Clean (and often fluoridated) water flowing effortlessly from water taps at home, daily showers or soothing baths, and a functioning, clean toilet connected to a central sewage system as a standard for every household - these are the likely associations for most BDJ readers when the words 'water, sanitation, and hygiene' (collectively termed as 'WASH') are mentioned. However, the realities for billions of individuals in their homes, educational institutions, and healthcare facilities can be vastly different.
The World Health Organisation (WHO) stresses the importance of clean water, sanitation, and hygiene (WASH) as the foundation for health, development, and poverty reduction.1 Access to WASH services is integral to both general and oral health and is recognised as a fundamental human right by the UN. This led to the inclusion of a dedicated goal, SDG 6, aiming for universal access to WASH by 2030. However, the global community is falling short of realising this ambition.2
According to the WHO/UNICEF Joint Monitoring Programme for WASH, around 785 million people lack access to basic drinking water services (2021).2 Additionally, 2.3 billion people are without access to basic sanitation facilities, leading to open defecation and water contamination. Despite the importance of hygiene highlighted during the COVID-19 pandemic, 3 billion people lack basic handwashing facilities with soap and water at home.
Safe, effective, and quality healthcare is not possible without basic WASH services.
Similarly, about 30% of schools have no basic water and sanitation services, and 40% lack basic hygiene services.2 Equally troubling is that only about half of healthcare facilities have basic hygiene services, including sinks with soap near toilets. This translates into a staggering 3.85 billion individuals encountering healthcare environments bereft of the fundamental opportunity for hand hygiene prior to medical services or interventions. Shockingly, approximately 780 million people are served in healthcare settings without sanitation services.2
The repercussions of these critical gaps in WASH services are substantial and preventable. They encompass elevated rates of infectious diseases, resulting in high mortality rates among vulnerable groups like infants, children, and the elderly. These service gaps also lead to school and work absences due to illness, hinder proper personal and environmental hygiene practices, and increase the risk of food-borne infections and many other detrimental impacts on individuals, communities, and economies.
In healthcare contexts, inadequate WASH services hamper infection control, resulting in complications and increased likelihood of hospital-acquired infections. Hygiene deficiencies also contribute to the concerning emergence of antimicrobial resistance. While specific data on WASH coverage in oral healthcare facilities are lacking, it is reasonable to assume a similar and equally challenging situation. Safe, effective, and quality healthcare is impossible without basic WASH services.
Without access to water, personal and oral hygiene are affected. Without water in schools, implementing hand and oral hygiene programmes becomes difficult, limiting health education and practice. This is why SDG 4, focusing on education, includes a target for universal WASH services in schools. Access to a centralised water network is also crucial for introducing water fluoridation to prevent dental caries.
Improving global WASH access faces various challenges, including: infrastructure, economics, politics, and environmental factors. Estimates show that achieving universal WASH access in the 43 poorest countries would require yearly investments of $6.5-9.6 billion USD until 2030, just $0.6-1 USD per person annually - a reasonable investment for governments and the international community.3
The pandemic underscored the link between environmental, animal, and human health, including WASH needs. The One Health concept offers a framework for addressing these interconnections and advancing SDG 6. The WHO Global Oral Health Action Plan includes WASH-related actions and promotes sustainable, resource-efficient oral healthcare. It is vital for all stakeholders and oral health professionals to embrace such thinking, engage in WASH initiatives, and contribute to sustainable universal WASH access for all within a generation.
WHO. Water, sanitation, hygiene and health: A primer for health professionals. Geneva: WHO, 2019.
Wash Data. Homepage. Available at www.washdata.org (accessed September 2023).
Chaitkin M, McCormick S, Alvarez-Sala Torreano J et al. Estimating the cost of achieving basic water, sanitation, hygiene, and waste management services in public health-care facilities in the 46 UN designated least-developed countries: a modelling study. Lancet Glob Health 2022; DOI: 10.1016/S2214-109X(22)00099-7.
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Benzian, H. SDG 6 - water, sanitation and hygiene are foundational for oral health. Br Dent J 235, 359 (2023). https://doi.org/10.1038/s41415-023-6337-0