Documente Academic
Documente Profesional
Documente Cultură
environmental health
Pete Kolsky
Energy and Water Department
Outline
Some facts about water, san and
health
Historical evolution
Classification by transmission
The Literature of impact studies
The nature of the problem
Conclusions for practitioners
Some water, sanitation and
health numbers
Faecal-oral (focus of this presentation)
Diarrhoeal disease
2 million deaths/year from diarrhoea, mostly under 5
Jumbo jet crash every hour and a half…
One billion cases/year
4.3% of Burden of Disease DALYs
88% (?) attributable to inadequate WSH
1/3 of developing world pop’n carry intestinal worms
200 million infected by schistosomiasis (bilharzia)
6-9 million blind from trachoma (1/4 reduced by
adequate water supply)
Natural chemical hazards
Arsenic
Skin lesions, various cancers
“20 to 60” million exposed in Bangladesh
Major problem other parts of S. Asia, also
Argentina, Chile, China, Hungary, Mexico, Peru
Fluorosis
Dental damage, crippling bone damage
“affects millions” (WHO) but often of mild form
Historical evolution: water
quality and health
John Snow Cholera
Broad Street Pump 1854
Water Companies' Studies
William Budd Typhoid in 1850's-60's
Koch Cholera
vs. Pettenkoffer Hamburg/Altona 1892
1937 Croydon Typhoid
And many more…
Characteristics of these (and
other) waterborne outbreaks
1. True outbreaks…sudden spikes
Very visible and dramatic!!
Politically hot!
2. Common source…the water supply
If you’re a water engineer…you don’t want one on
your watch!
Cholera is the water engineer’s best friend…Money for
chlorine suddenly becomes available…
3. Until 1970s, water quality dominated
environmental health perception of diarrhoea
Classifications of disease
Classification usually by organism (viral,
bacterial, etc) or organ (diseases of
head, heart, liver etc.)
Classification by transmission route
Bradley’s great innovation in 1970s
If you know how it’s spread, you know how
to stop it…
…so engineers loved it!
The F-Diagramme
Water supply
Fingers
Faeces Food Future
Victim
Flies
Fields/
Floors
The great debates of the 80s
Water-borne or water-washed?
Is water quality or water quantity more important?
Fingers
Faeces Food Future
Victim
Flies
Fields/
Floors
How people see their city
River &
Environs
City
Peri- Ward
domestic
Home
(street,
school,
work-
place)
An environmental view
Home
Peri-
domestic (street,school,
Ward workplace)
City
Central Treatment
Works
Collectors
Street
Sewers
House
Connections
A public health view
Street Sewer River &
Sewer Mains Environs
City
Peri- Ward
Interceptor/ domestic
Collector Home
House
Connection
Treatment
Plant/Outfall
Take home messages…
Diarrhoea is a huge problem in child health
Water, sanitation and hygiene can reduce diarrhoea between 25-
50%…
Very broad consensus that:
Focus on the household…
Hygiene matters!
Water quality matters, but it’s not “just” water quality…faecal
contamination gets around many ways
Sanitation, WS infrastructure can make hygiene possible!
Health studies are tough…live with indicators rather than “health
outcome”
HH water treatment continues to be a growing focus of attention…
perhaps even more relevant for chem. contam.
Thank you for your attention!