Archive for the ‘Water’ Category

The Fight for Fluoridation in Portland, Oregon

March 8, 2017

Although the U.S. Center for Disease Control called community water fluoridation (CWF) one of the great public health achievements of the 20th century, it remains a contentious issue in Portland. Since CWF as a public health intervention was initiated in 1945, Portland has adamantly rejected fluoridation four times with the most recent CWF ballot measure defeated in 2013. Currently, Oregon ranks 48th among U.S. states for fluoridated public water systems with only 22.6% of Oregonians on public water systems receiving fluoridated water compared to 73.9% of the total U.S. population.

Why this strong aversion to fluoridation? We Oregonians love our famously clean tap water and the idea of “contaminating” our water with additives makes us uncomfortable. An article by Bianchi et al., 2016, analyzed fluoridation articles from the 2013 CWF ballot campaign and found that anti-fluoridation proponents frequently cited CWF’s “chemical” nature and called it forced medication.  They reasoned that Oregon’s oral health could instead be well-maintained through alternative measures.

However, alternatives just do not provide enough protection especially to our most vulnerable populations. According to Oregon Health Authority, 58% of third graders have experienced tooth decay with those from lower-income households having double the rate of tooth decay than children from higher-income households. Moreover, attempts at alternatives like oral fluoride supplementation resulted in low adherence.

I believe the key to bring CWF to Portland would require pro-fluoridation stakeholders to reframe the message as regulating fluoride levels during the next CWF ballot campaign. Fluoridation typically connotes the adding of fluoride but it could be more accurately described as the regulation of fluoride levels in water since fluoride is a naturally occurring ion in water. Through the regulation of fluoride in the water, we could maintain fluoride’s optimal range for oral health and ensure strong oral health for all Oregonians.


Urban slum communities have right to health, too

March 10, 2013

For the first time in history, the majority of the world’s population is living in urban settings. With the fastest migration to cities occurring in low- and middle-income countries, governments are failing to provide adequate infrastructural growth. This has resulted in brimming urban slums, often built on abandoned private properties. These impromptu settlements are peripheral – geographically, socially, and politically.

Slum families are precariously considered “undocumented” inhabitants of a municipality, without governmental recognition, representation, and perhaps most importantly, without governmental health services.

Urban slums like Mlolongo (Nairobi, Kenya) are growing rapidly, but, are “invisible” to government decisionmakers. Despite efforts of local NGOs like the Orphans and Vulnerable Children (OVC) Project to lobby for service provision, the ten-year-old slum is still deemed a “temporary problem” for the municipality. But, unlike the flimsy materials comprising the slumdwellers’ homes, these settlements anything but temporary. (The nearby and world-renowned Kibera slum was established in the early 1900s.)

In an attempt to provide basic healthcare and parenting support, the OVC Project has established a shadow-troop of Community Health Workers (CHWs) similar to the official CHW strategy employed by the Kenyan Ministry of Public Health and Sanitation

Urban slums have extreme challenges with access to potable water, and high under-five mortality, communicable diseases rates, and other health inequities – Mlolongo needs help.

If the local government cannot provide adequate infrastructure to meet the needs of its growing population, then it ought to fulfill its responsibility to recognize and address the basic needs of all of its citizens.

Image [Photo: R. Minhas]

Would you ban bottled water from our campus?

March 11, 2012

Today’s Washington Post features an article entitles “Solid opposition to bottled water is building on college campuses.” According to the article more than 90 schools are either banning or restricting the sales of bottled water.

Not all schools or students favor the idea – the thought is that people will turn to other bottled beverages that are sweetened and have worse individual health implications as well as maintain the problem of “bottle pollution.”

A few years back the city of Baltimore reminded us that tap water is not only safe but purified (and many bottled water companies simply take municipal water and resell it!). One can get safe water from a drinking fountain, but one ban not get juices or carbonated beverages out of the tap – so why spend money and create a carbon footprint with plastic and manufacturing when safe water is already at hand?

Interestingly there is even an International Bottled Water Association. This organization supposedly is not yet worried about such bans on their 9 billion gallon a year industry.
We are certainly lucky to have access to safe water when many people throughout the world do not. Ironically, a large plastic bottle of water in Nigeria can cost more than a large bottle of beer.

So far this appears to be a small scale effort changing policies from organization to organization, not yet taking it to local, state and national governments for debate. Would you voluntarily stop buying bottled water at school and just use the fountains and taps?

No Water for the Thirsty

August 16, 2009
A mother and her four daughters, who fetch 20 buckets of water a day for their family

A mother and her four daughters, who fetch 20 buckets of water a day for their family

Tanzania is a casebook example of the dangers of water privatization. In 2003, the World Bank and IMF encouraged the country to privatize its public water system. Tanzania thus accepted the services of City Life water, a British company who purchased DAWASA (now DAWASCO), the municipal water corporation. Within two years however, the water supply had not improved, and the situation was so terrible that the government finally arrested the business leaders of City Life and sent them back to England as undesirable immigrants.

The most recent 2006 World Health Organization data for Tanzania show that a significant portion of the population has access to improved water sources (92% of the urban population and 62% of the rural population). However this number is misrepresentative. While public standpipes are considered improved water sources, i.e. “likely safe water sources,” they are not a sustainable solution. Many households must wait hours at public standpipes alongside herds of women, all hoping that the water will last until their turn to fill their 20L bucket, which they must then carry one kilometer or more back to their residence. If anecdotal evidence does not suffice, diarrhea remains the number four cause of mortality of children under five in Tanzania.

Buckets- the long line for water at the public spigot.

Buckets- the long line for water at the public spigot.

In addition to the obvious human rights issues, according to both the Tanzania Gender Networking Program and, water access problems have gender implications. Decreased access to water threatens the education of girls who must fetch water.  The Tanzanian Water and Environmental Sanitation Projects Maintenance Organization also shows how water access difficulties place an undue burden on already vulnerable HIV/AIDS-affected families in Tanzania, who need more water for proper disinfection of household items.

Instead of focusing on privatization as the solution, the World Bank and other international donors ought to focus on improving infrastructure. But in the mean time, perhaps big thinkers can rely on some forward-thinking engineering ideas to bring clean water to more people. The Cooper-Hewitt museum’s exhibit “Design for the Other 90%” highlights many water ideas, including the brilliant Q-drum. It is a cylindrical doughnut-shaped 50 L plastic jug that can be rolled instead of toted, thus making a water fetching much simpler. But with this solution, as with most others, “the problem,” says the inventor Piet Hendrikse, “is that those who need it, cannot afford it. And those who can, they don’t need it.”

Potable Water in Rural Villages Surrounding Comayagua Honduras

August 14, 2009

In 1998 the Central American country of Honduras was among the hardest hit by hurricane Mitch. Over 7,000 lives were lost, 3.8 billion dollars in damage was sustained and 70-80% of Honduras’ transportation and infrastructure were lost. Then President Carlos Flores said at the time that the hurricane annihilated almost fifty years of development and progress toward a better Honduras. Those most affected were the inhabitants of some of Honduras’ most rural areas. Entire villages were swept away by the mudslides resulting from Mitch.

The most damaged infrastructure was Honduras’ already fragile potable water system. According to the organization called, post hurricane Mitch 75% of the populace were left without safe drinking water. The country has struggled ever since to catch up and bring safe drinking water back to their people.

The continued poor water quality poses major health risks to the Honduran people. According to the WHO diarrheal disease alone accounts for 4.1 % of the total global burden of disease and is responsible for the deaths of 1.8 million people every year. The most vulnerable in any the population are children under the age of five. According to WHO statistics in Honduras the mortality rate per year for children under the age of five from diarrheal illness alone is 12.1%.

The VHC Medical Brigade (VHCMB) together with their partners Engineers Without Borders (EWB) and the members of the Peace Corps in Honduras have tried to bring potable water systems to the most remote areas of Honduras. They have completed their first such project in Valle Bonito Honduras and are looking to complete others in neighboring villages in the same mountainous remote region. Specifically in San Antonio de la Libertad.

Two of the major barriers to the success of these projects are lack of appropriate funding and economic support from the local government in Comayagua and lack of appropriate transportation and road infrastructure for supplying the projects. The burden of funding and working around infrastructure issue falls predominantly on NGO’s such as VHCMB, EWB and others like them. VHCMB in partnership with EWB and local Peace Corps workers together with the Water Board comprised of local leaders in the target village in San Antonio de la Libertad are lobbying the government in Comayagua. They want government help funding these projects. They also want policies in place that require local municipalities to fund and execute the maintenance of the transportation and infrastructure required to support the building of potable water systems in rural villages.

The impact that funding and economic support and policy change at the municipality level could have on the lives and health of the recipients of these new water systems is staggering. The reduction in water born illness and the empowerment of the people in the villages themselves is vital to the future of Honduras itself.

Access to Potable Drinking Water in Urban and Rural Area of Honduras

Urban (46% of the population)

Rural (54% of the population)


Water Non household connection 95% 81% 87%
Household connections 91% 62% 75%

* Source: WHO/UNICEF Joint Monitoring Program/2006

From personal pictures: Water system built in Valle Bonito Honduras

From personal pictures: Water system built in Valle Bonito Honduras