A public health issue

According to the Centers for Disease Control and Prevention, USA, each year, 1.7 million to 2.2 million persons die from waterborne diseases; one billion episodes of gastroenteritis and other infections are caused by unsafe drinking water globally; and each day, 5,000 children die from infectious diarrhea acquired from unsafe drinking water.

Pakistan also faces an alarming situation regarding water-borne diseases and compromised sanitation hygiene, which collectively are the major underlying determinants of child health and malnutrition. According to a recent World Bank study, 'When Water Becomes a Hazard', despite Pakistan having made a considerable improvement in reducing poverty, health – especially nutrition – indicators remains stagnant. The reason for that is stunting and wasting being linked with lack of access to safe water, inadequate sanitation facilities and basic hygiene practices because of repeated exposure to infectious diseases.

According to a Unicef report, contaminated water contributes to 40 percent of deaths in Pakistan. Another study conducted by Unicef found that 20-40 percent of the hospital beds in Pakistan are occupied by patients suffering from water-related diseases, such as typhoid, cholera, dysentery and hepatitis, which are responsible for one-third of all deaths.

The presence of toxic elements in water is quite common in many areas of Pakistan. It has been assessed that the primary source of contamination is sewerage, which is extensively discharged into the drinking water supply. And the other secondary source of pollution is the disposal of toxic chemicals from industrial effluents, pesticides, and fertilizers from agricultural sources into the water bodies.

Arsenic is another hazard in drinking water which can lead to many dangerous diseases and prolonged exposure to which can result in cancer. Arsenic occurs naturally in the earth crust. It is hard to notice in drinking water, as it has no colour, taste or smell. According to the World Health Organization, the accepted upper limit of arsenic is 10 microgram/liter, but researchers have found concentration limits up to 3,000 microgram/liter in some areas of the country.

Pakistan, being a signatory to the Sustainable Development Goals, is committed to achieve Goal 6 which ensures safe access to clean water and sanitation to its population. In order to attain the goal, various initiates have been taken in past. For example, Punjab Housing, Urban Development, and Public Health Engineering Department aimed to set up filtration plants in the provinces. Another initiative at the provincial level was the Saaf Pani Company Punjab, for the provision of clean drinking water to the community but somehow the company could not attain its objectives.

Recently, a bill approved by the Punjab Assembly by the name of the Aab-e-Pak Authority (PAPA) is all set to take off with an objective to supply clean drinking water. The National Water Policy 2018 and Punjab Water Act 2019 (in the final stages of approval) are the latest documents focused on addressing the issue by highlighting provision of clean and safe water to the community. Besides developing all these documents on paper, the need is to fully implement them with strong monitoring without political interference to achieve the required goals for the population of the country.

With an increasing population and dwindling availability of clean drinking water, there is a desperate need for the government to address the issue on an emergency basis. The burden of water-borne diseases is significantly impacting the health economics of the country. Preventive measures at both the individual and policy levels can help make a significant shift in health and nutrition indicators. For example, diarrhea, one of the immediate causes of malnutrition, is largely preventable through access to safe drinking water and basic sanitation. Promoting household sanitation activities can minimize the stress of childhood water-borne diseases, consequently improving nutrition status.

But the need is to make people aware about the issue at a mass level. In this regard, a collaboration of government agencies with the private sector is needed to increase population awareness and adoption of positive hygiene behaviours. Similarly, at the policy level a few immediate interventions are required. Most important is advocacy to secure political support for setting clear targets for access to quality and clean water, open-defecation-free environment, and other WASH preventive measures. Research and development to identify optimal technologies and messages to reach marginalized communities with clean drinking water and improved sanitation can also make a big difference.

The writer is a public health consultant.

Email: fauziawaqar_28@hotmail.com