August 15, 2006
by Troy Ritter, Environmental Health Coordinator for ANTHC’s Department of Environmental Health Support. This program works to ensure that ANTHC construction efforts provide maximum health benefit. Troy can be contacted at (800) 560-8637 ext 4290.
Here at the Alaska Native Tribal Health Consortium we have the pleasure of working with many people dedicated to protecting and promoting Alaska Native health. One such group is the water and wastewater system operators of rural Alaska. In my opinion, the contributions of these invaluable public health professionals often exceed the credit and recognition they receive. Most of us realize that contact with sewage and drinking of contaminated water can make us sick, but few take the time to thank the person (or people) responsible for providing us with clean drinking water and safe wastewater disposal. Possibly, this is because most people are unaware of the specific health benefits brought about through provision of sanitation services. This article will discuss the findings of modern scientific research, as well as some historical examples, in order to show that no single factor is more important to the protection of public health than the availability of clean water and safe wastewater disposal.
Historical records show that people have recognized the public health value of water and wastewater services for at least 7000 years. For example, in 5000 BC the Babylonians understood that contaminated water could cause disease, and as a result, brought in fresh water every day; the ancient Romans built primitive water and sewage systems; and Hippocrates first suggested that boiling water could remove impurities in 400 BC. Certainly, these early populations understood that provision of water and wastewater services were important, but it wasn’t until the days of modern research that we were able to quantify the value of sanitation services in terms of diseases prevented and lives saved.
One of the first scientific studies on this subject is also one of the most important. A 1958 Kentucky study provided a foundation for Alaskan sanitation facility construction programs. The researchers examined many different environmental factors such as household crowding, family income, education level and abundance of flies before concluding that all other factors were secondary to the availability of sanitation services (1). The researchers also found that differing types of sanitation services provide differing levels of health protection. Specifically, piped systems provide the greatest level of health protection. The researchers found that residents of homes with piped services had 60 percent less diarrheal disease than residents of homes without piped services.
A 1969 study conducted on a Hopi Indian reservation found that providing homes with indoor plumbing reduced diarrhea-related clinic visits by 58 percent (2). To my knowledge, this was the first study on the subject of sanitation improvements and health involving an American Indian or Alaska Native population. A reduced need for medical attention is particularly valuable in rural Alaska where medical care is sometimes more difficult to access than in more populated areas.
In 1990, researchers reviewed 144 studies before concluding that residents of homes with sanitation services had, on average, 22 percent less diarrhea-related sickness and 65 percent less diarrhea-related death than residents of homes without services (3). What makes this study unique is its comprehensiveness. The researchers started with every known study on the subject and then eliminated those with questionable research methods and those which did not undergo peer review. Interestingly, the results of the remaining studies were remarkably similar, even though they were conducted in different geographic settings using different study populations from all parts of the world.
A 1994 rural Alaskan study was the first to confirm that the health benefits which had been documented outside of Alaska could be replicated here; the researchers noted that 72 percent of hepatitis A cases occurring during their observation period were among residents of honeybucket villages (4).
Historically most of the health benefits of sanitation services have been thought to be diarrheal/gastro-enteric in nature. However, this author has learned that Alaskan researchers have been busy studying the relationship between sanitation services and diseases such as respiratory infections and diseases of the skin. Of course, respiratory syncytial virus (RSV) and methicillin resistant staff aureus (MRSA) are two important emerging diseases threatening rural Alaskan populations. While the report was unavailable at the time of this publication, I am hearing that this research could establish a link between inadequate sanitation services and these diseases.
As a longtime water plant operator once asked me- “What does all this scientific mumbo jumbo mean?” Regardless of the statistics and facts presented above, since the first water and wastewater operators began working in rural Alaska, the percentage of deaths from infectious disease has decreased from 46 percent to 1.3 percent; infant mortality has decreased by 90 percent; and Alaska Natives are living an average of 22 years longer (source: IHS 1998). Much of this progress has been made possible through the contributions of those who work in some pretty tough conditions to bring us these critical services. So, it is important to remember that our water and wastewater system operators provide not only clean water and safe wastewater disposal, but longer and healthier lives for our friends, families and fellow community residents. I hope you will remember to thank your water and wastewater system operators for the work they do.
References:
1) Schliessmann, D.J., Atchley, F.O., Wilcomb, M.J., Welch, S.F. (1958). Relationship of environmental factors to the occurrence of enteric diseases in areas of Eastern Kentucky. Public Health Monograph, 54, 1-33.
2) Rubenstein, A., Boyle, J., Odoroff, CL., Kunitz, SJ., (1969). Effect of Improved Sanitation Facilities on Infant Mortality in a Hopi Village. Public Health Reports 84: 1093-1097.
3) Esrey SA, Potash JB, Roberts L, Shiff C. (1990). Health benefits from improvements in water supply and sanitation. WASH Reprint: Technical Report No. 66, vi-viii.
4) U.S. Congress, Office of Technology Assessment. (1994) An Alaskan Challenge: Native Village Sanitation, OTA-ENV-591 (Washington DC: U.S. Government Printing Office).