A Challenge on World Water Day
“Water, like air, belongs not to those who can pay for it. Water belongs to those who are thirsty.”
Those words, written by Uruguayan author Eduardo Galleano, opened my undergraduate thesis on water, political belonging, and health in rural Peru. Access to clean drinking water in Peru is very unequal between rural and urban populations, a reality I experienced firsthand during my gap year. Living in beautiful Urubamba, where visitors can fall ill from eating an unpeeled vegetable, I often saw children suffering from water-borne diseases. This experience deepened my appreciation for clean water and made me aware of a pervasive global injustice: 80% of the people who lack access to clean water live in rural areas.
In the face of this reality, I want to use World Water Day to challenge myself and my fellow Global Health Corps fellows — how can we act to transform Galleano’s words into reality? How do we live the underlying sentiment of health and environmental equity?
The right of all people to potable water has been enshrined since 2010, when the United Nations (UN) acknowledged that “clean drinking water and sanitation are essential to the realisation of all human rights.” Nevertheless, in 2015, 844 million people still lacked a basic water service. In Uganda, where I currently live, only 39% of the population have access to safely managed water. Around the world, nearly 1,000 children die every day due to preventable water and sanitation related diarrheal diseases.
As a visitor, it is easy to become accustomed to boiling your water before you drink it and to buying bottled water as needed. It is just as easy — far too easy — to forget that the ability to do so is a privilege, and that so many thousands in the city around you can’t afford to boil or buy their water. What’s more, the mass consumption of bottled water causes massive harm to our environment, and the fuel used by many around the world to boil unclean water can lead to further environmental damage.
“Access to clean water is one of the issues that exemplifies how population health and environmental health are inextricably intertwined, a reality that is the inspiration and basis for the emerging field of planetary health.”
Access to clean water is one of the issues that exemplifies how population health and environmental health are inextricably intertwined, a reality that is the inspiration and basis for the emerging field of planetary health. Planetary health is defined in The Rockefeller Foundation–Lancet Commission on Planetary Health as “the achievement of the highest attainable standard of health, wellbeing, and equity worldwide through judicious attention to the human systems…that shape the future of humanity and the Earth’s natural systems… Put simply, planetary health is the health of human civilisation and the state of the natural systems on which it depends.”
In Peru, where millions of people depend on the country’s tropical glaciers for water, food, and hydroelectricity, this interdependent relationship could not be more evident. There, the phenomenon of melting ice caps due to climate change is causing economic, political, and social challenges. While in Peru, I would often hear people talk about how much the glacier above Urubamba had shrunk since they were young. Meanwhile, in Uganda (as well as in neighboring countries in East Africa), new weather patterns caused by climate change threaten to worsen food insecurity and poverty. In both contexts, the impact of climate change is gradual and therefore made less visible, yet it can have devastating consequences for communities’ health and livelihoods.
Alive Medical Services (AMS), an HIV clinic in Kampala, Uganda that has been my placement organization for the past eight months, provides over 13,000 HIV-positive clients with free, comprehensive HIV treatment and care. This includes all aspects of their care — from counseling to nutritional support and more. For instance, every client receives a water purification kit, including water purifying chemicals, a plastic bucket, a filtering cloth, and a stirring rod.
“It is surely not the norm for clinicians to be able to prescribe ‘clean water refill’ alongside antiretrovirals and antibiotics. In fact, access to safe water, sanitation, and hygiene are all especially important for people living with HIV, as they are key to preventing opportunistic infections such as diarrhea and skin diseases.”
At first glance, this may seem outside the purview of an HIV clinic. It is surely not the norm for clinicians to be able to prescribe ‘clean water refill’ alongside antiretrovirals and antibiotics. In reality, however, access to safe water, sanitation, and hygiene are especially important for people living with HIV, as they are key to preventing opportunistic infections such as diarrhea and skin diseases. As such, this comprehensive, preventative approach offers critical support for the health of our clients.
The relationship between HIV and clean water exemplifies why the interdisciplinary lens of planetary health is so crucial. It also helps answer the challenge I set for myself and my peers: how to live the values of health and environmental equity. In addition to making environmentally conscious choices in our day-to-day lives, we should challenge ourselves to learn about the interconnections between different aspects of health and actively strive to make our work more sustainable. Being conscious of such relationships can highlight the fact that what many perceive as siloed — HIV/AIDs, sanitation, climate change — are in fact interrelated many times over. This awareness, in turn, can reveal innovative, interdisciplinary approaches to ever-evolving challenges in public health.
On a personal level, a heightened awareness of the inherently interdisciplinary nature of health has helped clarify the questions about my own professional journey, allowing me to recognize the ways in which my seemingly disconnected experiences in fact build on one another. On a broader, systems-level, this lens highlights the importance of protecting our natural resources, in particular by using our privilege to lobby and work for comprehensive, sustainable policies and programs.
Because we can. Because we should. Because water belongs to everyone who is thirsty.
Helena Hengelbrok is a 2017–2018 Global Health Corps (GHC) fellow at Alive Medical Services in Uganda. All GHC fellows are united by the belief that health is a human right.
