11/18/2010 03:33 pm ET Updated May 25, 2011

Cholera Is the Just Tip of the Iceberg: How Millions of Lives Can Be Saved

Cholera has dominated the headlines in recent weeks. In Haiti, but also in Nigeria and Pakistan, there have been outbreaks killing hundreds of people. The great tragedy that is too rarely reported is that cholera is entirely and easily preventable. With sanitation in particular but also with safe water and better hygiene, cholera can be stopped in its tracks.

This is one small part of a greater tragedy that is brought to light by a series of peer-reviewed papers published today in the international medical journal, Public Library of Science Medicine (PLoS). The series describes how the inexcusable lack of progress on sanitation and water undermines the very foundations of health. The authors -- an international group of respected experts -- open with a simple question, "how is the opportunity to prevent so many deaths failing to attract the attention of the international health community?"

The new analysis presented in this series shows that improved access to safe sanitation and water could save nearly 2.5 million lives each year. The vast majority of these preventable deaths are among children; each day an estimated 5,500 children under five will die from causes associated with poor sanitation and water. Diarrhea alone kills more children than HIV/AIDS, TB and malaria combined. According to new research published in the Lancet this year, diarrhea is now the leading killer of children in Africa.

As our understanding of the risks associated with poor sanitation and water improves, we are better able to grasp the true extent of its impact on human health. We know now for example that repeated bouts of diarrhea and parasitic infections are major causes of malnutrition that, in turn, render children more vulnerable to other diseases. Recent evidence shows that when a child is recovering from diarrhea his or her susceptibility to pneumonia -- the other leading cause of child deaths -- is significantly increased; so that as much as a quarter of all pneumonia is associated with diarrhea-induced susceptibility.

A lack of these basic services also places a huge burden of morbidity or illness on developing countries; crippling the workforce and keeping children out of schools. Recently, economists at the World Bank estimated that lack of safe sanitation and water, costs developing countries as much as 9 percent of their gross domestic product stifling struggling economies and preventing the economic growth that could lift millions out of poverty.

Sadly none of this should come as a surprise when the lack of international progress on sanitation and water is considered. In 2010, the UN reports that 2.6 billion people lack access to even a basic safe toilet and still almost a billion are without a safe source of drinking water. And this crisis may be further exacerbated by the effects of climate change. We have internationally agreed targets on sanitation and water under the Millennium Development Goal (MDGs), but progress has been woefully inadequate. In Africa, the target to only reduce by half those without access to sanitation by 2015, will not be met at current rates of progress until the twenty-third century.

And yet, the World Bank lists these interventions as highly cost-effective with hygiene education as the single most cost-effective health intervention available with promotion of sanitation close behind. The WHO estimates that for every dollar spent on sanitation and water, eight dollars will be returned in benefits resulting from increased productivity and reduced health care costs.

There is much for the global health community to be proud of in recent decades. At an international level, many diseases have been brought to their knees by a combination of scientific research, global activism, political leadership and the sustained hard work of professionals at every level of the health system. But why not the same urgency and focus from the health community for sanitation and water?

This year, as we again see, multiple cholera outbreaks across three continents, and recognizing that this is just the tip of the iceberg of sanitation and water related death and disease, we must undertake to tackle the root causes of this health crisis. As individuals and as members of organizations concerned with global health, we add our voice to the call to action issued to the global health community. There is no excuse, when we know the cause of this crisis and we have the means at hand to end it, for millions of children to continue to die from entirely preventable causes.

Jan Eliasson Chair of WaterAid Sweden and former President of the United Nations General Assembly.

Peter Piot, M.D.Director of the London School of Hygiene and Tropical Medicine and former Executive Director of UNAIDS.

The London School of Hygiene and Tropical Medicine and WaterAid are members of the newly launched SHARE Research Consortium that is focused exclusively on identifying the means to accelerate progress on sanitation and hygiene in the world's poorest countries.