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No-Plumbing Disease

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A few days ago at a DC-style networking session for public health folks, I introduced myself as the Communications Director for Water Advocates.

I am used to receiving surprised -- even shocked -- expressions when people learn that poor sanitation and unsafe water cause the illnesses that fill half of the hospital beds in the developing world and 10 percent of the entire global disease burden, even if I am amidst the public health folks of the world.

Yet, without missing a beat, the doctor who organized the event spoke up: "You must know that plumbing was the biggest contribution to improving public health in history."

"Yes!!" I exclaimed, overjoyed to finally meet a medical doctor who understands that plumbing is the best way to save lives.

He was referring to the fact that when developed countries like the U.S., Japan, and England installed water and sanitation systems, they eradicated diseases like cholera and typhoid that caused death by diarrhea. Plumbing has saved millions of lives -- our lives.

Still, billions of people in the world don't have access to safe drinking water or a place to dispose their feces. Subsequently, 1.5 million children die every year.

We hear public outcries -- in national news headlines, through savvy leadership, and championed by celebrity spokespeople -- on many poverty-related diseases that are more costly to prevent, cannot yet be treated, or kill fewer people.

When such a simple, cheap, tried-and-true public health intervention is so present in our lives -- and could prevent the astronomical death toll -- why am I still surprised when people know about it?

Blame it on the name.

There are over 25 diseases (deadly and debilitating) that are the result of poor sanitation and unsafe water. These include cholera, typhoid, amoebic dysentery, campylobacter enteritis, giardia, Guinea worm, schistosomiasis, bacillary dysentery (shigellosis), Escherichia Coli diarrhea. And there are at least 10 lesser known ones.

Perhaps if we considered these as one disease it would garner the public outcry it deserves. Let's call it No-Plumbing Disease.

We would then see that No-Plumbing Disease kills more children than HIV/AIDS, malaria, and TB combined. We would see the truth of this ugly situation; the relentless outbreaks of diarrhea that, when they don't kill kids, weaken them month after month -- the instances of a single child, for example, suffering a dozen bouts of it per year, the ensuing malnutrition, the family's economic burden of curing the child, the impact this constant sickness has on a child's education.

The most practical investment we can make in global public health is plumbing.

Of course, plumbing is an oversimplified way of talking about solutions for improving water and sanitation. Many of the existing solutions are simple basic infrastructure, such as a ceramic water filter or a pit latrine. And we need to be more environmentally minded as we develop these systems.

But the main point remains: dirty water and lack of sanitation cause No-Plumbing Disease. The solutions exist right now to solve this crisis. Call it what it is, and give it the attention it rightfully deserves. We will save millions of lives each year.

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Katryn Bowe from Water Advocates co-authored this blog