need to be overcome to improve the current situation and introduce the policy instruments that exist in this region to achieve health goals.
The right to water forms part of the right to public health, which was first reflected in the WHO constitution adopted in 1946 and then reiterated in the 1978 Declaration of Alma-Ata and at the World Health Assembly in 1998.
However, the most authoritative interpretation of the right to health - including the right to water - is in the International Covenant on Economic, Social and Cultural Rights (ICESCR). In May 2000, the Committee on Economic, Social, and Cultural Rights, which monitors the Covenant, adopted an interpretation of the provisions of the ICESCR, or "general comment", on the right to health (Article 12). This was followed in November 2002 by a similar interpretative statement in relation to the right to water. (1) The adoption of the general comment on the right to water means that the 145 ratifying countries of the Covenant now "have a constant and continuing duty" to progressively ensure that everyone has access to safe and secure drinking water and sanitation facilities.
Access to water
WHO is currently updating its figures on water supply in the 51 countries of the WHO European region. Health problems associated with water are still present in the European region. Current problems may worsen with increasing scarcity of water, changes in climate, and by changes in land use and agricultural practices.
One in seven denied access
The United Nations Economic Commission for Europe (UNECE) says that one in seven Europeans are denied access to safe drinking water and adequate sanitation.
Several sources of reference on access to potable water exist. One is the World Bank’s "World Development Indicators" (2002) on urban household access
A scarce resource
Over 97% of the earth’s waters are saline. Of the 3% remaining, 79% are stored in polar ice caps or high mountain glaciers, 20% are in groundwaters, and barely 1% are in easily accessible surface freshwater. (2)
Freshwater resources across the region vary greatly. Significant local differences may exist within one country, or even within one river basin. Urban demand for freshwater often exceeds the local long-term availability of the resource, especially in southern Europe and in the industrial centres of northern Europe. (3)
Besides local over-use of finite resources, desertification is a valid concern in certain semi-arid and water-scarce areas of Europe. Desertification refers to the degradation of land in arid, semi-arid and dry sub-humid regions, primarily by human activities and climatic variations. It has many causes but the following are amongst the most prevalent for the European Region:
crisis conditions in agriculture associated with excessive pressure on existing resources, abandonment of traditional agriculture and associated land conservation;
unsustainable exploitation of land resources, leading to pollution, salinisation, and exhaustion of aquifers; effects of seasonal droughts, very sudden and high-intensity rainfalls.
The United Nations Convention to Combat Desertification (UNCCD) entered into force on 26 December 1996. (4) It has been ratified by most countries of the European Region. Ten are sufficiently concerned to have developed national action plans (NAP) to combat desertification. They are Armenia, Greece, Italy, Kyrgyzstan, Portugal, Republic of Moldova, Romania, Tajikistan, Turkmenistan, and Uzbekistan.
Recent forecasts show that water stress is likely to become an increasingly important issue for the European Region.
Freshwater stress
Water scarcity occurs when the amount withdrawn is so great that water supplies are no longer adequate to satisfy all human or ecosystem requirements. "High water stress" (40% or more water withdrawal as a percentage of total available) already exists in some countries of North Africa and the Middle East. This will spread to more countries, including India and South Africa over the next 20 years. By 2025, the USA and several countries in Europe are expected to have reached "medium-high water stress", i.e. water withdrawal at 20-40% of total volume of water resources available.
Extreme weather events
Flooding is the most common natural disaster in Europe, and also the most costly. The EM-DAT (5) International Disaster Database recorded 238 floods in Europe between 1975 and 2001. In the last decade, 1,940 people died during floods and 417,000 were made homeless. Between January-July 2002, Europe suffered eight major floods killing 93 people, affecting 336,000 others and causing approximately Euro 480 million in damages.
Water and health
Water is essential to human life. Adverse health effects related to water can be organised in four categories:
Water-borne disease: those associated with water contaminated by human, animal, and chemical wastes. Examples include: cholera, typhoid, shigella, polio, meningitis, and hepatitis A and E. Globally, between 1,085,000 and 2,187,000 deaths are due each year to diarrhoeal diseases attributed to water, sanitation, and hygiene, 90% of them amongst children below five years of age. In the WHO European region, diarrhoeal disease death rates among under-5s are falling.
Water-related vector disease: those where a vector, usually an insect, is transmitting the disease. The most wide-spread water-related vector disease, malaria, causes 1 million people to die each year. Malaria is making a comeback in the WHO European Region.
Water-scarce disease: those that develop in areas where clean freshwater is scarce. Examples are trachoma and tuberculosis. Rates of tuberculosis in Europe have risen steadily over the past 10 years.
Water-based disease: those caused by aquatic organisms. Examples include guinea worm (dracunculiasis), paragonimiasis, and schistosomiasis (bilharzia). The latter disease is prevalent in over 70 countries and infects some 200 million people world-wide.
The scourge of water-related disease is often forgotten in the media, and overtaken by "new" health threats, such as HIV/AIDS and bioterrorism.
Effects of weather on health
The health impact of extreme weather events, in particular flooding, can be categorised into direct and indirect health effects. Direct health effects occur during the flood itself and are caused by the flood water. These may include deaths from drowning, heart attacks and injuries. Indirect health effects can be the consequence of damage to major infrastructure and property. They include infectious diseases (gastrointestinal diseases, dermatitis, conjunctivitis) and some rare cases of vector-borne diseases; poisoning caused by the rupture of underground pipelines, dislocation of storage tanks, overflow of toxic waste sites, or release of chemicals stored at ground level, and post-traumatic stress disorder, including anxiety and depression, psychosocial disturbances and suicides.
WHO-supported goals
The Millennium Declaration was adopted in September 2000, and set goals in seven specific areas, including child and maternal mortality, protection of the common environment, protection of the vulnerable, development and poverty eradication. WHO supports the attainment of these goals through a number of actions, including the development of appropriate indicators and strengthened reporting schemes on a variety of topics. The water and health-related Millenium Development Goals supported by WHO are:
Goal 4 : Reduce child mortality Target 5: reduce by two thirds, between 1990 and 2015, the under-5 mortality rate
Goal 6 : Combat HIV/AIDS, malaria and other diseases Target 8 : have halted by 2015 and begun to reverse the incidence of malaria and other major disease.
Goal 7: Ensure environmental sustainability Target 10: halve, by 2015, the proportion of people without sustainable access to safe drinking water Target 11: by 2020 to have achieved a significant improvement in the lives of at least 100 million slum dwellers.
Emerging problems
Challenges to meet the Millennium goals are wide and varied in the European Region. Some relate to interventions of a "classic" nature such as the control of cholera. Others require a closer co-operation between medical specialists and scientists from other disciplines. The need for co-operation will increase in importance when, for example, storage reservoirs built to deal with increasing water stress will at the same time increase the population of toxic cyanobacteria. Joint action will be required to safeguard water quality. Managing the risks associated with re-use of water, either directly or indirectly, is also likely to become an increasingly important topic.
Instruments
The Water Protocol - formally the Protocol on Water and Health to the 1992 Convention on the Protection and Use of Transboundary Watercourses and International Lakes - was adopted in London on 17 June 1999 in the framework of the Third Ministerial Conference on Environment and Health (16-18 June 1999). (6) It requires its parties to set targets and report progress on a variety of issues related to the surveillance and control of water-related diseases, including the development of water management plans (Article 6), international co-operation (Article 11), joint and international action (Article 12), co-operation in relation to transboundary waters (Article 13).
Articles 8, 12, 13, deal specifically with the response to extreme weather events. Public awareness, education, training, research and development, and information is dealt with in Article 9, while Article 10 sets forth the approaches towards public information.
The Protocol has been signed on behalf of 35 states in the WHO European Region,(7) and it has been ratified by Albania, Azerbaijan, the Czech Republic, Hungary, Luxembourg, Romania, the Russian Federation, and Slovakia. It will enter into force on the ninetieth day after the date of deposit of the sixteenth instrument of ratification, acceptance, approval or accession. It is anticipated that the sixteenth ratification will take place before the 4th Ministerial Conference on Environment and Health in Budapest, Hungary in June 2004.
In 1999, the UNECE/ISDR/WHO/WMO guidelines on sustainable flood prevention (8) were developed and include recommendations on water retention areas, land use, zoning and risk assessment, structural measures and their impact as well as early warning and forecast systems. The implementation of the guidelines will be assessed in the meeting of the signatory parties in 2004.
The United Nations Millennium Declaration and the recognition of water as a basic human right have been a great support for the work of WHO. However, many challenges remain to be overcome. Early ratification of the Protocol on Water and Health will be important to mobilise the resources of the countries of the Region to manage limited resources sustainably while preserving and improving health. Support of the NGO community to overcome these challenges would be most welcome.
Article submitted by R. Aertgeerts, B. Menne, H. Takasawa, WHO European Centre for Environment and Health, February 2003..
References
(1) UNESC ref.E/C.12/2002/11 dd. 26 November 2002.
(2) Lean and Hinrichsen 1994 (107) quoted on http://www.jhuccp.org/pr/m14/m14figs.shtml
(3) EEA (1999), Sustainable water use in Europe - Part 1: Sectoral use of Water, pp 8-9
(4) UNCCD, http://www,unccd.int
(5) EM-DAT, http://www.cred.be/emdat/
6. For information on the Protocol and activities specifically related to health, see http://www.euro.who.int/watsan/MainActs/20011210_3
7. Current status of Protocol signatures and ratification, http://www.unece.org/env/water/status/lega_wh.htm
8. Meeting of the Parties to the Convention on the Protection and Use of Transboundary Watercourses and International Lakes. Sustainable flood prevention. Geneva, United Nations, 2000.
