Public water supply and access to improved water sources: fact sheet No. 1.2, May 2007

The indicator estimates the achievement of the minimum requirements for access to an adequate supply of piped and safe water in the home. It is a core indicator for risks related to water and hygiene. There is a clear east-west divide as regards access to drinking-water. In western Europe, close to 100% of the population have had access to safe drinking-water since the 1990s. In the eastern part of the Region access remains low, albeit rising, ranging from 58% to 80%. According to the World Health Organization and United Nations Children´s Fund (WHO/UNICEF) Joint Monitoring Pro- gramme assessment (1), there are important disparities between urban and rural areas: In the east only 30– 40% of rural households have access to individual sources of safe drinking-water. RATIONALE Proportion of population with continuous access to adequate amount of safe drinking-water at home Public water supply and access to improved water sources FACT SHEET NO. 1.2 · MAY 2007 · CODE: RPG1_WatSan_Ex1 KEY MESSAGE The data mainly reflect the proportion of the population supplied from a public system controlled reg- ularly for quality criteria compliance, and only to a lesser extent the safety and adequacy of drinking- water available to the population. The complexity of the definition of an improved source, combined with the voluntary nature of the reporting, means that care should be taken in interpreting the data. Note. Data for France and Germany are for 2001; data for Italy are for 1999; data for Portugal are for 1998; data for Slovakia are for 2003; data for Sweden are for 1997. Source: EUROSTAT (1). Cyprus Netherlands Italy France Germany Bulgaria Denmark Belgium Iceland Hungary Slovenia Ireland Czech Republic Austria Norway Sweden Poland Portugal Slovakia Liechtenstein Estonia Romania 0 10 20 30 40 50 60 70 80 90 100 Proportion of population (%) Fig. 1. Proportion of population connected to public water supply in Europe, 2002, or last available year Fact sheet 1.2 18.05.2007 23:56 Uhr Seite 1 1 Fig. 2. Percentage of the population with access to an improved water supply in urban and rural areas, WHO European Region, 2004 or last available year Proportion of population (%) Note. Data for Belgium, Greece and Portugal are for 1995; data for Armenia, Azerbaijan, Belarus, Cyprus, Georgia, Kazakhstan, Kyrgyzstan, Republic of Moldova, Russian Federation, Tajikistan, Turkey, Turkmenistan, Ukraine and Uzbekistan are for 2002. Serbia and Montenegro became two separate Member States of WHO in September 2006. In this fact sheet the data refer to 2004 and relate to the then one country of Serbia and Montenegro. Source: WHO/UNICEF Joint Monitoring Programme (2). Monaco Andorra Republic of Moldova Romania Azerbaijan Belarus Tajikistan Kazakhstan Kyrgyzstan Turkmenistan Turkey Georgia Uzbekistan Albania Ukraine Portugal Russian Federation Lithuania Latvia Serbia and Montenegro Armenia Croatia Bulgaria Greece Estonia Bosnia and Herzegovina Belgium Hungary Czech Republic Finland Slovakia Poland Malta Italy Ireland Germany United Kingdom Luxembourg Switzerland Spain Sweden Norway Netherlands Iceland France Denmark Cyprus Austria Rural house connection Urban house connection 0 20 40 60 80 100 Fact sheet 1.2 18.05.2007 23:56 Uhr Seite 2 2 PRESENTATION OF DATA Figure 1 is based on EUROSTAT data covering 22 countries in Europe which show that close to 100% of the population in almost all the west- ern countries have continuous access to ade- quate amounts of safe drinking-water at home. Figure 2 shows data covering 48 countries from the Joint Monitoring Programme data- base. This gives a broader view of the Region and reveals that an important proportion of the population, especially in the Common- wealth of Independent States, has poorer access to improved drinking-water sources, particularly in rural areas. HEALTH – ENVIRONMENT CONTEXT Access to safe drinking-water is strongly con- nected to basic health benefits. Hence, from the public health point of view, the proportion of the population with access to safe drinking- water is an indicator that measures the extent to which basic needs (as defined by the United Nations in recognition of water as a funda- mental human right) are met (3,4). Outbreaks of disease related to contaminated drinking-water continue to occur even in the economically developed European countries. They can severely affect human health, with infants and young children bearing the highest risk. According to WHO estimates, poor qual- ity drinking-water causes over 13 500 deaths from diarrhoea in children aged 0–14 years in the European Region (5.3% of all deaths in that age group) (5). While the vast majority of outbreaks of water- borne diseases result from microbial (bacterio- logical, viral, protozoan or other biological) contamination, serious health concerns may also arise as a result of chemical contamina- tion of drinking-water. These considerations explain the need to achieve high common stan- dards for drinking-water so as to reduce the burden of diseases attributable to poor quality water, sanitation and hygiene. POLICY RELEVANCE AND CONTEXT At present, there is no specific European Union (EU) legislation regarding the compul- sory reporting of access to safe drinking-water. The WHO-United Nations Economic Com- mission (UNECE) for Europe Protocol on Water and Health, which entered into force in August 2005, is the first legally binding instru- ment for the prevention and control of water- related diseases through improved and harmo- nized water supply and management. Article 4 of the Protocol requires parties to provide ade- quate supplies of wholesome drinking-water free from any microorganisms, parasites and substances which, owing to their numbers or concentration, constitute a potential danger to human health. To this end, parties are required to set targets and report on progress (6). The Millennium Development Goal No. 7, target 10, is to “halve by 2015, the proportion of people without sustainable access to safe drinking-water and basic sanitation”. Millen- nium Development Goal No. 4 (reduction of child mortality) is also relevant: 90% of the circa 1.8 million deaths that occur every year from diarrhoeal diseases are in children aged under five years, mostly in developing coun- tries (7). Target 5 is “to reduce by two thirds the under-five mortality rate between 1990 and 2015”. In the European Region, a lack of safe water and adequate sanitation has been recognized as a major cause of child mortality and mor- bidity, especially in eastern countries. One of the four strands of the Children’s Environ- ment and Health Action Plan for Europe (CEHAPE), the Regional Priority Goal 1, focuses on specific action “to increase the proportion of households with access to safe water and adequate sanitation, thereby ensuring that the proportion of children without access to clean water and sanitation is halved by 2015” (8). The implementation of the WHO-UNECE Protocol supports the achievement of the Mil- lennium Development Goals as well as of CEHAPE. ASSESSMENT By estimating the proportion of the general population with access to piped water in the home, the indicator also provides an estimate of the number of people without such access who are potentially exposed to water-related health risks. With very few exceptions accessi- bility is close to 100% for many western Euro- pean countries, but several hot spots can be detected in countries in the eastern part of the Region. However, accessibility (i.e. a water connection in the home) does not include com- pliance with the other criteria for this indica- tor such as an adequate water supply or com- pliance for quality or quantity of the water or the sustainability of a water supply. The big disparities in water and sanitation coverage are in the countries grouped in the WHO Eur-B sub-region (Albania, Armenia, Azerbaijan, Bosnia and Herzegovina, Bulgar- ia, Georgia, Kyrgyzstan, Poland, Romania, Serbia and Montenegro, Slovakia, Tajikistan, The former Yugoslav Republic of Macedo- nia, Turkey, Turkmenistan, Uzbekistan), where 86% of the population have access to an improved water source but only 63% have a household drinking-water connection. This situation accounts for the significant contri- bution of this region to the total burden of disease. Although data are only available for the gener- al population, they could be considered a good estimate for the child population as well, an indicator of progress in achieving the goals and a good marker for countries where action should be taken to increase the proportion of the (child) population with access to safe drinking-water. DATA UNDERLYING THE INDICATOR Data source 1.) EUROSTAT (1) 2.) WHO/UNICEF Joint Monitoring Programme (2). Description of data Data on the total population with access to safe drinking-water are collected by question- naire, either from the national statistics insti- tutes (for EUROSTAT) or by WHO/UNICEF country representatives (for the Joint Monitor- ing Programme). EUROSTAT data provide information on the proportion of the population with access to piped water in the home. Joint Monitoring Programme data cover total access, that is, they include all “improved” water supply sources, both private and public. An “improved” water supply source, as defined by the Programme, is a source likely to provide at least 20 litres per person per day of safe water, such as a household connection, a borehole, a protected dug well, a protected spring or rainwater collection, within one kilo- metre of the user’s dwelling. Method of calculating the indicator The indicator was computed as: connected population/total population x 100. Geographical coverage The EUROSTAT database covers almost all the EU countries plus some others. Data were avail- able for Austria, Belgium, Bulgaria, the Czech Republic, Cyprus, Denmark, Estonia, France, Germany, Hungary, Iceland, Ireland, Italy, Liecht- enstein, the Netherlands, Norway, Poland, Portu- gal, Romania, Slovakia, Slovenia and Sweden. Fact sheet 1.2 18.05.2007 23:56 Uhr Seite 3 3 The Joint Monitoring Programme database covers almost all the 53 countries in the WHO European Region, including the Common- wealth of Independent States. Period of coverage The EUROSTAT database provides data from 1980 to 2003, with annual reporting periodicity. The Joint Monitoring Programme database offers data for five time points: 1990, 1995, 2000, 2002 and 2004. Frequency of update Annually for the EUROSTAT database. Data quality Owing to the voluntary nature of the data col- lection, the data sets obtained by both EURO- STAT and the Joint Monitoring Programme are incomplete and do not relate to the child population. Because of the relevance of those data in relation to the quality of the water sup- plied and, consequently, to water-related risks for children, there is a need for further improvement. The data reported should be in accordance with the standardized definition of the terms “accessibility”, “safe” and “ade- quate” in order to reflect the real dimensions of the problem and its potential implications for health. The collected data are useful in a policy context to identify areas where there is a need to focus on improving the water supply. For the future, however, there is a need for standardized, regu- lar and clearly defined reporting on the propor- tion of the population with access to safe water, to allow for the estimation of water-related risks for children (in schools and kindergartens). 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. The right to water. Geneva, World Health Organization, 2003 (WHO Health and Human Rights Publication Series, No. 3; http://www.who.int/water_sanitation_health/rtwrev.pdf, accessed 16 March 2007). 4. Committee on Economic, Social and Cultural Rights. General Comment No. 15 (2002): The right to water (arts. 11 and 12 of the International Covenant on Economic, Social and Cultural Rights). Geneva, United Nations Economic and Social Council, 2003 (E/C.12/2002/11;http://www.unhchr.ch/tbs/doc.nsf/0/a5458d1d1bbd713fc1256cc400389e94/$FILE/G0340229.pdf, accessed 16 March 2007). 5. 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). 6. 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). 7. Health and the millennium development goals. Geneva, World Health Organization, 2005 (http://www.who.int/hdp/publications/mdg_en.pdf, accessed 16 March 2007). 8. 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). Further information 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). Millennium Development Goals Report 2006. New York, United Nations, 2006 (http://mdgs.un.org/unsd/mdg/Resources/Static/Products/Progress2006/MDGReport2006.pdf, accessed 27 March 2007). Author: Alexandra Cucu, Senior Lecturer, University of Medicine and Pharmacology “Carol Davila”, Bucharest, Romania. Fact sheet 1.2 18.05.2007 23:56 Uhr Seite 4 © 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 Document number: WHO/EURO:2007-6376-46142-66757 4