2006 Dr Jamie Bartram: Drinking Water- Where Science Meets Policy

The Pumphandle lectures for the John Snow Society have covered a wide range of topics on the prevention or understanding of disease, but few have been so pertinent to the pumphandle theme as that chosen by Dr Jamie Bartram, Coordinator of Public Health and Environment at the World Health Organization’s headquarters in Geneva.

Dr Bartram started his career in water science in England and has now worked on the development and application of evidence-based policy and good practice to water sanitation and hygiene in 30 developing and developed countries around the world.

In this, the 14th lecture in the Pumphandle Series, Dr Bartram discussed the evidence used to inform policy in international water and sanitation initiatives. He argued that water health is an essential starting point for successful economic development. Inadequate or unsafe water supplies cause poverty via disease burdens, health care costs and the time and effort required to fetch water. In poor countries with comparable levels of per capita income, those with improved water supply and sanitation have a GDP (Gross Domestic Product) growth of 3.7%, compared to 0.1% in those without these facilities. Unsafe water causes high levels of diarrhoeal diseases, killing 1.8 million people each year and costing an estimated $7 billion annually to health agencies. Of the top 10 environmental contributors to disease burden, diarrhoea secondary to infection has the highest level of preventability. Other water related contributors, such as drowning and malaria, also score high on the preventable scale. Research has demonstrated that schistosomiasis (snail fever), infecting 200 million world-wide, could be reduced by 77% by improvement in basic sanitation. Possibly the lack of high quality epidemiological studies explains why other conditions or diseases still receive relatively more funding and investment. In the era of evidence-based policy, it has become more urgent to provide accurate estimates of the impact on health and poverty. Useful evidence includes the data on water outbreaks in developed countries such as the USA, household surveys and estimates of the impact of targeting urban slums as well as rural areas. Research is needed into real lifecycle costs for interventions before international funders can be persuaded to put in more interventions.

Water related disease: costly in many ways, but oh so preventable 152 years after Dr John Snow demonstrated that cholera was waterborne, this lecture demonstrated that water, sanitation hygiene and health is not a problem from the past but a growing current dilemma, with shameful ignorance about the evidence needed to “take the handle off the pump”.