Water for people.pdf - WHO Thailand Digital Repository

C I T I E S : C O M P E T I N G N E E D S I N A N U R B A N E N V I R O N M E N T / 1 6 9where the inhabitants are willing and able to pay the full cost of sodoing. This suggests the need for assessments of who has access todifferent levels of provision in each settlement – i.e. detailed data foreach household within each settlement. This information would thenallow the authorities to focus on ensuring ‘improved’ provision toeveryone and supporting better quality provision wherever possible.Child mortality ratesIn cities served by piped water, sanitation, drainage, waste removaland a good healthcare system, child mortality rates are generallyaround 10 per 1,000 live births and few child deaths are the result ofwater-related diseases (or other environmental hazards). In cities orneighbourhoods with inadequate provision, it is common for the rateto be ten to twenty times this. This is the case in many low-incomecountries, some of whose child mortality rates have increased in recentyears. Many middle-income nations still have urban child mortalityrates of 50 to 100 per 1,000 live births (Montgomery, 2002).These are average figures for entire urban populations and as such,they obscure the higher rates within the lower-income settlements. In awell managed city, the difference in mortality rates for children betweenthe lowest and highest income areas is not very large; in a badlymanaged city they can vary by a factor of 10, 20 or more. Surveys inseven settlements in Karachi (Pakistan) found that infant mortality ratesvaried from 33 to 209 per 1,000 live births (Hasan, 1999).Diarrhoeal diseasesDiarrhoeal diseases are still a primary cause of infant and child deathfor large sections of the world’s urban population. When provision forwater and sanitation is poor, diarrhoeal diseases and other diseaseslinked to contaminated water (such as typhoid) or contaminated foodand water (such as cholera and hepatitis A) are among the mostserious health problems within urban populations. Case studies inlow-income settlements have shown the high proportion of childrenwho have debilitating intestinal worms (Bradley et al., 1991). Theprevalence of various skin and eye infections such as scabies andtrachoma associated with a lack of water supplies for washing isparticularly high among children living in poor-quality homes andneighbourhoods (see for instance Landwehr et al., 1998). Chapter 5on health gives more details on water-related diseases.Unsanitary environments contribute also to malnutrition bychallenging children’s immune systems. Long-term impacts for childrenare not restricted to health; research in poor urban settlements inBrazil has related early childhood diarrhoeas to impaired cognitivefunctioning several years later (Guerrant et al., 1999).Factors contributing to the inadequacies in provision for water andsanitation exist at every level, from the most local to the international,as illustrated by figure 7.1.Figure 7.1: Examples of causes for the prevalence of diarrhoeal diseases in a squatter settlementLow priority givenby internationalagencies toproviding fundingfor urban waterLimited funding forinvestment in waterand sanitationnationally becauseof debt burdens andpoor economicperformanceWeak and ineffectivelocal government,lacking funds toinvest in water andsanitationLow transfers of fundsto local government;centralized governmentstructure unwilling tosupport development ofcompetent, effectivelocal governmentIllegal status of thesettlement with localgovernment notwanting to allowwater supply andsewers to 'illegalsquatters'Poor-quality provisionfor water andsanitation in thesettlementUse of water andweaning foodscontaminatedwith humanexcretaUnderlying causes Contributory causes Proximate causesDrawing on the particular example of the causes for the prevalence of diarrhoeal diseases, this figure shows that many factors contribute to the inadequacies for water andsanitation, from the international to the local level.Source: UNICEF, 2003.