Water for all: moving towards access to fresh drinking water and sanitation.

While over 70 per cent of the Earth's surface is covered by water, most of it is unusable for human consumption. According to the Government of Canada's Environment Department, freshwater lakes, rivers and underground aquifers represent only 2.5 per cent of the world's total water supply. Unfortunately, in addition to being scarce, freshwater is also very unevenly distributed. As many may know, the United Nations has compared water consumption with its availability and has predicted that by the middle of this century between 2 billion and 7 billion people will be faced with water scarcity.

Given this emerging reality, it is little wonder that water has been described as "the oil of the twenty-first century", a scarce commodity that will be a source of conflict between peoples and nations. If you think that is hyperbole, consider this: in addition to such a dire prediction, the United Nations also estimates that 1.2 billion in a world of just over 6 billion people do not have access to safe drinking water and 2.4 billion lack proper sanitation facilities.

In early 2005, the world had a powerful reminder of how tenuous access to safe drinking water could be. Following the tsunami that devastated southern Asia and parts of Africa in December 2004, the World Health Organization warned that as many as 150,000 of the estimated 5 million people affected by this natural disaster were at "extreme risk". WHO Director General Dr. Lee Jong-wook made it clear that the most urgent need was access to safe drinking water.

For many people in my home country, this is a difficult concept to grasp. After all, Canada is blessed with an abundance of safe drinking water and is ranked third in the world, behind only Brazil and the Russian Federation, in the supply of renewable freshwater. It has approximately 25 per cent of the world's wetlands, the largest on the planet. And almost 9 per cent of Canada's total area--more than 890,000 square kilometres--is covered by freshwater. However, as a prosperous country with this natural wealth, Canada has a moral obligation to lead by example and address the global problem of water scarcity, helping its neighbours gain access to a sustainable supply of safe drinking water and proper sanitation facilities.

The urgent need for action is quite clear. In the developing countries, 80 per cent of illnesses are water-related. Due to the shortage of safe drinking water in much of the world, there are 3.3 million deaths every year from diarrhoeal diseases caused by E. coli, salmonella and cholera bacterial infections, and from parasites like giardia and cryptosporidium, as well as viral pathogens like rotavirus. In fact, between 1990 and 2000, more children died of diarrhoea than all the people killed in armed conflicts since the Second World War.

However, the impact of water shortage goes far beyond widespread diseases in the developing world. In fact, unless we take action, this shortage could be the defining issue of the first half of the twenty-first century. Consider that between 1990 and 1995, global water consump-tion rose sixfold, which is more than double the rate of population growth, due in part to industrial demand. For example, it takes 300 litres of water to produce 1 kilogram of paper, and 215,000 litres to produce 1 metric ton of steel. Changes in our diet are also driving water consumption; it takes 15,000 tons of water to produce a ton of beef, while it only requires 1,000 tons of water for a ton of grain.

As nations like China, India and Mexico continue their rapid industrialization and catch up with the developed world, this consumption will only increase. Consider the depletion of aquifers--the vast natural underground storage systems that provide many with drinking water. As a result of over-consumption and depletion of its water table, Beijing is sinking into the ground at the rate of 4 inches per year. Certain barrios in Mexico City sink as much as a foot a year. China is an excellent illustration of the daunting water management challenge that we face in this century. It has approximately 21 per cent of the global population, but access to only 7 per cent of the planet's freshwater. This situation is exacerbated by its rapid industrialization, with millions of people migrating from the countryside to the cities, a greatly increased use of indoor plumbing and changing diets that include water-intensive foods like beef and pork.

In recent years, the increased water use by cities and big industries has led to a shortage of water for agricultural production. For example, in the eastern Shandong province, which grows much of China's grain, the shortage led to a number of dry years at the beginning of this century. As a result, a report in 2002 stated that 9 million people faced a grain shortage. Those of us in North America should not assume that these changes do not affect us. In fact, water shortage will have a major impact on all of our lives. For example, were China forced to make up such a large grain shortfall on global markets, grain prices for the rest of the world could be expected to rise dramatically. Alternatively, North America would be affected by water-driven tensions in the Middle East, or by the spread of water-related diseases in Africa.

Given recent developments and the potential water shortage that looms on the horizon, it is understandable that the United Nations launched in March 2005 the "International Decade for Action: Water for Life, 2005-2015", appropriately named to focus on the need for safe drinking water worldwide. Of course, we should not need a United Nations declaration that water is an essential human right in order to motivate us. We must take what we have learned from our own drinking water tragedies, including the use of new water purification technologies and the need for water-treatment protocols, and provide ongoing resources and expertise to the world. Fortunately, the Government of Canada has already taken the first, albeit largely symbolic, steps that would allow it to do so. The Action Plan on Health and Nutrition of the Canadian International Development Agency (CIDA), released in November 2001, identified several areas for action, including improving access to clean water and sanitation.

Canada's funding for health and nutrition programmes in the developing world has more than doubled during the 2000-2005 period, increasing from $152 million to $305 million per year. This represents a total investment of more than $1.2 billion over five years. At the same time, it is worth noting that CIDA is involved in a number of projects designed to help people gain access to safe drinking water and sanitation. For example, in Honduras, a rural water-supply project combines construction of new water systems and latrines with the training of local people on the safe storage and handling of water, and on causes and prevention of common waterborne diseases. In the West Bank and Gaza, CIDA is funding a reconstruction project that targets basic water and sanitation services, and in the town of Keren in Eritrea, it is supporting a rehabilitation and expansion of water and sanitation services. These and other initiatives led by CIDA are excellent examples of Canada's commitment to helping the developing world address its needs regarding safe drinking water and sanitation.

However, there is much more that we should and could be doing. An excellent example is the Disaster Assistance Response Team (DART) mission to South Asia, which did so much in Sri Lanka following the December 2004 tsunami disaster. The DART operation has the capability of producing 150,000 to 200,000 litres of safe drinking water a day, using a Canadian-built Reverse Osmosis Water Purification Unit--an advanced water treatment system capable of purifying any water source in the world. Indeed, it can be used to treat water contaminated by nuclear, biological or chemical warfare agents, as well as fresh, brackish and sea water. During the mission in Sri Lanka, DART produced a total of more than 3.5 million litres of drinking water. Canada could expand the use of this technology and make bringing safe drinking water to the developing world the top priority of its international development efforts. This would address one of the most pressing health questions of our time.

Another option for action can be seen in the work of WaterCan, a Canadian non-governmental organization dedicated to providing safe drinking water to some of the world's poorest. All of its projects include three key components: appropriate water systems, sanitation facilities and hygiene education. Since its inception in 1987, this organization has helped more than 1 million people in 32 developing countries. In partnership with the Canadian Physicians for Aid and Relief-Uganda, WaterCan in 2003 completed what it called the "Safe Water and Sanitation Project for Aber and Iceme Sub-counties". Its key accomplishments include: the development of 45 shallow wells, 39 protected springs and 17 rainwater tanks that directly benefit more than 50,000 people; training of 102 villagers as water-source caretakers to ensure that new water systems are properly operated and maintained; casting and distribution of 1,000 cement slabs for the construction of latrines by local families; and hygiene education activities carried out in the general community and local schools. As a result, people in Iceme now have the capacity to operate and maintain their own water systems, and more than half of the households use some type of pit latrine. Villagers report that their health, especially among young children, has improved.

We in Canada and the rest of the developed world are fortunate to have the ability and the resources to help our neighbours around the globe. If the tsunami disaster taught us anything, it is that we are all connected, no matter where we live. Let us draw inspiration from that and make the "International Decade for Action" an "International Decade for Results". Let us use our expertise to make this world a better, safer, healthier place for all peoples.

Albert J. Schumacher, MD, is President of the Canadian Medical Association and has been a member of its General Council since 1989. He is a former Chair of the Ontario Medical Association, of which he has been a member for 18 years. Dr. Schumacher is active on the issue of medical education and was a founding chair of the Medical Student Bursary Fund.

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The Water for Life Decade Logo depicts a fountain of water painted in dark blue. The fountain consists of two cupped hands rising out from an ocean of water represented by two horizontal broad wavy lines. In a point-line style the water streams out of the fountain in both directions, portraying water that is harnessed 'for Life'.

DRINKING WATER

             Coverage in  Coverage in  Projected coverage  MDG attained
Region       1990 (%)     2002 (%)     in 2015 (%)         target (%)

World         77          83           90                   89
Developed    100          98           96                  100
  countries
Eurasia       92          93           94                   96
Developing    71          79           88                   86
  regions

             Population served and
             unserved in 2002       Projected population served and
             (thousands)            unserved in 2015 (thousands)
Region       Served     Unserved    Served     Unserved

World        5,150,169  1,074,706   6,442,043  755,208
Developed      978,159     14,896     997,505   41,563
  countries
Eurasia        260,965     20,005     257,217   16,418
Developing   3,911,045  1,039,805   5,187,321  697,227
  regions

                               Annual increase
                               needed in people
                               served 2002-2015
             Annual increase   to reach the MDG
             in people served  drinking water
             1990-2002         target
Region       (thousands)       (thousands)

World        91,163            99,375
Developed        ID                ID
  countries
Eurasia          ID                ID
Developing   86,345            98,175
  regions

SANITATION

             Coverage in  Coverage in  Projected coverage  MDG attained
Region       1990 (%)     2002 (%)     in 2015 (%)         target (%)

World         49           58          68                   75
Developed    100           98          96                  100
  countries
Eurasia       84           83          82                   92
Developing    34           49          63                   67
  regions

             Population served and  Projected population served and
             unserved in 2002       unserved in 2015 (thousands)
             (thousands)
Region       Served     Unserved    Served     Unserved

World        3,606,595  2,618,280   4,918,571  2,278,680
Developed      973,194     19,861     997,505     41,563
  countries
Eurasia        231,182     49,788     224,381     49,254
Developing   2,402,219  2,548,631   3,696,685  2,187,863
  regions

                               Annual increase
                               needed in people
                               served 2002-2015
             Annual increase   to reach the MDG
             in people served  sanitation water
             1990-2002         target
Region       (thousands)       (thousands)

World        87,164            137,796
Developed        ID                 ID
  countries
Eurasia          ID                 ID
Developing   84,193            118,494
  regions

Source: Water for Life: Making it Happen [c] WHO and UNICEF, 2005
ID -- Insufficient Data