Water as a social determinant of health: bringing policies into action | Published in Journal of Global Health Reports

A substantial amount of research, particularly in the last two decades, indicates that social factors, in addition to medical care, have a significant influence in determining health across a wide range of indicators.

Introduction

A substantial amount of research, particularly in the last two decades, indicates that social factors, in addition to medical care, have a significant influence in determining health across a wide range of indicators. This highlights the fact that in addition to medical care, there are social conditions in which people are born, grow, work, live, and age that influence health outcomes.¹ This emphasises the need to address social determinants of health which are crucial for improving health and reducing health disparities, necessitating actions with a multisectoral approach.

Social Determinants of Health

Social determinants of health are defined across domains spanning clean air, health care, food, education, decent working conditions, adequate housing, clean water and standard of living.² Access to safe drinking water is one of the social determinants of health and a key factor towards improving health outcomes and inequalities.³ The importance of access to safe water has been accepted as an international agenda and priority, which was emphasised through United Nations, UN-driven global goals, i.e., Millennium Development Goals, MDGs (2002-15), followed by a call for action towards sustainable health systems through the Sustainable Development Goals, SDGs (2016-30). MDGs included access to water and sanitation under target 7C aimed to “halve the proportion of people without sustainable access to safe drinking water and basic sanitation” which was continued as a global goal under redesigned SDGs (Goal 6) to provide “clean water and sanitation for all”.^4,5

India’s National Health Policy 2017

India’s National Health Policy 2017, following the agenda of achieving SDG targets towards its path to attain Universal Health Coverage (UHC), included “safe drinking water and sanitation to all” as one of the cross-sectoral goals related to health.⁶

Current Scenario of Drinking Water and Disease Burden

With SDGs in place and a priority across the globe, the nations have demonstrated improved access to safe drinking water. However, it has yet to reach the SDG targets, with 26% (nearly 2 billion) of the world’s population reporting a lack of access to safe drinking water.⁷ In the Indian context, out of the 1.3 billion population, around 50% of the population doesn’t have access to safe drinking water, which is essential for human development and the building of a healthy nation.^8,9 The access to safe drinking water has increased by almost ten per cent in the last decade, from 85.5% in 2011 to 95.9% in 2021.^10,11 Focussing on geographical disparities, the Joint Monitoring Programme (JMP) 2020 Report showed huge variations in rural and urban areas for access to basic water services.

Water-Related Diseases and Impact

Evidence shows that lack of access to safe water sources is the leading cause of infectious diseases like diarrhoea, Cholera, Dysentery, Hepatitis A, Typhoid, and Polio. It is also one of the primary causes of illness and death among children under 5 in LMICs.^12,13 An estimated 1.2 million people in the world die prematurely because of unsafe drinking water, which accounts for 2.2% of deaths globally, with 6% of deaths in LMICs alone.¹⁴

Initiatives to Improve Access to Safe Drinking Water

Safe and adequate water services have been identified as essential component for protecting, maintaining and promoting public health and reducing the total burden of disease globally.^15,16 Increased access to safe drinking water would not only improve health outcomes but also contribute towards developing resilient communities and enhancing the country’s economic growth.

Evolution of Schemes and Initiatives

The government of India has undertaken several initiatives to ensure safe drinking water for all its citizens, beginning with the National Water Supply Programme, launched in 1954 as part of the first five-year plan (1951-56).²³ Over the last seven decades, the drinking water supply schemes and programmes have evolved to improve the availability and access to clean drinking water (Figure 2). Focussing on areas with low availability of water and areas prone to waterborne diseases, GoI launched the Accelerated Rural Water Supply Programme (ARWSP) in 1972 to supplement the efforts of States to provide safe drinking water to the community. Providing scientific input and cost-effective technological solutions to address water scarcity, the National Drinking Water Mission (NDWM), popularly known as the Technology Mission, was launched in 1986. To institutionalise the mechanisms and develop a legal framework for resolving the issues and challenges related to water management in India National Water Policy was drafted in 2012.²⁴

Jal Jeevan Mission (JJM)

National Health Policy 2017 has envisaged access to safe drinking water and sanitation to all as one of the cross-sectoral goals related to health. NRDWP was reformed and incorporated under Jal Jeevan Mission (JJM), which was launched by the Hon’ble Prime Minister on 15th August 2019 to provide Functional Household Tap Connection (FHTC) to every rural household, i.e., Har Ghar Nal Se Jal (HGNSJ) by 2024.²³ Until 2019, efforts were focused on providing a safe drinking water supply to the rural population either through hand pumps, protected wells, or piped water supply with public stand posts. With the launch of JJM, the focus has shifted to providing functional household tap water connections to each rural household. Under JJM, the government is investing in the development of water infrastructure to supply piped water to rural households. With the launch of JJM, tap water connections in rural households have increased from 16.69% in 2019 to 62.79% by June 2023, with 1220 lakh new household tap water connections being provided as of 8th June 2023 (Figure 3).²⁵

SDGs, Targets, and Indicators

SDGs, Targets, and Indicators

1. SDG 3: Good Health and Well-being
   • Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health care services, and access to safe, effective, quality, and affordable essential medicines and vaccines for all.
   • Indicator 3.8.1: Coverage of essential health services.
2. SDG 6: Clean Water and Sanitation
   • Target 6.1: By 2030, achieve universal and equitable access to safe and affordable drinking water for all.
   • Indicator 6.1.1: Proportion of population using safely managed drinking water services.
3. SDG 10: Reduced Inequalities
   • Target 10.2: By 2030, empower and promote the social, economic, and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion, or economic or other status.
   • Indicator 10.2.1: Proportion of people living below 50 percent of median income.

Explanation of Findings

1. SDG 3: Good Health and Well-being

The article highlights the importance of addressing social determinants of health to improve health outcomes and reduce health disparities. It emphasizes the need for actions with a multisectoral approach, indicating a connection to SDG 3. The specific target under SDG 3 that can be identified is Target 3.8, which aims to achieve universal health coverage and access to safe and affordable essential health care services. The article mentions the importance of access to safe drinking water as a social determinant of health, which is crucial for improving health outcomes and reducing health disparities.

2. SDG 6: Clean Water and Sanitation

The article specifically addresses the issue of access to safe drinking water and its importance for improving health outcomes and reducing health disparities. This aligns with SDG 6, which focuses on clean water and sanitation. The specific target under SDG 6 that can be identified is Target 6.1, which aims to achieve universal and equitable access to safe and affordable drinking water for all. The article mentions the SDG target of providing “clean water and sanitation for all” and highlights the progress made in increasing access to safe drinking water globally but also acknowledges that the SDG targets have not been fully achieved.

3. SDG 10: Reduced Inequalities

The article discusses the disparities in access to safe drinking water, with a focus on rural and urban areas. This highlights the issue of inequalities in access to clean water, which is relevant to SDG 10. The specific target under SDG 10 that can be identified is Target 10.2, which aims to empower and promote the social, economic, and political inclusion of all, irrespective of their status. The article mentions the variations in access to basic water services between rural and urban areas, indicating the existence of inequalities in access to safe drinking water.

Table: SDGs, Targets, and Indicators

Behold! This splendid article springs forth from the wellspring of knowledge, shaped by a wondrous proprietary AI technology that delved into a vast ocean of data, illuminating the path towards the Sustainable Development Goals. Remember that all rights are reserved by SDG Investors LLC, empowering us to champion progress together.

Source: joghr.org

Join us, as fellow seekers of change, on a transformative journey at https://sdgtalks.ai/welcome, where you can become a member and actively contribute to shaping a brighter future.