Two of the world’s mightiest rivers, the Ganges and the Brahmaputra, meet and marry in Bangladesh. If a nation’s wealth were measured by its influx of water, then this tiny country—also fed by frequent monsoons and countless tributaries—would be among the richest at the global table.
“Bangladesh is all about water—water is everything,” said Richard Cash, senior lecturer on international health at HSPH. He was speaking at a symposium, The Impact of the Global Water Crisis on Health and Human Development, held at the School on May 11.
Yet the reality of clean water is far different. In 1993, naturally occurring arsenic was found in the water in Bangladesh’s vast network of wells, forcing millions of residents to go thirsty or seek water from often polluted streams and rivers. The fact that clean drinking water is in such short supply in this water-drenched country was one of many ironies discussed at the symposium, which was organized by the International Science and Health Network, a Harvard-wide student organization dedicated to understanding and bridging the gap between the developing and developed worlds.
Speakers depicted a planet riven in two—the water-rich and the water-poor. Incongruities piled up on both sides of the divide. In water-poor countries, women—the primary collectors, carriers, and storers of water—are poisoning their families with chemical- and microbe-laced water. Babies, the innocents of society, are spreading disease on a massive scale through their waste.
In the water-rich world, people with access to clean tap water are spending $46 billion a year on bottled water that despite its association with purity and health is polluting the environment with plastic.
Statistics spoke loudly too. Cash opened the symposium, which was sponsored by the Harvard Integrated Life Sciences program, the Center for International Development at Harvard University, and the Harvard Initiative for Global Health, by describing how 99 percent of people in water-rich nations have access to clean drinking water while more than 40 percent in the water-poor world do not. From this limited access flows a plethora of problems—poor sanitation and hygiene and high levels of life-threatening illnesses, in particular water-associated diseases such as cholera, hepatitis A, dysentery, schistosomiasis, and malaria.
Yet solutions—some stunningly simple—do exist. In the late 1960s, Cash and colleagues undertook clinical trials in Bangladesh of a low-cost, easy-to-use oral rehydration therapy—essentially packets of salt and sugar thrown into water—for massive diarrhea caused by cholera and other water-associated diseases. Over the past four decades, this therapy has saved nearly 50 million lives. It might have saved more. “Some of these diseases can kill you in six to eight hours, yet people often wait until the last minute to go to a clinic,” he said.
The danger of simple technology being thwarted by the vagaries of human behavior was echoed by several speakers. The solution, many said, is education. Inspired by a group of Nepali women at an international water conference decades ago, who told of having to serve polluted water to their families, Susan Murcott and her students designed a method for purifying water—essentially a large plastic bucket layered with sand and gravel. “We designed a system for the poorest of the poor, and we designed it holistically, to be low-cost and user-friendly,” said Murcott, senior lecturer on civil and environmental engineering at MIT. She and her students return to Nepal each year to help the women implement the system in their homes. Nearly 95 percent of the filters are still in use.
“The biggest mistake we can make is simply dropping technology on people. There has to be an educational component,” said Murcott. Deciding how exactly to teach—and more generally how to design—technological interventions may first require becoming a student of the culture, said David Gullette, a professor of English and interdisciplinary studies at Simmons College. He is also a cofounder of the Newton Workshop on Appropriate Technology, an organization that brings water filters and other technology to a small town in Nicaragua. To address the question Why are children dying of disease? he and his colleagues had to consider a host of other questions such as What do families know about sanitation? Do people understand how illness occurs? Are there cultural or folk narratives that might improve sanitation efforts?
In fact, 2.6 billion people, or 40 percent of the world’s population, lack adequate sanitation, said the next speaker, Christine Moe of Emory University, who introduced her presentation by saying, “I’m here to talk to you about toilets.” Water is used to whisk waste away in the developed world. A variety of latrines have been introduced in water-poor countries, but they have to be properly used to be effective. Moe and her colleagues evaluated latrine use in El Salvador and found that young children were not using them, in part because the stairs were too high. Children’s feces could be seen ringing the latrine and were also being scooped up by local women for use in gardens. It turns out, they thought infant waste was pure. “I started off as a microbiologist and what I’ve come to understand is it’s not the microbes that are so difficult to understand, it’s the people,” she said.
Such attempts at local understanding stand in stark contrast to the approach traditionally taken by governmental and international agencies. In asking the big question Why are most countries poor? such agencies have tended to focus on tangibles such as lack of capital, resources, and know-how—and on rational, top-down solutions, often made in high offices. This approach has led to a master-of-the-universe perspective, said Pete Kolsky, senior water and sanitation specialist at the World Bank. Recently, agencies like the World Bank have come to appreciate the role played by vested interests, instability, war, corruption, and politics—a gnarlier, less manageable brew. “We are not masters of the universe. We are constrained, half-blind actors operating in a complex process,” he said.
People in the developed world, who drink billions of bottles of water each year thinking they are doing something healthy, may also be deluding themselves. Despite its association with purity and cleanliness, bottled water is bad for the environment,” said Andrew Essex, CEO of the ad agency Droga5. Inspired by a New Yorker article on drought in India, his agency embarked on a project aimed at discouraging people from drinking bottled water while raising public awareness—and funds—for the worldwide water crisis. “We thought, what if we could make the ordering of tap water the cool thing to do?” he said. Partnering with UNICEF, they came up with the Tap Project. On March 22, 300 New York City restaurants participated, offering patrons the opportunity to pay a dollar for their normally free glass of tap water.
Essex believes the response may be the first step in a public movement. “I think the tipping point will happen soon,” he said. “A couple of MySpace pages, and it’s over.”
