Rural communities in developing countries understand that high population growth rates, poor health, and environmental degradation are connected, said Population Action International’s Roger-Mark De Souza at a recent Wilson Center event. An integrated approach to development – one that combines population, health, and environment (PHE) programs – is a “cost-effective intervention that we can do very easily, that responds to community needs, that will have a huge impact that’s felt within a short period of time,” said De Souza. “This is how we live our lives, this makes sense to us – it’s completely logical,” community participants in PHE projects told him.

Hello from Addis Ababa, where I am blogging from the 5th annual general assembly of the Population, Health, and Environment (PHE) Consortium of Ethiopia (see further coverage here). Along with the Philippines, Ethiopia is the largest PHE programmer in the world, both in terms of number of programs and people affected, and for good reason: The country combines dire need, willing donors, and a great deal of local capacity and will.

Unsafe drinking water causes nearly 1.8 million deaths each year from diarrhea, “a number that dwarfs the casualties associated with violent conflict,” said U.S. Representative James McGovern at a congressional human rights commission hearing earlier this month on water as a basic right. Nearly all of these deaths are children under the age of five, he said. “This is a war against families, children, and women on an ongoing basis,” said Representative Earl Blumenauer, also speaking at the hearing, titled “Realizing the Right to Safe Water and Sanitation.”

There are currently 884 million people in the world without access to safe drinking water, according to UNICEF, and 2.6 billion without improved sanitation. As population growth and climate change place added stress on fresh-water systems, by 2025, two thirds of the world’s population will live in water-stressed conditions, according to the Food and Agriculture Organization. “This is a severe global crisis,” said McGovern.

“A Human Right”

With 2011 World Water Day only weeks away, the hearing harkened back to Secretary Clinton’s widely quoted statement from World Water Day 2010, marking a commitment by the Obama administration to address global water issues:

It’s not every day you find an issue where effective diplomacy and development will allow you to save millions of lives, feed the hungry, empower women, advance our national security interests, protect the environment, and demonstrate to billions of people that the United States cares. Water is that issue.

Four months after that statement, the UN passed a resolution to make access to water and sanitation a human right, not just a development priority. Said Catarina de Albuquerque, a UN independent expert who testified at this month’s congressional hearing, the resolution stipulates that water must be “available, accessible, affordable, acceptable and safe.” A “right to water” is an important “sign of political will,” that will place increased obligations on governments to improve access to water and sanitation, she said. But in the meantime, for the millions without access to safe water, “there is no change.”

According to the UN, the world is on track to meet the Millennium Development Goal target of halving the number of people without access to an improved water source by 2015. But de Albuquerque noted that the reality is not quite so optimistic. On a UN fact-finding mission, she encountered at least one family who by UN definitions had access to an “improved drinking water source,” yet their tap water was literally black. “Water quality is not being monitored” and for many of the people who do have access, it is simply “undrinkable,” she said.

In developed countries as well, there are significant barriers to access, especially for marginalized communities. On a recent mission to the United States, de Albuquerque found that America’s “voiceless” – people of color, Native Americans, and the homeless – face significant discrimination in access to water. “Society closes its eyes to them,” she said. Thirteen percent of Native Americans lack access to safe water, in comparison to 0.6 percent of non-native Americans, she said in a statement to the press releasing her findings. And in Boston, “for every one percent increase in the city ward’s percentage of people of color, the number of threatened cut-offs increases by four percent.” To make the necessary improvements to fill these gaps in America’s aging water infrastructure would cost $4 to $6 billion annually, she said.

A National Security Issue

Water “is a security issue as well as a human development issue,” said Blumenauer. Since, according to UNEP, 40 percent of the world relies on river basins that share two or more political boundaries, water management has enormous potential for both conflict and cooperation. Echoing Clinton’s World Water Day statement, McGovern championed the cross-cutting nature of water:

The right to water is inextricably linked with other basic rights…including the right to food, the right to health, and the right to education.

The burden of collecting water in underdeveloped countries often creates a gender gap and exposes women and girls to violence and rape, he said. And it “has been the basis for many territorial and violent disputes between various peoples and even nations.”

Last month, a staff report by the Senate Foreign Relations Committee expressed a similar sentiment with the publication of their report, Avoiding Water Wars: Water Scarcity and Central Asia’s Growing Importance for Stability in Afghanistan and Pakistan. The report commends the Obama administration for recognizing the importance of water: “For the first time, senior government officials are recognizing the critical role that sound water management must play in achieving our foreign policy goals and in protecting our national security.” However, by exclusively focusing on Pakistan and Afghanistan’s water issues and “neglecting the interconnectivity of water issues between Central and South Asia, the U.S. approach could exacerbate regional tensions,” the report says.

To be more strategic about water assistance, the report recommends the United States: (1) provide technical support in data collection to better manage water; (2) help increase water efficiency and reduce demand for water; (3) recognize the transboundary nature of water issues and “provide holistic solutions;” and (4) “safeguard institutions against shocks to water supply and demand.”

Moving Forward

The Obama administration’s commitment to water issues, the UN’s recognition of water as a human right, and the 2005 Water for the Poor Act have all been important steps towards fulfilling the pledge of making access to safe water a human right. “We’ve come a long way,” Blumenauer (who authored the Water for the Poor Act) said at the hearing, but there is still significant work ahead.

“We’re going to have to be more strategic moving forward” in order to meet global water shortages, said Aaron Salzberg, special coordinator for water resources for the U.S. Department of State who testified at the hearing. Salzberg recommended that the U.S. government take steps to integrate water management with the food and health sectors; build political will; mobilize financial support; promote science and technology; and form partnerships with other governments and aid organizations. The United States must also “be smarter” about allocating funds based on the dual criteria of “need” and “opportunity.” Balancing efforts with partners to find out which countries have the greatest need and the least resources will allow limited U.S. funds to make the deepest impact, he said.

John Oldfield, managing director of the WASH Advocacy Initiative, urged Congress to increase funding for foreign assistance, continue appropriations for the Water for the Poor Act, and improve the effectiveness of existing water, sanitation, and hygiene (WASH) assistance. “Each dollar invested in water and sanitation leads to an 8:1 return from reduced healthcare costs and time savings,” he said. “The world does not need to bury millions more of its children in the coming years when we know how to prevent waterborne disease today.”

Sources: FAO, UNEP, UNICEF, United Nations, WHO.

Image Credit: Adapted from “School girl drinks water from new handpump,” courtesy of flickr user waterdotorg.

The original version of this article, by Hu Angang and Liang Jiaochen, appeared on ChinaDialogue.

Five-year plans (FYPs), which set down and clarify national strategy, are one of China’s most important policy tools. Just as they have helped to drive China’s economic success over recent decades, so they will play a pivotal role in putting the country on a green development path. The 12th Five-Year Plan, now under consideration by the National People’s Congress, marks the beginning of that process in earnest (Editor’s note: Since this was originally published, the National People’s Congress voted in favor of the plan).

By integrating population, health, and environment (PHE) efforts, development programs can make a difference in people’s lives in a real and meaningful way – one which they understand, appreciate, and desire, said Roger-Mark De Souza in this interview with ECSP. De Souza is the vice president of research and director of the Climate Program at Population Action International.

This PHE Champion profile was produced by the BALANCED Project.

Fifty-one-year-old Sam Rugaba is a dedicated teacher who loves his job at the Bujengwe Community Primary School. The school is the result of a community-based project located in the Bujengwe Parish of the Kayonza subcounty in the Kanungu district of Uganda – just 18 kilometers from the Bwindi Impenetrable National Park (BINP). The biodiversity-rich BINP is home to many rare species including the endangered mountain gorilla. Sam is also a Conservation Through Public Health(CTPH) community volunteer and community conservation health worker.

“Health and Health-Care Systems in Southeast Asia: Diversity and Transitions,” launches a series in The Lancet on health in Southeast Asia. While social, political, and economic development have paved the way for substantial health improvements in some countries, demographic transitions are taking place at among the fastest rates in the world, including reductions in fertility, population aging, and rural-to-urban migration. An epidemiological shift is occurring as well, from infectious to chronic diseases. Rapid urbanization and population movement can not only affect the emergence and spread of new infectious diseases directly, but can also exacerbate environmental changes that indirectly contribute to the burden of waterborne and vector-borne diseases. The series, available early online, addresses these concerns in more detail. Moving forward, the authors advocate for “enhanced regional cooperation in the health sector to share knowledge and rationalize health systems operations, leading to further public health gains for the region’s diverse populations.”

The cover of my book, Environmental Politics: Scale and Power, shows two cows casually rummaging through piles of garbage on the streets of a city somewhere in India. It’s a colorful, but disturbing, image. Why not show cows in their “natural” setting, say, in a Kansas pasture? Who let them into the street? Why are they eating garbage? The image is symbolic of what the book aims to achieve: to get us out of our comfort zones in thinking about environmental issues and challenge us to reconsider how we think about issues like climate change, energy, food security, garbage, toxins, and resource conflicts.