Water is a key component in humans, animals and plants. Despite the varying percentages of water in the three life forms, there is no debate that water is life. Humans are particularly more vulnerable compared to most animals and plants as water accounts on average 75%, 60% & 55% of the body weight of infants, adults and the elderly respectively (Popkin et al., 2010). Therefore, to sustain life in humans, sufficient, continuous, safe, accessible and affordable water is necessary, and to sustain good health, water has to be free of all forms of biological, chemical, physical and radiological contaminants. 

The World Health Organization defines social determinants of health as the nonmedical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life such as health. Clean water is considered a social determinant of health as access to safe and adequate water is key in protecting, maintaining and promoting public health by preventing the spread of infectious diseases. Despite access to clean water and sanitation being a key international agenda through the Millennium Development Goals and Sustainable Development Goals, lack of access to clean and safe water continues to be a driver of health inequalities in various countries due to a myriad of disparities. Currently, 2.2 billion people worldwide lack access to safely managed drinking water and even more reside in water-stressed countries. Although in 2022, 73% of the world’s population used safely managed drinking water services, the remaining 27% face sharp geographic, sociocultural and economic disparities, which require more investment to ensure they receive clean and safe water (WHO, 2023). 

Lack of access to clean and safe water has been attributed to several diarrheal diseases and is also identified as a driver of the growing silent pandemic, Antimicrobial Resistance (WHO, 2019). Currently, Southern and Eastern Africa is facing one of the worst cholera outbreaks with over 230,000 cholera cases and 4,000 deaths recorded across 14 cholera-affected countries. Although this epidemic was largely driven by extreme weather events such as prolonged droughts, heavy rainfall, and floods, access to clean and safe water remains one of the key factors needed to reduce the spread of the infection and to support the treatment of affected patients (UNICEF, 2024).

Unfortunately, clean and safe water access disparities do not only affect health but also disproportionately burden the poor. Poor communities and informal urban settlements & slums that often lack access to safe drinking water sources, proper sanitation facilities, and hygiene practices, have higher exposure risks to waterborne diseases and have poor health outcomes. Additionally, the cost of accessing clean water and sanitation services can be overwhelming for low-income households, leading them to resort to unsafe alternatives or forgo essential hygiene practices, further driving the cycle of poverty and poor health. This eventually affects economic productivity, as illnesses caused by waterborne diseases impose direct healthcare costs on households and result in lost productivity due to absenteeism from work or decreased productivity while at work. Additionally, the burden of caring for sick family members can further strain household finances and limit opportunities for economic advancement (Oskam et al., 2021). Given the interconnectedness of water as a social determinant of health and daily life, water-related illnesses create a vicious cycle of poverty and poor health, as individuals and communities trapped in Water, sanitation and hygiene (WASH) deprivation struggle to break free from the economic and social barriers perpetuated by inadequate access to clean water and sanitation.

However, all is not doomed, for the solutions are well known to us. The WASH infrastructures are of global, regional and national importance and receive sufficient attention and resources to drive change. Communities should advocate for WASH rights by raising awareness about the importance of clean water and sanitation for health and well-being. A successful example of community-led advocacy is the Water Project in Kenya, a grassroots initiative that empowers communities on WASH advocacy to improve access to water and sanitation facilities. Partnerships between NGOs, government agencies, and other stakeholders are important in amplifying advocacy efforts and leveraging resources to address water and sanitation challenges effectively. Additionally, communities should hold governments and institutions accountable for their commitments to WASH by monitoring progress, reporting violations, and advocating for transparency and accountability in water management and service delivery (Nelson et al., 2021).

Furthermore, there are readily achievable measures that communities can undertake to ensure they have access to clean and safe water. Communities can practice community-led safe water source management approaches by implementing measures to protect water sources from contamination. These include fencing off water bodies, planting vegetation buffers, and enforcing regulations against pollution. Individuals can also ensure they have access to safe water through boiling water, chlorination, filtration, Solar Disinfection (SODIS), and using point-of-use water purifiers such as activated carbon, UV light, or ceramic filters to remove contaminants from water (CDC, 2022).

References

1. Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Foodborne, Waterborne, and Environmental Diseases (DFWED), National Center for Environmental Health (NCEH). 2022. Making Water Safe in An Emergency 

2. Nelson, S., Drabarek, D., Jenkins, A., Negin, J., & Abimbola, S. (2021). How community participation in water and sanitation interventions impacts human health, WASH infrastructure and service longevity in low-income and middle-income countries: a realist review. BMJ open, 11(12), e053320. https://doi.org/10.1136/bmjopen-2021-053320 

3. Oskam, M. J., Pavlova, M., Hongoro, C., & Groot, W. (2021). Socio-Economic Inequalities in Access to Drinking Water among Inhabitants of Informal Settlements in South Africa. International journal of environmental research and public health, 18(19), 10528. https://doi.org/10.3390/ijerph181910528 

4. Popkin, B. M., D'Anci, K. E., & Rosenberg, I. H. (2010). Water, hydration, and health. Nutrition reviews, 68(8), 439–458. https://doi.org/10.1111/j.1753-4887.2010.00304.x 

5. UNICEF. 2024. Cholera Outbreak in Eastern and Southern Africa. 

6. United Nations. UN World Water Development Report. 

7. WHO 2019. Burden of disease attributable to unsafe drinking-water, sanitation and hygiene: 2019 update

8. WHO Social Determinants of Health 

9. WHO. 2023 Drinking Water.