Academic journal article Bulletin of the World Health Organization

Regional Disparities in the Burden of Disease Attributable to Unsafe Water and Poor Sanitation in China/Disparites Regionales Dans la Charge De Morbidite Attribuable a Une Eau Insalubre et Un Assainissement Deficient En Chine/Disparidades Regionales En China En la Carga De Morbilidad Atribuible a la Insalubridad del Agua Y a Las Deficiencias En El Saneamiento

Academic journal article Bulletin of the World Health Organization

Regional Disparities in the Burden of Disease Attributable to Unsafe Water and Poor Sanitation in China/Disparites Regionales Dans la Charge De Morbidite Attribuable a Une Eau Insalubre et Un Assainissement Deficient En Chine/Disparidades Regionales En China En la Carga De Morbilidad Atribuible a la Insalubridad del Agua Y a Las Deficiencias En El Saneamiento

Article excerpt

Introduction

Chinas rapid economic growth has brought about a shift in health priorities as infectious diseases associated with poverty are gradually displaced by chronic illnesses. (1) Yet the traditional causes of illness, including infections resulting from unsafe water and poor sanitation and hygiene, (2,3) still exist and are unevenly distributed across Chinas diverse cultural and geographic landscape as a result of regional differences in urbanization, economic development and environmental factors. (4,5) Country-wide measures of important infectious diseases (2,3) conceal important regional and socioeconomic disparities that, although widely recognized in China, (6,7) have been poorly documented, particularly for diseases resulting from environmental pollution? In light of Chinas large, diverse population and the government's recent commitment to invest heavily in water infrastructure, (8,9) estimates of the burden of disease attributable to unsafe water and poor sanitation and hygiene are needed at a resolution capable of capturing regional disparities. Such estimates can inform policies for targeting vulnerable populations through investments in health care and in infrastructural development.

Globally, unsafe water and poor sanitation and hygiene account for approximately 1.9 million annual deaths and 4.2% of the global burden of disease. (10) Where water and sanitation facilities are inadequate, faecal contamination of drinking water and soil permits transmission of diarrhoeal pathogens and, according to prior estimates, diarrhoea accounts for the largest fraction (> 90%) of the global burden of disease attributable to unsafe water and poor sanitation. (11) In addition, unsafe disposal of human waste can promote the transmission of water- and soil-transmitted helminthic infections. Poorly managed surface water resources can facilitate vector breeding and promote the transmission of vector-borne diseases such as malaria and dengue. The burden of diseases attributable to unsafe water and poor sanitation and hygiene is largely borne by the poorer members of society (10,11) and the resulting health effects, including impaired child growth and reduced work capacity, are substantial and poverty-reinforcing. (12)

Over the past two decades, the water and sanitation infrastructure has improved dramatically in China. However, access to safe water and good sanitation varies markedly throughout the country, which suggests that some population groups bear a greater risk of disease than others. Rural residents, who represent 60% of Chinas population, may be particularly vulnerable. In urban areas, piped water coverage rose from 48% in 1990 to nearly 94% in 2007. (13) Access to sanitation facilities and piped water in rural areas has more than tripled since the initiation of a national campaign in the 1980s, (14) yet in 2006 only 55% of 60 000 rural households surveyed across China had access to a centralized public water supply. (15) Furthermore, 44% of rural water supplies did not meet minimum drinking water quality standards, (15) largely on account of contamination from untreated sewage. (16,17) To inform policy to further improve water and sanitation in China, we estimated the burden of eight diseases attributable to unsafe water and poor sanitation and hygiene and examined the distribution of disease burden by age, province and level of economic development.

Methods

Unsafe water and poor sanitation and hygiene can cause illness through various pathways. Drinking water can be contaminated with biological or chemical agents, soil, water or fomites can be contaminated with faeces, and, if water resources are poorly managed, they can become vector habitats. We used the comparative risk assessment (CRA) framework (18) to estimate the amount of ill health in China that could be prevented by improving unclean water and sanitation facilities, promoting access to pathogen-free water supplies and reducing vector habitats. …

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