As increasing numbers of people risk health impacts related to water scarcity, Carlos Dora and Roberto Bertollini call for an urgent agenda to promote research and action.

Today, two billion people live in water scarce environments,¹ face related health risks,² and their number is rapidly growing. However, no framework exists to protect their health. Health leaders are yet to take up opportunities for health protection in dry environments which could also save resources.

Some options are available now, for example, health systems can switch to water saving taps, reuse waste water,³ and harvest rainwater.⁴ The water savings can help replenish and support green infrastructure, such as parks, protect against floods, and create opportunities for outdoor physical activity to improve mental health,⁵ enable children’s contact with nature,⁶ and reduce excess city temperatures (“the urban heat island effect”).⁷

Opportunities to promote health extend well beyond the realm of healthcare. Connection to public transport, and shaded cycling and walking routes, while enabling better access to healthcare also increases healthy social interaction.⁸ In parts of the world where people spend much of their time indoors because of the heat, adequate space and ventilation will help reduce the spread of infections like covid-19.⁹

Water availability has a beneficial effect on non-communicable diseases by encouraging local fruit and vegetable agriculture, and reducing consumption of sugar sweetened beverages if water fountains are installed in public spaces and schools.¹⁰

Cross sectoral advantages are often overlooked by standard measures of health risks,¹¹ but considering drivers of health risks in other sectors, such as land use, buildings, transport, and agriculture, helps identify ways to reduce disease burden through better sanitation and hygiene, reduction in non-communicable diseases, and improved child health and nutrition.

An urgent agenda of research and action is required to develop more efficient and effective societal responses to the health risks unique to water-scarce settings, which affect a growing number of people worldwide.¹² Firstly, health risks must be mapped to their root causes, including in sectors other than health. Opportunities for synergistic preventive action can be identified, along with gaps, constraints, and enabling factors. Existing knowledge, tools, and initiatives can be shared.  

Secondly, we should engage communities, policy makers, and researchers, to identify barriers, motivate them to develop a better response to health risks, and obtain support to implement pilot schemes.

Thirdly, leading cities and regions can cooperate to move from analysis to policy and program implementation by agreeing ways to track progress, identify success, and exchange learning.¹³ One approach would be to drive the response by convening a coalition for health in dry environments, bringing together interested groups from civil society, research, and philanthropy that is geared towards action and implementation.

These initiatives would find synergies with existing global, regional, national, and local agendas and funding mechanisms, such as those to combat climate change, desertification, and water shortages.¹⁴

Success will only be achieved if health systems in dry cities strengthen their capacity to work with and influence other sectors,¹⁵ drawing on experience from the Health in All Policies and Intersectoral Action for Health agendas promoted by the World Health Organization and championed by several countries.¹⁶ Health leadership will be central to prioritising, funding, and implementing this agenda in dry cities, as well as safeguarding women’s health concerns, and reducing health disparities suffered by poor people and members of disenfranchised minorities.¹⁷

An ambitious agenda along these lines can unlock the potential for health protection in dry environments and contribute much needed adaptation to an increasingly water-scarce world. This month delegates at the World Innovation Summit for Health will discuss health challenges in dry cities.¹⁸ They are well placed to commit to lead and support such a collaboration and can launch a network, develop the discipline,¹⁹ and realise this agenda. 

Carlos Dora, independent advisor, Global Environmental Health Governance, Switzerland

Roberto Bertollini, MD MPH, senior advisor, Ministry of Public Health, Qatar

Competing interests: None declared.

This article is part of a series commissioned by The BMJ for the World Innovation Summit for Health (WISH) 2020. The BMJ peer reviewed, edited, and made the decisions to publish. The series, including open access fees, is funded by WISH.

 

1. World Water Assessment Programme (Nations Unies), The United Nations World Water Development Report 2018 (United Nations Educational, Scientific and Cultural Organization, New York, United States)
2. UN WATER, 2018. SDG 6 Synthesis Report 2018 on Water and Sanitation. (accessed on May 25, 2020)
3. Guidelines for water reuse and recycle in health care facilities. Victoria, Australia, 2009.
4. WHO UNICEF 2019. Water, sanitation and hygiene in health care facilities: practical steps to achieve universal access. ISBN 978-92-4-151551-1.
5. Braubach M, Egorov A, Mudu P, et al. Effects of Urban Green Space on Environmental Health, Equity and Resilience. In: Kabisch N, Korn H, Stadler J, et al., eds. Nature-Based Solutions to Climate Change Adaptation in Urban Areas: Linkages between Science, Policy and Practice. Cham, Switzerland: Springer International Publishing 2017:187-205.
6. Brown, C., de Lannoy, A., McCracken, D., Gill, T., Grant, M., Wright, H. and Williams, S. (2019). Special issue: child-friendly cities. Cities & Health 3(1–2): 1–7. 
7. Heaviside C, Macintyre H, Vardoulakis S. The Urban Heat Island: Implications for Health in a Changing Environment. Current Environmental Health Reports. 2017. 10.1007/s40572-017-0150-3.
8. Mueller, Natalie, Rojas-Rueda, David, Cole-Hunter, Tom, de Nazella, Audrey, Dons, Evi, Gerike, Regine,…Nieuwenhuijsen. (2015). Health impact assessment of active transportation: A systematic review. Preventive Medicine, 76, 103–114. http://doi.org/10.1016/j.ypmed.2015.04.010
9. Laith J. Abu Raddad, Hiam Chemaitelly, Houssein H. Ayoub et al.  Characterizing the Qatar advanced-phase SARS-CoV-2 epidemic. medRxiv 2020 https://doi.org/10.1101/2020.07.16.20155317
10. Muckelbauer R, Libuda L, Clausen K, Toschke AM, Reinehr T, Kersting M. Promotion and provision of drinking water in schools for overweight prevention: randomized, controlled cluster trial. Pediatrics. 2009;123:e661–667. 
11. NCD Countdown 2030 collaborators.  NCD Countdown 2030: pathways to achieving Sustainable Development Goal target 3.4. The Lancet Health Policy.  www.thelancet.com Published online September 3, 2020 https://doi.org/10.1016/S0140-6736(20)31761-X 
12. Boretti, A., Rosa, L. Reassessing the projections of the World Water Development Report.npj Clean Water 2, 15 (2019). https://doi.org/10.1038/s41545-019-0039-9
13. Oliveira JA, Doll CN, Siri J, Dreyfus M, Farzaneh H, Capon A. Urban governance and the systems approaches to health-environment co-benefits in cities. Cad Saude Publica. 2015;31 Suppl 1:25-38. doi:10.1590/0102-311X00010015
14. Peters D, Hanssen O, Gutierrez J, Abrahams J, Nyenswah T. Financing Common Goods for Health: Core Government Functions in Health Emergency and Disaster Risk Management. Health Systems & Reform. 5. 10.1080/23288604.2019.1660104
15. Sacks E, Morrow M, Story WT, et al. Beyond the building blocks: integrating community roles into health systems frameworks to achieve health for all.  BMJ Global Health 2019;3:e001384.
16. Leppo K, Ollila E, Pena S , Wismar M, Cook S eds. Health in All policies. Seizing opportunities, implementing policies.  Ministry of social Affairs and Health Finland. 2013.
17. Peters D, Hanssen O, Gutierrez J, Abrahams J, Nyenswah T. Financing Common Goods for Health: Core Government Functions in Health Emergency and Disaster Risk Management. Health Systems & Reform. 5. 10.1080/23288604.2019.1660104
18. Frumkin Howard, Das Maitreyi Bordia, Negev Maya, Rogers Briony C, Bertollini Roberto, Dora Carlos et al. Protecting health in dry cities: considerations for policy makers BMJ 2020; 371:m2936
19. Hussein T, Plummer M and Breen B. Stanford Social Innovation Review. How field catalysts galvanize social change. Winter 2018.