Shifting Exposures, Shifting Paradigms: Global Trends Warrant a Focus on Chemical Contaminants in the WASH Sector

摘要

WASH is the collective term for Water, Sanitation and Hygiene. Because access to, and quality of, water, sanitation, and hygiene are interrelated, they are grouped together in a collective sector. Traditionally, health impacts related to improvements in WASH infrastructure focused on the incidence of diarrhea in children under five years of age (under-5). This is because diarrhea is one of the major single causes of under-5 mortality, surpassed only by acute respiratory infections. As many international WASH organizations aim to reduce under-5 diarrhea and related mortality, WASH research and infrastructure improvements traditionally focus on stopping fecal-oral transmission of microbial pathogens via water, food and other exposure routes that cause diarrhea. However, over the past two decades, international efforts to improve WASH infrastructure and reduce under-5 mortality have been successful, and both the rate and number of child deaths were reduced more than half between 1900 and 2015. However, globalization and various development activities have contributed to a rise in chemical contamination of water sources during this same time period. A shift in the focus of the burden of disease related to WASH is warranted to include exposures to both microbial pathogens and chemical contaminants. This shift has begun, as evidenced by the United Nations' Sustainable Development Goal 6, to ensure availability and sustainable management of water and sanitation for all, which has targets including reducing pollution, eliminating dumping and minimizing release of hazardous chemicals and materials. It is critical that future research and innovation in the WASH sector shift to focusing on both chemical and microbial improvements in water quality. Low- and middle-income countries (LMICs) without resources to identify and mitigate chemical water quality problems need support to improve water quality and reduce acute and chronic morbidities from chemical exposures.