Module 5: Inequities in Water Accessibility

Access to piped water has been a significant factor in health improvements in most developing regions.  As opposed to other water sources, piped water can provide water to homes, plots, and yards and is thought to be the safest drinking water source, provided that the pipes are maintained to ensure water quality.(1)  On average, urban households have more piped water coverage than rural households, but large inequities exist between and within cities. 

For example, while wealthy city dwellers may experience a comfortable availability of safe drinking water, 137 million urban inhabitants do not have access to a quality water supply.(2) Water transmits over half of the world’s diseases, and 25 million deaths occur annually due to water pollution.(3) The most substantial gaps exist between the richest and the poorest city dwellers of Africa, the Americas, and Asia, but it is also important to consider the inequities that exist along the entire socioeconomic gradient.  Though correlations vary between regions, studies indicate that the level of piped water access corresponds to the wealth of those accessing it.  In some countries such as Mozambique, this difference is very large, while in other countries, including Morocco, inequities are less notable. Within cities, slums are usually overlooked, and administrative data often refers to existing water sources without taking into account whether or not they are actually usable. Though water systems may be in place, they need to be maintained in order to provide safe and potable water.(4) 

Living Conditions: Sanitation and Consumption

Many of the health burdens suffered by impoverished urban dwellers are related to water-borne diseases.  Insect vectors breed in standing water found in water storage containers such as pots, small tanks, cisterns or small cans around the house.  These areas of standing water provide breeding grounds for Anopheles mosquitoes that spread malaria, as well as for Aedes mosquitoes that spread dengue fever, dengue hemorrhagic fever, and yellow fever.(5) Improving access to piped water reduces the spread of these diseases because people no longer have to store water in vulnerable open areas.

Apart from mosquito-related diseases, a range of hygienic health issues stem from lack of piped water.  For example, in a study of housing settlements in Cape Town, South Africa most houses had no tap water near the toilets; after using the toilet, residents had to wash their hands in the tap where food was prepared.  This one tap was also used for bathing, washing, and other activities that could transfer pathogens to food.(6) The shortage of water in impoverished areas also leads to increased sharing of facilities, and consequently less sanitation in toilet areas.  In Kampala, Uganda only 10% of the population has a private toilet, while 75% share a toilet and 15% use a public pit latrine.(7) Lack of access combined with cramped conditions creates a multitude of sanitation-related health risks that can be eliminated with more effective distribution of safe water.

In addition, consumption of water can be dangerous in some urban areas.  A study conducted in urban slums of Indonesia determined that the poorest families could only afford inexpensive drinking water, which was associated with more cases of diarrheal morbidity, malnutrition and infant mortality.  Urban slums generally use an informal water market that includes cart vendors, water tank operators, and neighbors reselling water from wells or taps.  A recent study in Jakarta found that people who used pumps or running water were generally of the same health status as those who purchased the more expensive and treated water.  However, it was the individuals who did not have access to running water that bought the lower-quality bottled water.  Many people in the study recognized that the street vendor water was not safe and that it must be boiled before drinking, suggesting that this is not a case of lack of information, but of a lack of physical and economic accessibility.  Discussions of alternative solutions include point-of-use water treatments, household based chlorination, filtration, solar disinfection, and improved water storage.(8)                 

Water Shortages and Pollution

In the larger picture, urban water shortages and water pollution can affect an entire city and its surrounding regions.  In poor areas, the only drainage system available is often flushable toilets, so people waste a great deal of water by flushing away dirty water and waste.(9) This leads to significant city water shortages even though it improves sanitation in individual households.  Moreover, sanitation, by necessity, uses large volumes of clean water, further contributing to the shortages.  Countries could conserve more clean water by separating the water needed for consumption from the water needed for washing, as the latter would still be safe at a lower quality.(10)

Apart from physical water shortages, many shortages occur based on the availability of unpolluted water.  In countries with weak piping systems and maintenance, a large proportion of water (up to 70% in some developing countries) leaks through pipes and makes quality water coverage more costly.(11) Many cities face major obstacles in dealing with water pollution from human and domestic waste, poor sewage and water treatment systems, and recycling of water.  Waste can also contaminate areas outside of the local environment through groundwater, lakes, and rivers that are used for fresh-water supplies by communities in surrounding areas. In nations that provide frequent treatment, river water is often recycled repeatedly before it reaches the ocean.  However, in developing countries that lack adequate treatment services, river water becomes unsafe to use once it is polluted after passing through one city.(12)

Case Study: Inadequate Sewerage in China

Several cities in China have suffered from poor regulation of sewerage.  On average, only 4.5% of China has wastewater plant coverage, leading to considerable deterioration of water quality nationwide, as well as consequent economic losses.  The city of Jinzhou suffered so tremendously from pollution that their existing well water became undrinkable and the construction of new wells cost $18 million.  Similarly, Shanghai spent $300 million to move its water supply 40 kilometers away to avoid polluted water surrounding the city.(13)

Other Concerns

Many cities have grown so large or have mismanaged their local water supply that they can no longer provide enough fresh water from local sources.  Coastal cities have over-pumped local aquifers, resulting in saltwater infiltration.(14) Additionally, groundwater resources have been overexploited, resulting in costly side effects.  In Bangkok, for instance, groundwater was over drafted to the point where the land fell below sea level and the region now experiences severe flooding.(15) Today, increasing numbers of cities are obtaining their water from distant and expensive water sources to the disadvantage of the areas from which it is drawn.(16)

Footnotes

(1) World Health Organization (WHO), and United Nations Human Settlements Programme (UN-HABITAT). Hidden Cities: Unmasking and Overcoming Health Inequities in Urban Settings. 2010.

(2) Shetty, P. (2011). Health Care for Urban Poor Falls Through the Gap. The Lancet 377: 627-628. 

(3) Niemczynowicz, J. (1999). Urban hydrology and water management–present and future challenges. Urban water, 1(1), 1-14.

(4) World Health Organization (WHO), and United Nations Human Settlements Programme (UN-HABITAT). Hidden Cities: Unmasking and Overcoming Health Inequities in Urban Settings. 2010.

(5) Satterthwaite, D. (2003). The links between poverty and the environment in urban areas of Africa, Asia, and Latin America. The Annals of the American Academy of Political and Social Science, 590(1), 73-92.

(6) Govender, T., Barnes, J. M., & Pieper, C. H. (2011). Housing conditions, sanitation status and associated health risks in selected subsidized low-cost housing settlements in Cape Town, South Africa. Habitat International, 35(2), 335-342.

(7) Katukiza, A. Y., Ronteltap, M., Oleja, A., Niwagaba, C. B., Kansiime, F., & Lens, P. N. (2010). Selection of sustainable sanitation technologies for urban slums—A case of Bwaise III in Kampala, Uganda. Science of the total environment, 409(1), 52-62.

(8) Semba, R. (2009). Purchase of Drinking Water is Associated With Increased Child Morbidity and Mortality Among Urban Slum-Dwelling Families in Indonesia International Journal of Hygiene and Environmental Health 212: 387-397.

(9) Govender, T., Barnes, J. M., & Pieper, C. H. (2011). Housing conditions, sanitation status and associated health risks in selected subsidized low-cost housing settlements in Cape Town, South Africa. Habitat International, 35(2), 335-342.

(10) Niemczynowicz, J. (1999). Urban hydrology and water management–present and future challenges. Urban water, 1(1), 1-14.

(11) Ibid.

(12) Wright, A. Toward a Strategic Sanitation Approach: Improving the Sustainability of Urban Sanitation in Developing Countries. UNDP – World Bank Water and Sanitation Program, 2007.

(13) Ibid.

(14) Satterthwaite, D. (2003). The links between poverty and the environment in urban areas of Africa, Asia, and Latin America. The Annals of the American Academy of Political and Social Science, 590(1), 73-92.

(15) Niemczynowicz, J. (1999). Urban hydrology and water management–present and future challenges. Urban water, 1(1), 1-14.

(16) Satterthwaite, D. (2003). The links between poverty and the environment in urban areas of Africa, Asia, and Latin America. The Annals of the American Academy of Political and Social Science, 590(1), 73-92.