|Water and Health in Europe (WHO, 1999, 70 pages)|
Water - the basis for development and wealth
Developments and improvements in health across the European region over the centuries have been possible on the basis of proper management of the vital resource water. Effectively managed, water supply and resource protection systems, generate the inevitable basis for agricultural and industrial production. Healthy urban and rural development occurred throughout the region, where effective water source management has taken place. While in many growing cities in the Region this process started as early as the 15th and 16th century, at least five decades of the 19th century saw water as a central occupation of all State and industrial leaders. As a result, and in the course of the first half of the 20th century, life expectancy increased, food supply became more healthy and infant mortality decreased. A number of major diseases no longer posed a serious threat to the health of European people. Scientific and technical development has made excellent water supply feasible for public, farming and industrial purposes all over the region. With only a few exceptions, the region as a whole was, by the mid-1970's, on the way to eradicating water-related diseases and to guaranteeing safe water to all.
It is obvious that industrial development and wealth has been dependent upon safe and reliable water supply and management. It has been demonstrated as the single most effective investment in economic and social development, and no other part of socio-economic development has continued to be as incredibly cost-effective in relation to the wealth created. Over a wide range of income distributions, citizens in rich and poor countries have to invest less than 1 per cent of the average income to ensure excellent water supply and resource management. This may be perceived as a major success. But, on the other hand, it may also be the reason for the loss of focus on the central role of water in societies' development and well-being: Always present and cheap, water supply has been taken for granted, and efforts to build and maintain both technical and human resources have lost their visibility and political weight. Instead of sustainable development, progressive erosion of responsibility by individuals, industry and civil servants has been realised. The withdrawal of public and governmental responsibility, gave room for privatising attractive portions of the available funds while basic elements were ignored or left to the public. While this happened mainly in the west of the Region, the eastern part failed to encourage local responsibility and accountability, with the sole result that locally visible processes of decay and lack of maintenance were omitted from the agenda of political and economic decision-makers. Thus, east and west clashed in the early 1990s with two accelerating processes of destabilisation, in public services in general, and in water management in particular.
Combating the creeping freshwater crisis - in competition or partnership?
The competition amongst agriculture, industry and urban areas for limited water supplies has intensified with populations increase and economies growing. The intensification of agriculture, modern forestry practices and the diversions of water for irrigation are key areas that place additional stresses on water resources. Widespread mismanagement of water resources in the past amongst all sectors - industry, farmers, large urban populations and small communities has contributed to the creeping freshwater crisis silently threatening the European Region. Little recognition has been given to the worsening local conditions in the privatised water supply of the United Kingdom, while water abuse in cotton farming under the Soviet regime was publicly accused. The continuous water crisis in southern European farming regions remained largely unchanged, even though, considerable quantities of water diverted or pumped for irrigation is wasted. Abuse of large bodies of water such as the two big rivers feeding 60 billion cubicmeters annually into the Aral Sea basin, the irreversible deterioration in surface water quality by urban and industrial waste, saline intrusion of coastal aquifers and contamination of groundwaters by nitrates, are all examples of avoidable stress on water resources that are available and suitable for required uses. Poor recognition of relations between quality and quantity of water bodies increases the potential for water-related diseases.
The past has seen considerable economic resources invested in water borne sanitation such that the tools needed to maintain water resources of good quality and quantity are available. To meet the continued demands for high quality water well focussed investment of little additional money is still required to be spent to treat water to an acceptable quality and handle it in a sustainable way. Increasing costs of municipal and industrial wastewater disposal for pollution abatement accelerates the need for alternative technologies for protecting drinking water resources without producing sewage. Effective management of water is essential to reverse the reducing availability of suitable resources.
Public or private? Take responsibility!
Inconsistent legislation on one hand and ineffective implementation of existing laws on the other hand, together with loss of responsibility and staff in public supervising agencies, in eastern Europe the weakening or destruction of the Sanepid institution, accelerated the destruction of resources. At the same time, collapsing industries in eastern Europe released rivers, lakes and groundwater from some of the continuously-flowing pollutants. Non-coherent and inconsistent EU directives, together with varying national policies of implementation, created a huge administrative burden, but only reduced the speed of destruction of water resources. Despite a broad variety of political action, the Aarhus - report of the EEA could not identify substantial improvement of Europe's water quality.
Technical requirements in legislation were far behind what has been proven to be cheap and effective wherever local awareness and interest has resulted in excellent performance. Examples such as resolving the ecological crisis in the Ruhr-Gebiet (Germany) between 1910 and 1960, implementation of advanced sewage treatment in Sweden or Switzerland in the 1970s and '80s, and co-operatives between water supplies and farmers in several areas across the region gave rise to hope.
Price or value - the precious public good
Economic efficiency, rather than a simplifying attitude to focus every political action on economic growth, is an important development objective in many countries. The financial burden on users to pay for water together with sanitation is incredibly low in comparison to the health cost incurred in the case of failure. In the overall context of increasing and health cost, water has to be highlighted as a central political issue. Over 30 million cases of water-related disease could be avoided annually through water and sanitation interventions. Investing in water supply and sanitation has produced benefits far above those directly related to cost of treatment for water related diseases.
The organisational structure in water services throughout the region has seen an increasing trend towards private sector participation - varying from a wholly privatised water industry in England and Wales, a part private system in France, and a variety of other approaches ranging from direct operation and management by local authorities, to economic enterprises governed separately by public administrations. However the effectiveness of some of the privatizing approaches in terms of public health as well as in economic terms, still need to be evaluated, while publically provided water services over many decades have proven to be most effective - world-wide!
Services in central and eastern European countries are now predominately run by local administrations, who have lost recognition and resources. It seems to be difficult for the international funding agencies, to invest into local sustainable water and sanitation services. This is not only due to the fact, that low (or no) water prices cannot help to raise enough funds for the needed reconstruction of damaged networks and treatment facilities. Basic issues still need to be addressed such as the provision of a continuous supply of water of adequate microbiological quality.
Public valuation and participation
The willingness by consumers to pay for water of good quality is huge - the growing consumption of bottled water in a number of countries - Austria, France, Spain, Italy and Switzerland for example is one way to illustrate this. Due to lack of confidence in the quality of their tap water, many individuals have invested a lot into household filtering devices - not knowing that most of these filters do not effectively control contaminants or pathogenic germs. Public pressure and a greater awareness have helped to create and conduct to a number of pollution control programmes in the past decades in several European countries. But increasingly people are seeking cleaner waters for recreation and are prepared to pay in the form of travel, to recreational waters of good quality. The internalisation of external costs thus challenges the existence of the 'polluter pays principle': at least in the area of water quality, the "consumer pays principle" is valid. As globalisation of trade increases, internalising the costs will be more and more complicated.
It is clear that the detachment of activity from responsibility is accelerating the crisis. Participation by NGOs and other private sector groups is crucial to improving the management of water resources. Many NGOs originate from local initiatives and are independent and self managed. Their knowledge of local issues and conditions as well as their local contacts aid the motivation and awareness of local communities to advocate change. The co-operation of such organisations with public efforts at community or national level is essential to providing an improved environment for human health. Public policies need the consent and sometimes the active participation of individuals. Accepting responsibility is an important and basic element.
New commitment building up
Having recognized the impeding force of non-coherent legislation, the member States of the European Union agreed to develop the 5th Framework Directive in order to produce an instrument for integrated water management, aiming to create a holistic framework for the protection of inland surface waters, transitional water, coastal waters and groundwater. At the same time, the obvious need for action also outside the EU resulted in the European Member States decision to embark on a pan-European legally-binding instrument. Focussing on health and wellbeing targets in all member states, this 'Water Protocol' will foster partnerships in order to improve the outcome of water supply and resource management with a focus on Health for All. Intersectoral action has been placed in the centre of the new health 21 Policy by all Member States of the EURO Region at the Regional Committee Meeting in Copenhagen 1998.
This type of action needs a well-established and widely agreed database - not only about health concerns, but much more about ways of developing sustainable, healthy and economically sound water management systems. This publication on the one hand gives an overview from many perspectives:
· Comparison between countries of availability of water resources
· Variations in data collection and density in various parts of the region
· Different types of stress on water quality and quantity
· Differences in economic valuation and pricing of water use and services
The compilation of country reports is hiding a most important aspect of water management and health in Europe: In almost every country, we can identify a large variety of good and bad approaches - to solve or to create problems related to water and health. Further work is needed to elaborate the general essence coming out of many case studies of 'environmental excellence'.
May this publication be a starting point for identifying excellent approaches. Most of these have been proven to be not only good for health and wellbeing, but also economically sound and sustainable. There is no reason to implement the 'average' bad performance mechanisms, but good chances to develop awareness and engagement for best solutions. The motivation and expectations of individuals is high and must be encouraged and realised - the successful management of water resources will depend on the ability and willingness of the regulators to meet those expectations.