Water Management is Health Management

With climate change accelerating and its effects exacerbating other geopolitical and development crises, the role of environmental protection in preserving and improving human wellbeing has become starkly apparent. This recognition lies at the heart of the concept of “planetary health,” which focuses on the health of human civilization and the condition of the natural systems on which it depends.

***BY GIULIO BOCCALETTI***

The concept’s logic is simple: If we try to deliver better health to a growing population, without regard for the health and security of our natural resources, we will not just struggle to make new strides; we will reverse the progress already made. Where things get complicated is in applying the concept, particularly when addressing the nexus of water services, health and ecosystem integrity.

Since at least 1854, when John Snow discovered that cholera was spread through contaminated water supplies in central London, humans have understood that polluted water is bad for our health. The degradation of freshwater ecosystems often brings disease, just as the protection or strengthening of such ecosystems improves health outcomes.

But, while it is now well understood that progress in one area improves outcomes in another, such co-beneficial dynamics often are insufficient to spur investment in both areas.

For example, investing to protect a watershed can also protect biodiversity and improve water quality in associated rivers, thereby benefiting human health. But if the goal is explicitly to improve human health, it might be more cost-effective simply to invest in a water-treatment plant.

A more compelling dynamic is complementarity: when investment in one area increases the returns on investment in other areas. In this scenario, investments in protecting a watershed would aim not just to produce returns directly, but also to boost the returns of simultaneous investments in human health. Complementarity produces mutually reinforcing dynamics that improve outcomes across the board.

A well functioning water sector already attempts to balance complementary interventions. Indeed, such a system amounts to a multidisciplinary triumph of human ingenuity and cooperation — involving engineering, hydrology, governance and urban planning — with far-reaching complementary impacts on both human health and economic development.

In 1933, through the Tennessee Valley Authority Act, the United States established an agency whose purpose was to build hydroelectric dams on the Tennessee River. That effort benefited industry, agriculture, flood control and conservation throughout the Tennessee Valley watershed, until then one of the country’s most disadvantaged regions.

Since then, governments all around the world have recognized the potential of water infrastructure to complement other economic and social policies, including those intended to improve health outcomes. It is no coincidence that one of the World Bank’s largest lending portfolios — $35 billion worth of investments — comprises water projects.

But understanding the potential of complementarity is just the first step. To maximize results, we must design a coherent strategy that takes full advantage of the dynamic, at the lowest possible cost. The question is whether there is an optimal mix of environmental protection and direct health interventions on which policymakers can rely to maximize investment returns for both.

A recent analysis suggests that, in rural areas, a 30 percent increase in upstream tree cover produces a 4 percent reduction in the probability of diarrheal disease in children — a result comparable to investing in an improved sanitation facility. But, if that is true, we have yet to determine at what point reforestation becomes a better investment than improving sanitation, let alone increases the returns of other health interventions by the highest possible amount.

Another study found that an estimated 42 percent of the global malaria burden, including a half-million deaths annually, could be eliminated through policies focused on issues like land use, deforestation, water resource management and settlement siting. But the study didn’t cover the potential benefits of employing insecticide-treated nets as a tool for fighting malaria, ruling out a comparison of the two investments’ returns.

Worldwide, around 40 percent of cities’ source watersheds show high to moderate levels of degradation. Sediment from agricultural and other sources increases the cost of water treatment, while loss of natural vegetation and land degradation can change water-flow patterns. All of this can adversely affect supply, thereby increasing the need to store water in containers — such as drums, tanks and concrete jars — that serve as mosquito larval habitats. Can we show that ecological restoration of the watershed could do more than just insecticides or mosquito nets to support efforts to reduce malaria (and dengue) in cities?

In all of these cases, finding the best option requires knowing not just the relative contribution of different interventions, but understanding their complementarity. In a world of limited resources, policymakers must prioritize their investments, including by differentiating the necessary from the desirable. To that end, finding ways to identify and maximize complementarity is vital.

Some 2.1 billion people worldwide lack access to safe, readily available water at home, and more than twice as many — a whopping 4.5 billion — lack safely managed sanitation, severely undermining health outcomes and fueling river pollution. With a growing share of the world’s population — including many of the same people — feeling the effects of environmental degradation and climate change firsthand, finding solutions that simultaneously advance environmental protection, water provision and health could not be more important. Global health and conservation professionals must cooperate more closely to find those solutions — and convince policymakers to pursue them.

Giulio Boccaletti is chief strategy officer and global managing director for water at The Nature Conservancy. © Project Syndicate, 2018

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• Public Health
• Environmental Health
• Ecological Sanitation
• Rural Water Supply & Sanitation
• Sanitation
• Sustainable Sanitation
• Water & Sanitation
• Waterless Sanitation
• Sanitation & Hygiene
• Sanitation & Hygiene
• Sanitation Services
• Sanitation & Waste Management
• Sanitation and Hygiene
• Water Sanitation & Hygiene (WASH)

1 Comment

1. No effort at the local level can protect the environment. A single concept of saving the planet is needed.
   Millions of years created water in symbiosis with the biota. For several hundred years a man has been trying to unravel her secrets. Can not. Uses it, just as a working body. It is a mobile very complex solvent and a supplier of substances to each object, living creatures and plants on Earth. The way of its transformation in the circuit through soil, flora and fauna, evaporation and participation in atmospheric phenomena, return to the soil. In each of these links it changes its properties, appearance, structure. We are cutting this way. We deprive her of her main destiny in advancing through food and vegetable channels. With the development of civilization, mankind destroyed biota with arable land, reservoirs, dumps, asphalt. This territory has become more than 60 percent of the land inhabited by the area and every day it grows. An abridged way of transforming water has appeared: a draft - movement in pipes, work for a person as a coolant, a washer, a cooler - an outlet into the sewage system and evaporation. It is assumed that the volumes of such evaporations, let's call them artificial, exceeded the volumes and speed of organic, natural fumes, created a new phenomenon: the circulation of artificial fumes, changed the celestial mechanics, the essence of atmospheric phenomena, the natural disasters became more frequent, the climate changed.
          Groups of scientists have revealed that all this comes from CO2 emissions. This hypothesis has become the only direction in "mitigating the effects of climate change and adaptation." It seems that it has become a dogma, and leads the planet to disaster. Occupying the whole of mankind with microscopic efforts to reduce harmful emissions, a person continues turning the rivers, building new reservoirs, opening new mines, plowing the land, paving and concreting the remaining 40 percent of the territories, continues to destroy the biota. And the development of new technologies with increasing "slavery" of water finally deprives her of life-giving paths and abilities. Not to mitigate the consequences it is necessary, but to return to nature its primordial functions, to return the taken away areas, organic evaporation. And to reduce artificial evaporation. This requires the creation of a new concept in the relationship with water. With such here, approximately, elements:
   • Create a new ideology for the entire population of the Earth about the total economy of water and energy. For example, stop squandering water when washing. We brush our teeth and the water flows. Adjust the temperature of the jet for washing, and clean water goes to the sewer. Centrally heat the water, pipes, atmosphere and mix with the cold in the shower, the sink, the shower. Do not use the heat of water leaving the sewer. We wash out of the toilet bowls with clean drinking water, although devices using water for washing after handwashing are known.
   • Switch to a full-scale reconstruction of agriculture: develop drip irrigation, and non-plowing.
   • Stop the construction of new reservoirs and release water from old ones. There are interesting technical solutions for the release of water from reservoirs with the preservation of hydroelectric power stations.
   • Eliminate the creation of new landfills and dumps, eliminate existing ones.
   • Walls and roofs, existing residential and industrial buildings, completely covered with plants. There you can develop a new direction in the production of vegetables and fruits. New production facilities, urban infrastructure, and housing build underground, as a continuation and development of subway construction, and under water. There are real projects, and even construction, of such cities.
   • Very large areas are flooded with water in floods, also leading to artificial fumes that kill biota. This happens because the rivers are silted and form rolling - underwater dams, invisible from the coast.