Global Policy Forum

By Margaret Catley-Carlson *

In May, we will assemble in Washington to discuss Our Future on Common Ground: Health and the Environment. It will be an exciting moment. Practitioners, health service providers and administrators, experts, researchers, and the good and great of environmental health will come together to share what has been learned, to reach out for new and better ways of promoting health in the global community.

Do we really live on common ground? Hardly. The miserable living conditions of the poor throughout the world - those 2 billion living on less than U.S. $1 per day - bear little resemblance to those of the rich. The informal settlements, with their lack of amenities and lack of security, bear no relationship to the skyscape of apartment buildings in my New York window as I write, or to the suburbs of bungalows or mansions in countries around the world.

Even today, 800 million people are malnourished at some time of the year, with a disproportionate impact on children. How can we claim common ground while the problems of over-nourishment, obesity and its attendant diseases now rank ever higher in the health problems list of an increasing number of countries? Relative maternity risk for women, whether through the health toll posed by the 'too soon, too many, too quickly' syndrome, or the dreadful death toll of maternal mortality, bears almost no resemblance to the situation of their sisters in richer lands.

How do these disproportionalities work in the world of freshwater management policy, where, for the last few years, I have spent most of my time? The world where a tap turned on provides guaranteed flows of safe water are a long way from the 'women walking water,' or the vendor supplied world of the 1.2 billion people who do not have reliable access to drinking water, or the more than 2 billion without access to sanitation. Absence of sanitation has a terrible effect on the dignity of the person, on attendance at school by girls, and on community health. The differences between the situation of rich and poor is immense. Mark Twain is credited with the aphorism that water "flows uphill...toward the powerful."

The U.N. Millennium Goals for water set a goal: By 2015, reduce by half the proportion of people without access to safe water. The Johannesburg Earth Summit added a similar target for sanitation. These goals sound wonderful, but, in fact, imply incredibly ambitious if not impossible enterprise. In the 5,000 days remaining till 2015, another 290,000 people would have to gain access to clean water every day, and more than 500,000 would need to gain access to sanitation for these goals to be met. This is simply not going to happen under anything remotely like current conditions. The Pacific Institute estimates that even if we meet the U.N. Millennium Goals for water, as many as 76 million people will die between now and 2020 of water-related disease and affliction. This horrific toll will be taken largely from among poor populations.

So where is the common ground?

What do the rich and the poor share? The answer to this is, quite literally, in the air we breathe, the water we drink, the climate of our planet. As population continues to increase and we move toward and perhaps beyond the 7.5 billion mark, as we urbanize, as development increases the number of people with carbon dioxide emitting motor vehicles, as we throw more chemicals into our water, and divert more of it for more food to feed richer and larger populations, as more and more of us spend days in internal spaces and the built environment, as industrialization and manufacturing growth continue in areas of little or no environmental regulation, we are creating a magnitude of hazard that will affect all and that will have health impacts on ever larger numbers of people.

We have common ground in that both rich and poor will feel the impact, including the damage to health resulting from climate change. Traffic jams and air pollution affect all. The increase in communicable diseases will present new health dilemmas.

In water, the situation is stark - one-fifth of freshwater aquatic species are in peril. Important ground water sources being used primarily by agriculture are almost exhausted. Deltas and wetlands are disappearing. Aquifer water levels are falling. Water quality is in decline everywhere, nowhere more so than in the burgeoning cities of the developing world where the major part of the world's population will live after 2010. The need to feed more people at better nutritional levels appears to demand more irrigated land - yet irrigation already accounts for over some 70-90 percent of water used in most developing countries.

Where is the roadmap? In this exceedingly complex situation, there are no silver bullets, no instant solutions. There are no alternatives to patient hard work, backed by research, that must shape policy so that problems are alleviated rather than accelerated, and set out programs that reach out to those most affected by the problems. But we have one tool, which if used better and more frequently, could aid us in these Herculean tasks.

Participation. It is a much used word - overused in fact - and underemployed as a concept. Yet it can be the key to major social improvements at all levels of the development process. What does real participation mean? It means involvement of those affected by an issue in the shape of programs and responses to deal with that issue. Many are integrally and intimately connected with environmental health and health improvements.

Participation could - and does - make a difference The World Commission on Dams (WCD), probably one of the more contentious documents of the last decade, noted the importance of dams and reservoirs to water, supply, flood protection, energy and irrigated agriculture. The WCD called for a new kind of participation - consultation with affected communities even before projects get to the drawing board. Projects have to be shaped, designed and put together in such a way that those most affected by them participate in the decisions, about them - decisions which may affect health, location, livelihoods and the wider environment.

Another example involves agricultural populations that must adjust to more variable patterns in water availability and temperature change. Better mechanisms, communication chains, and reaction patterns will allow more appropriate response to climate change. Participation is key here. When farmers participate in research, effectiveness soars. Neighbors gather to watch the results, farmers share in the decisions and the knowledge about better seeds, better planning times, better crop protection spreads quickly...researchers learn a lot, too.

Participation in education - particularly for girls - is still the closest thing we have to a silver bullet to improve family health, community GNP, child nutrition, child care practices, agricultural production, and access to health facilities, including family planning - but how many children, and among them girls, are still left out of school?

Participation also works in water supply issues. The world has recognized the overwhelming importance of water to health issues in the Millennium targets which, as noted above, are not going to be met under anything remotely like current conditions. Traditional, community scale - yes, participatory systems are going to have to play an infinitely larger role, both in parallel and to improve traditional water supply methods. And by the way, if we do manage to meet by 2015 the target of reducing by half the proportion of people without access to safe water, close to 700 million will still be left out. This means that water-related deaths totaling tens of millions will continue in the decades ahead.

Participation in international markets...the Globalization word. Nobody needs the benefits of globalization more than poor people in poor countries, but unless the right policies and institutions are in place at both national and international levels, globalization will continue to benefit the wealthy and will increase disparities.

Participation of the middle class in policy-making on issues that affect their health and well-being. We must inculcate the idea that good health depends on the existence of a number of public goods that must be protected and cherished. As difficult as it continues to be, we must spend more of our collective energies mobilizing people to speak up and speak out about essential direction of policy change. There is probably no more crucial challenge facing the health service world.

Is there common ground? Yes, and it is growing. It is not necessarily comfortable ground because too often increasing risk factors are forcing the pace...how much better would be a world in which solidarity with the poor set the agenda? But the indisputable fact is that we will all share the future - and we have a common interest in making it the best possible and healthiest future for all. I look forward to listening to your ideas in Washington in May. See you there!

About the Author: Margaret Catley-Carlson is the Chair of Global Water Partnership

For more information on the Global Water Partnership, visit www.gwpforum.org

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