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A Global View
Susan L. Hensler
Abstract
Millions of people in developing countries do not have easy access to safe drinking water and
often, basic hygiene and sanitation infrastructure is nonexistent. Higher morbidity and mortality
rates from diarrheal diseases caused by fecal contamination of drinking water are frequently seen
in areas without awareness of or access to simple hygiene measures or sanitation systems. The
increased burden of disease results in a decline in personal and global productivity and a
diminished quality of life. International organizations are striving to meet both short and long
term global goals toward improving the health of all populations with community education
programs that focus on hygiene and through the development of sanitary infrastructure and
accessible potable water. Lack of water and sanitation often extends to healthcare facilities and
improvements are required to gain public trust in a fledgling healthcare system. Nurses play a
fundamental part with clinical interventions like immunization and education. Climate change
and a growing global population is causing a shift in the worlds water supply and low
maintenance, cost-effective technologies are required for safe water, sanitation and hygiene to be
made readily available to all. Global health care is a growing field with many options available
A Global View
Living in a country where safe water and sanitation services are taken for granted, it is
difficult to grasp the notion of a life without running water, sewage, or sanitary systems. The
socioeconomic impacts of the lack of safe water, sanitation, and hygiene (WaSH) affect millions
of people globally both financially and through increased morbidity and mortality. International
organizations such as the World Health Organization (WHO), UNICEF, and the International
Medical Corps provide both immediate and long-term interventions like educating communities
on the benefits of handwashing and administering vaccines for disease prevention. Equally
important are the long-term infrastructure improvements like constructing sources to obtain safe
drinking water and building latrines. The implementation of low maintenance, cost-effective
technologies is an important element in improving the health and wellbeing of the global
population.
Socioeconomic Factors
Basic hygiene and sanitary environments brought about by proper disposal of human
waste and garbage collection are not available to over 35% of the worlds population, or roughly
2.5 billion people globally. Safe water is not available to over 780 million people worldwide
(Centers for Disease Control and Prevention, 2015). Although the United Nations Millennium
Development Goal (MDG 7) was met by halving the proportion of the worlds population
SAFE WATER AND SANITATION AND HYGIENE 4
without access to safe water, the 48 least-developed countries continue to fall short of the target
and still do not have access to safe drinking water or sanitation (World Health Organization,
2016).
The lack of Water, Sanitation, and Hygiene (WaSH) affects women more than men. Girls
are primarily responsible globally for water collection, and consequently miss more school than
boys. Additionally, schools lack appropriate sanitation facilities for menstruating girls and even
more days are missed (World Health Organization, 2016). This lack of education results in a
the global GDP due to decreased health care costs and improved personal productivity (World
Clean water and sanitation are a crucial component in improving the context of public
health. Poor sanitation and contaminated water are linked to the transmission of diseases such as
cholera, diarrheal diseases, dysentery, hepatitis A, polio, and typhoid (World Health
Organization, 2016) and evidence shows that simple handwashing can reduce the diarrheal rate
by half and the respiratory disease rate by about 25% (International Medica Corps, n.d.).
handwashing with soap and water after defecation and before meals is a simple, cost-effective
The World Health Organization reports over 1.4 million children die each year from
diarrheal diseases related to unsafe drinking water polluted by fecal matter or other
contaminants. Long-term solutions include the availability of safe water and the provision of
properly designed latrines, which has been proven to effectively reduce diarrheal diseases
The WHO/UNICEF Joint Monitoring Programme for Water-supply and Sanitation (JMP)
which monitors the progress of the MDGs has outlined areas for the improvement of water
supplies in developing countries. The three categories identified by the JMP are water piped into
individual dwellings or yards, improved sources like public taps or standpipes, and water
collected from unimproved sources that are not protected from contamination (Hunter,
MacDonald, & Carter, 2010). To determine whether a potential water supply has long-term
feasibility, six factors must be considered: the quality and quantity of the water, easy access to
and reliability of the source, the cost to the user, and the management of the supply to the
Sanitation infrastructure that is practical, efficient, and cost effective presents a challenge.
Sewage and wastewater treatment facilities generally require large amounts of land, water, and
energy to be effective and are not a realistic option in developing countries. Sewage treatment
alternative currently in use in developing countries do not kill fecal pathogens, attract insects and
are malodorous. Research continues for new technology for toilets that require no sewer
SAFE WATER AND SANITATION AND HYGIENE 6
hookups, electricity, or water and harness the byproducts from fecal sludge to be used as fuel or
Although evidence demonstrates that safe water and proper sanitation are the best long-
term solutions for cholera control, the distribution of an oral vaccine has shown to be a cost-
effective immediate option during times of endemics or outbreaks (Hsiao, 2016). Global climate
changes have generated concerns about potential increases in the incidence and redistribution of
cholera. New vaccines are being developed and stockpiled with an eye toward meeting the
Clinical Interventions
Many health care facilities in emerging countries are not equipped with safe water,
hygiene, and proper sanitation facilities. As a result, healthcare associated infection rates are high
and community members often avoid medical care rather than risk further illness. Facilities
without the ability to provide healthcare workers with proper hygiene are hard to staff and are
found to have a diminished morale among the heathcare providers (World Health Organization,
n.d.). Furthermore, setting a good example is important: WHO data indicates that patients who
observe proper hygiene being performed by healthcare providers in clinics, demonstrated better
hand hygiene while in their own setting (World Health Organization, n.d.). International funding
dedicated to improving water and sanitation services offer hope of improved clinical conditions.
Clinical interventions like administration of oral vaccines such as those for cholera and
polio are easy and effective for healthcare providers to administer in times of emergent outbreaks
SAFE WATER AND SANITATION AND HYGIENE 7
to prevent the rapid spread of diseases (Velleman & Wilson-Jones, 2016) and do not necessarily
Lack of resources is not the only obstacle to WaSH. For those living in developing
countries, lack of basic hygiene knowledge is a major element of the burden of disease. Often,
individuals in developing countries do not understand the correlation between hygiene and
disease, and education of both personal hygiene and public sanitation methods can play a large
role in improving their lives. Education provided by international organizations is often geared
toward training individual community members who in turn volunteer to share the message of
hygiene and sanitation methods. For education to be effective and of lasting value, nurses must
be sensitive to the diversity and the cultural customs and values of the community in which they
The World Health Organization estimates that due to climate change, population growth,
and urbanization, by 2025, half the worlds population will be living in areas affected by water
shortages (World Health Organization, 2016). With the long dry seasons that much of Africa and
Asia experience, safe, non-contaminated surface water is often nonexistent and drilling for
groundwater is often the only viable option. These underground reservoirs however, are not the
SAFE WATER AND SANITATION AND HYGIENE 8
perfect solution since they require rainfall to be replenished. Viable sources for safe drinking are
not always easy to locate and with large populations being served by a single standpipe, wells
Although the 2015 MDG 7 target on water supply was met, progress toward global
sanitation improvements has fallen short. Sanitation is often placed below healthcare, education,
and safe water as a priority, receiving less attention and funding. Estimates for successfully
tackling the logistics and improvements to sanitation infrastructure for developing countries
range from $6.7 billion to $75 billion per year, a significant increase from the $5.3 billion global
More opportunities than ever before exist for an individual interested in a global health
career. The job outlook in global health is excellent with a wide scope of career paths from which
healthcare workers can choose. Finding a global health career can be very competitive.
Individuals with oversees experience and a graduate degree in international or global health may
have greater success finding their dream job. Many colleges and universities offer public health
careers tracks such as health care finance, infectious disease and epidemiology, and public
nutrition (Liaison International, 2017). Because of the morbidity and mortality associated with
childbirth, diarrheal disease, and infectious disease in low and middle income countries, maternal
and child health is considered a high priority field of service (Liaison International, 2017).
Careers in global health can be found and applied for on websites such as UNICEF,
USAID, and The World Health Organization. Salaries range from $30,000 to $90,000 for
individuals with roughly six to nine years of higher education. Volunteer opportunities for
SAFE WATER AND SANITATION AND HYGIENE 9
healthcare workers also exist with organizations such as the Peace Corps, and the International
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