Wastewater treatment and access to improved sanitation: fact sheet No. 1.3, May 2007

This indicator assesses the potential level of pollution from domestic point sources entering the aquat- ic environment which may have an adverse impact on public health. It also monitors progress towards reducing this potential. In terms of population health, the indicator shows the percentage of the pop- ulation at risk of infection via the faecal-oral route due to the absence of adequate sewage disposal systems. In the European Union (EU) countries, there were significant improvements in the proportion of the population connected to wastewater treatment facilities between 1980 and 2003. On average, two thirds of the population had been connected by 2003, although there were significant variations. Further, data for the Region show that coverage in rural areas often lags behind that in urban areas, particularly in eastern Europe and central Asia. Diarrhoeal disease, which is estimated to have caused 13 000 deaths in children aged under 14 years in the eastern European and central Asian countries of the WHO European Region in 2001, is strongly associated with poor water quality. Improved wastewater treatment can reduce this burden, and con- tinued efforts to implement policies with this aim are essential. RATIONALE Percentage of the population in the community or area under consideration served by a sewerage system connected to a wastewater treatment facility or a safe local wastewater disposal system Wastewater treatment and access to improved sanitation FACT SHEET NO. 1.3 · MAY 2007 · CODE: RPG1_WatSan_P1 KEY MESSAGE This summary is based on data on the proportion of the population connected to wastewater treatment facilities or to sanitation facilities in urban and rural areas. Fact sheet 1.3 22.05.2007 20:29 Uhr Seite 1 1 Malta Turkey Slovenia Cyprus Belgium Bulgaria Portugal Iceland Slovakia Greece Hungary Poland Lithuania Italy Latvia Ireland Estonia Czech Republic Norway France Finland United Kingdom (Nothern Ireland) Sweden Austria Spain Denmark United Kingdom (Scotland) Germany Luxembourg Switzerland United Kingdom (England and Wales) Netherlands PRESENTATION OF DATA Figure 1 shows the percentage of the popula- tion living in agglomerations with more than 2000 inhabitants with home connections to wastewater treatment facilities in 1980, 1995 and 2003, or the most recent year between 1997 and 2003 for which data are available. The differences between western and eastern European countries are clear. Figure 2 shows the percentage of the popula- tion with house connections to sanitation facilities in urban and rural areas for 2004 in those Member States for which data are avail- able. Data cover domestic populations that are connected to a sewerage system, thus private septic tanks or dry sanitation are excluded. HEALTH – ENVIRONMENT CONTEXT Wastewater from households and industry places a significant pressure on the water envi- ronment through the release of loads of organic matter, nutrients, hazardous substances and pathogenic microorganisms. The majority of the European population lives in urban agglomera- tions (three quarters in 1999) and a significant proportion of wastewater is collected in sewers connected to public wastewater treatment plants. Low water quality reduces the availabil- ity of water resources for specific uses, in partic- ular domestic needs and irrigated agriculture, and has adverse implications for public health. The principal effect on health of poor water quality is diarrhoeal disease. A recent estimate of mortality from diarrhoeal disease attributable to poor water, sanitation and hygiene suggested that over 13 000 children aged under 14 years die annually in Europe and central Asia due to poor water conditions (3–5). In the European Region, the burden of diarrhoeal disease is esti- mated to be 5.3% of all deaths and 3.5% of all disability-adjusted life-years (DALYs) in chil- dren aged 0–14 years in 2001. The largest con- tribution to the burden of disease comes from those countries with low adult and low child mortality (countries in the WHO Eur-B sub- region),1 with over 11 000 deaths and almost 500 000 DALYs. This suggests that high poten- tial reductions in deaths and DALYs could be made by the development of infrastructures and better personal hygiene. For instance, giving the entire child population in the Eur-B countries access to a regulated water supply and full san- itation coverage, with partial treatment for sewage, would save about 3700 lives and 140 000 DALYs (6). For additional informa- tion, see ENHIS-2 fact sheet 1.1 of May 2007 on outbreaks of waterborne diseases (7). Fig. 1. Changes over time in the population connected to wastewater treatment facilities, selected European countries, 1980–2003 Pan-European and global context The WHO-United Economic Commission for Europe (UNECE) Protocol for Water and Health, adopted in 1999, requires all countries to provide sanitation to a standard which suf- ficiently protects human health and the envi- ronment through the establishment, improve- ment and maintenance of collective systems and wastewater treatment installations, and to establish a programme for monitoring situa- tions likely to result in outbreaks or incidents of water-related disease (8). Progress made is to be assessed in terms of suitable indicators, of which this indicator is one. 0 10 20 30 40 50 60 70 80 90 100 Proportion of population (%) Source: EUROSTAT (1). 2003 or latest available year 1995 1980 1 Albania, Armenia, Azerbaijan, Bosnia and Herzegovina, Bulgaria, Georgia, Kyrgyzstan, Poland, Romania, Serbia and Montenegro, Slovakia, Tajikistan, The former Yugoslav Republic of Macedonia, Turkey, Turkmenistan, Uzbekistan. POLICY RELEVANCE AND CONTEXT Fact sheet 1.3 22.05.2007 20:29 Uhr Seite 2 2 The size of the burden of disease attributable to poor sanitation and hygiene, and the avail- ability of means to reduce it, led to the inclu- sion of “access to improved sanitation”2 in the United Nations Millennium Development Goals indicators (9). In 2004, the Fourth Ministerial Conference on Environment and Health adopted the Chil- dren’s Health and Environment Action Plan for Europe (CEHAPE), which includes four regional priority goals to reduce the burden of environment-related diseases in children (10). One of the goals (RPG I) aims at preventing and significantly reducing morbidity and mor- tality arising from gastrointestinal disorders and other health effects, by ensuring that ade- quate measures are taken to improve access to safe and affordable water and adequate sanita- tion for all children. EU context Council Directive of 21 May 1991 (91/271/ EEC) concerning urban wastewater treatment prescribes the level of treatment required before discharge (11). It requires member states to provide all agglomerations of more than 2000 population equivalents (p.e.) with collecting systems. Secondary (biological) treatment must be provided for all agglomera- tions of more than 2000 p.e. discharging into fresh waters and estuaries and for all agglom- erations of more than 10 000 p.e. discharging into coastal waters. EU member states must identify water bodies as sensitive areas (vul- nerable to eutrophication) in accordance with the criteria of the Directive. In sensitive areas, they must provide more advanced treatment of wastewater with nutrient removal, placing more stringent criteria with specific monitor- ing requirements. The Directive is designed to protect the ecological status of receiving waters and does not require microbiological analysis of effluents discharged from waste- water treatment facilities. Member states are required to submit biennial reports to the EU of their progress towards the implementation of the Directive. The cohesion policy of the EU will continue to support sewage treatment plants from its € 336 billion budget for 2007–2013 for all new member states. Support is greatly need- ed as current investments in some of the east- ern European countries are at the level of € 5–10 per capita and will need to be increased to € 40–50 per capita to comply with the deadlines (12). ASSESSMENT An average of 66.5% of the population of the countries considered in the assessment were connected to wastewater treatment facilities in 2003. There are, however, wide differences between countries. In the Nordic and some northern European countries, which have the longest tradition of water purification, more than 85% of the population were connected to wastewater treatment facilities. In southern European countries coverage ranged between 40% and 60%, while in some of the new EU member states it was less than 40%. For the period considered, annual data were not available for a number of countries, which makes the derivation of time trends at the European level difficult. The available data show that on average there was a 70% increase in coverage from 1980 to 2003, with a 20% increase from 1995 to 2003. Some countries, including the Czech Republic, Hungary, Iceland and Poland, have made significant progress since 1995. The European Urban Wastewater Treatment Directive has resulted in significant improve- ments in urban wastewater treatment capacity (13). It is anticipated that with the planned increase in capacities of treatment plants and collection networks the situation will continue to improve. Fig. 2. Percentage of the population connected to sanitation facilities in urban and rural areas, selected countries in the WHO European Region, 2004 Note. Privately owed septic tanks or dry sanitation systems are not included in the data. Serbia and Montenegro became two separate Member States of WHO in September 2006. In this figure the data refer to 2004 and relate only to the then entity of Serbia and Montenegro (Serbia). Source: WHO/UNICEF Joint Monitoring Programme (2). Rural Urban Kazakhstan Romania Georgia Poland Serbia and Montenegro (Serbia) Hungary Ukraine Belarus Armenia Bulgaria Russian Federation Bosnia and Herzegovina Albania Croatia Lithuania Estonia Latvia Slovakia Finland Czech Republic Austria Switzerland Netherlands Sweden Spain 0 10 20 30 40 50 60 70 80 90 100 Proportion of population (%) 2“Improved” sanitation includes connection to a public sewer or septic system, pour-flush latrine, simple pit latrine or ventilated improved pit latrine. Fact sheet 1.3 22.05.2007 20:29 Uhr Seite 3 3 The data from the Joint Monitoring Pro- gramme for Water Supply and Sanitation (14) show a wide difference between urban and rural areas in a number of countries in terms of the percentage of the population with house connections to sanitation facilities. This underlines the urban and rural challenges of the decade in meeting the Millennium Devel- opment Goals target for drinking-water and sanitation. DATA UNDERLYING THE INDICATOR Data source 1. EUROSTAT (1) 2. WHO/UNICEF Joint Monitoring Programme (2). Description of data The EUROSTAT data are derived from the dataset “National population connected to wastewater treatment plants” (Table IWQ4). The Joint Monitoring Programme data are the datasets “san_urb_hc” and “san_rur_hc”, defined as “Percentage of population with house connections to sanitation facilities in urban and rural areas”. House connections only take into account domestic connections that are connected to a sewerage system and therefore exclude septic tanks or dry sanitation, even if privately owned. Improved sanitation includes connection to a public sewer, connec- tion to a septic system, pour-flush latrine, sim- ple pit latrine or ventilated improved pit latrine. Method of calculating the indicator The indicator was computed as: connected population/total population x 100. Geographical coverage The EUROSTAT database covers 27 EU coun- tries and Croatia. The Joint Monitoring Programme database covers all Member States of the WHO Euro- pean Region, including the Commonwealth of Independent States. Period of coverage The EUROSTAT database provides data from 1970 to 2003: every five years from 1970 to 1990 and annually from 1990 to 2003. The Joint Monitoring Programme database provides data for four time points 1990, 1995, 2002 and 2004. Frequency of update The EUROSTAT database is updated every two years. The Joint Monitoring Programme database is updated when a new questionnaire is filled in. Data quality Owing to the voluntary nature of the data col- lection, the data sets obtained by EUROSTAT and by the Joint Monitoring Programme are not complete and do not relate to the child population. EUROSTAT checks the data for plausibility, for example, for logical consistency and for extraordinary changes in time series. The data are revised whenever a new questionnaire is filled in. Because the data collected are useful in a poli- cy context to identify areas with low sanita- tion coverage, there is a need for improvement in the collection, management and reporting of data. A mechanism for regular reporting as well as a widening in the data coverage and improvement in the estimates of sanitation and wastewater treatment should be set under the WHO Protocol on Water and Health. © 2007 World Health Organization All rights reserved. The views expressed do not necessarily represent the decisions, opinions or stated policy of the European Commission or the World Health Organization. For further information, see the web site of the WHO European Centre for Environment and Health, Bonn www.euro.who.int/ecehbonn. World Health Organization · Regional Office for Europe Scherfigsvej 8 · DK-2100 Copenhagen Ø · Denmark · Tel.: +45 39 17 17 17 · Fax: +45 39 17 18 18 · postmaster@euro.who.int · www.euro.who.int References 1. EUROSTAT [web site]. Brussels, Statistical Office of the European Communities, 2007 (http://europa.eu.int/comm/eurostat/, accessed 17 March 2007). 2. WHO and UNICEF. Joint Monitoring Programme for Water Supply and Sanitation [web site]. Geneva, World Health Organization and New York, United Nations Children’s Fund, 2006 (http://www.wssinfo.org/en/, accessed 17 March 2007). 3. WHO/UNICEF. Global water supply and sanitation assessment 2000 report. Geneva, World Health Organization, and New York, United Nations Children’s Fund, 2002 (http://www.who.int/water_sanitation_health/monitoring/jmp2000.pdf, accessed 19 March 2007). 4. Valent F et al. Burden of disease attributable to selected environmental factors and injuries among Europe’s children and adolescents. Geneva, World Health Organization, 2004 (WHO Environmental Burden of Disease Series, No. 8; http://www.who.int/quantifying_ehimpacts/publications/en/ebd8web.pdf, 19 March 2007). 5. Prüss-Üstün A et al. Unsafe water, sanitation and hygiene. In: Global and regional burden of disease attribution to selected major risk factors. Geneva, World Health Organization, 2004:1321–1352. 6. Study on environmental burden of disease in children: key findings. Copenhagen, WHO Regional Office for Europe, 2004 (Fact Sheet EURO/05/04; http://www.euro.who.int/document/mediacentre/fs0504e.pdf, accessed 15 March 2004). 7. WHO European Centre for Environment and Health. Outbreaks of waterborne diseases. Copenhagen, WHO Regional Office for Europe, 2007 (ENHIS-2 project, Fact sheet No. 1.1). 8. WHO-UNECE. Protocol on Water and Health to the 1992 Convention on the Protection and Use of Transboundary Watercourses and International Lakes. Geneva, United Nations Economic Commission for Europe and Copenhagen, WHO Regional Office for Europe, 2006 (http://www.euro.who.int/Document/Peh-ehp/ProtocolWater.pdf, accessed 26 March 2007). 9. Millennium development goal indicators. New York, United Nations, 2006 (http://mdgs.un.org/unsd/mdg/, accessed 19 March 2007). 10. Children’s Environment and Health Action Plan for Europe. Declaration. Fourth Ministerial Conference on Environment and Health, Budapest, 23–25 June 2004 (EUR/04/5046267/6; http://www.euro.who.int/document/e83335.pdf, accessed 16 March 2007). 11. Council Directive of 21 May 1991 (91/271/EEC) concerning urban waste water treatment. Brussels, European Commission, Environment Directorate-General, 2007 (http://europa.eu.int/comm/environment/water/water-urbanwaste/directiv.html, accessed 19 March 2007). 12. Effectiveness of urban wastewater treatment policies in selected countries: an EEA pilot study. Copenhagen, European Environment Agency, 2005 (Report No. 2/2005; http://reports.eea.europa.eu/eea_report_2005_2/en, accessed 19 March 2007). 13. European Environment Agency. The European environment – state and outlook 2005. Part B: Core set of indicators. Luxembourg, Office for Official Publications of the European Communities, 2005:348–391. 14. WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation. Meeting the MDG drinking-water and sanitation target: the urban and rural challenge of the decade. Geneva, World Health Organization and New York, United Nations Children’s Fund, 2006 (http://www.who.int/water_sanitation_health/monitoring/jmpfinal.pdf, accessed 19 March 2007). Further information Water indicators. Copenhagen, European Environment Agency, 2007 (http://themes.eea.eu.int/Specific_media/water/indicators, accessed 19 March 2007). The Protocol on Water and Health. Copenhagen, WHO Regional Office for Europe, 2006 (http://www.euro.who.int/document/wsn/WaterProtocol_2006upd_web.pdf, accessed 26 March 2007). Author: Alexandra Katsiri, National School of Public Health, Athens, Greece. Fact sheet 1.3 22.05.2007 20:29 Uhr Seite 4 Document number: WHO/EURO:2007-6378-46144-66759 4