Target 10 was launched in 2000 as part of the U.N. Millennium Development Goals initiative, a global effort by member nations "to meet the needs of the world's poorest." The target is based on data from 1990, when 20 percent of the global population lacked a safe source of drinking water and 45 percent had no access to sanitation facilities. Now, halfway to the deadline, experts warn that the United Nations is on track to achieve only part of the Target 10 objective.
"The target of reducing to one-half the proportion of people who do not have access to improved water supplies will probably be met," said Jennifer "Jenna" Davis, assistant professor of civil and environmental engineering and a fellow at the Woods Institute for the Environment at Stanford. "[But] on the sanitation side, we're in big trouble. We're probably going to miss that goal by 500 million people."
Sanitation, the 'poor cousin'
Today, more than 1 billion people worldwide live without a safe drinking water supply and more than 2.5 billion people don't have basic hygiene facilities, according to the United Nations. Davis, a participant in the U.N. Millennium Project task force, attributed the lack of success in reaching the sanitation target to a myriad of reasons, starting at the level of the individual. "If you have a lack of resources and you have to decide whether to invest in having clean water or in having sanitation facilities, you're going to be going for the water," she said. "It's a rational prioritization in the short term. Everyone can figure out a place to defecate if forced to do so."
Politics also has contributed to the slow progress toward the sanitation target, she added, noting that in many countries there is simply no institution in charge of developing and enforcing sanitation policies. "But there's also a lack of leadership in stepping out and saying, this is a national crisis, it's a matter of dignity, and I'm going to change it," she said. "This is not surprising-championing excreta is just not as politically sexy as championing water."
Access to water and sanitation are "critically important" and intertwined, she noted. "Improving the quality of water at the source may have little effect on a household's health if, for example, that water is re-contaminated during storage by family members with inadequate hygiene practices. On the other hand, without a sufficient quantity available to the household, it is exceedingly difficult to practice good hygiene, such as hand washing."
In addition to health benefits, clean water and sanitation also have a positive effect on education and the economy, Davis added. "Having sanitation facilities in schools has a differential impact on girls' attendance at school," she said, noting that school attendance among girls goes up when there are separate sanitation facilities, especially after they reach puberty.
Better water and sanitation also can reduce the time that women and children spend fetching clean water, giving them more time to attend school or engage in other productive activities, she noted.
At the national level, economic development strategies, such as attracting foreign investment and tourism, often rely on good water quality and sanitation, Davis said. However, wealth does not necessarily translate into improved water and sanitation services. "Tracking the progress of countries from 1990 to 2004, we do see that countries that are at risk of missing either or both targets are more likely to be in the lowest income categories," she said. "They are a lso the fastest growing countries, with population-doubling rates of about 30 years. At the same time, some of the wealthiest developing countries have made very little progress toward the water and sanitation targets."
On the other hand, some of the world's poorest countries have made impressive strides toward the targets, she said. In Myanmar, for example, where the 2005 per capita gross domestic product was only about $1,700, the sanitation target has already been met. According to Davis, political commitment has been a crucial factor in Myanmar, which has celebrated a National Sanitation Week each year since 1998 and has incorporated sanitation services into its national health policy. By contrast, neighboring Indonesia, with a per capita gross domestic product of $4,500, is lagging in its efforts to expand access to sanitation services and is expected to miss the 2015 target.
Despite the challenges, Davis said that it is still possible to meet both Target 10 goals, because in recent years new actors, such the Bill and Melinda Gates Foundation, and new strategies, such as focusing on sanitation in rural as well as urban areas, have emerged on the scene.
"It would be simpler to meet the national targets by focusing on urban areas, because you can serve more people more quickly when they are clustered together," she said. "From a public health perspective, you may also argue that it's the smart thing to do, because densely settled areas are particularly vulnerable to the transmission of waterborne diseases. But from an ethical perspective, such a strategy is untenable."
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