Let’s be honest. Nobody reading this started the day with a two mile hike to collect the family’s daily supply of water from a stream. None of us suffered the indignity of having to use a field, the roadside, or a plastic bag for a toilet. And our kids don’t die for want of a glass of clean water and some basic sanitation.

Perhaps that’s why we have such a parochial view of what constitutes a ‘water crisis’. Dwindling reservoirs, rumblings about compulsory water meters, and a few ministerial exhortations to flush the toilet less often and abandon the bath in favor of a quick shower, and we’ve got a national emergency on our hands. Hold the front page, we could be heading for a hose pipe ban in the Home Counties.

In the next 24 hours, diarrhea caused by unclean water and poor sanitation is going to claim the lives some 4000 children. The annual death toll from this relentless humanitarian catastrophe is bigger than the population of Turkish city of Manisa. Dirty water poses a greater threat to human life than war or terrorism. Yet it barely registers on the radar of public debate in rich countries.

Preventable child death is the tip of an iceberg. At any one time close to half the population of the developing world is suffering from water-related diseases. These diseases rob people of their health, destroy their livelihoods, and undermine education potential: they account for roughly 400 million lost school days each year.

The statistics behind the crisis make for grim reading. At the start of the 21st Century, and in the midst of an increasingly prosperous global economy, some 2.6bn people – have no access to even the most rudimentary latrine. Over 1 billion have no source of safe drinking water. The Millennium Development Goals (MDGs) include a pledge to halve by 2015 the proportion of people without access, but the world is hopelessly off track.

Unequal access to water powerfully captures the gross disparities that divide our world. In Britain, come rain, flood or drought, the average person uses 160 litres of clean water each day. In rural Mozambique or Ethiopia, people use what women and young girls can carry back from rivers and lakes: around 5-10 litres a day for each household member. The iconic image of a women carrying water belies a more brutal reality. You try carrying a 20 litre plastic jerrycan of water that weighs about 25kg for four miles in the baking sun.

The global sanitation gap is even more overwhelming. Those of you who have seen The Constant Gardner will recall the vibrant, colorful Kenyan slum visited by Rachel Weisz. The slum was Kibera. With a population of around 750,000 it is one of the largest informal settlements in Africa and accounts for one quarter of people living in the capital, Nairobi. Over 90 per cent lack access to a latrine, giving rise to a phenomenon that didn’t figure in the movie: the ‘flying toilet’. Lacking any alternative, people defecate into plastic bags that are thrown into street or ditches, with terrifying consequences for public health.

Kibera is a microcosm of what happens across the developing world. Rapid urbanization and a crumbling water and sanitation infrastructure in cities like Jakarta, Manila, Nairobi and Lagos have left millions of desperately poor people in overcrowded slums facing a constant threat from water infected with human excrement.

To add insult to injury, the poor invariably pay more for their water than the rich. In Kibera, you pay three times more per unit of water than in Manhattan or London – and ten times more than in high-income suburbs of Nairobi. Similar patterns are repeated across the cities of the developing world. The reason: water utilities pump cheap subsidized water to well-off customers, but seldom reach the poor. Most slum dwellers face the choice between buying water from high-cost private traders, or taking a trip to the nearest stream.

Overcoming the water and sanitation divide is a cause that unites moral imperative with economic common sense. Meeting the MDG target would cost around $4bn a year for the next decade. To put the price tag in context, it represents about one month’s worth of spending on bottled mineral water in Europe and the US. Put differently, for less than people in rich countries now spend on a designer product that produces no tangible health gains, we start rolling back one of the main causes of preventable childhood death.

And for every $1 invested another $3-4 would be generated through savings on health spending and increased productivity. As investments go, this one’s a no-brainer.

So why is progress so slow? Partly, of course, because this is a crisis borne overwhelming by poor people. Too often, governments in sub-Saharan Africa and elsewhere are more disposed to provide subsidized water for the rich, rather than universal access for the poor. The low priority attached to water and sanitation is reflected in national budgets – and, more acutely, in the chronic under-financing of infrastructure.

Aid donors have also under-delivered. Even with increased domestic financing and improved utility governance, the poorest countries need a step increase in external financing. Extending water and sanitation infrastructure requires large up-front investments with payback periods of 20 years or more. Yet the share of aid dedicated to these sectors (adjusted for the inevitable surge to Iraq) has halved and fallen in real terms since 1997 and fallen in real terms. To make matters worse, aid flows are weakly related to need. Sub-Saharan Africa faces the greatest financing gaps, but the region accounts for only 15 per cent of aid.

Sterile debates about ‘public versus private’ provision do not help take things forward. Privatisation is not a magic bullet, though in some cases the private sector can provide the services needed to enhance efficiency. Conversely, failures and under-financing in the public sector is already forcing poor people into private water markets, with disastrous consequences.

Water is not just another commodity. It is a source of life, dignity, and equality of opportunity. That is why it is too important to be left to the market – and why governments bear ultimately responsibility for extending access. Human need, regardless ability to pay, must be the guiding principle. South Africa has shown the way by introducing legislation requiring all providers, public and private, to supply a minimum amount of water free of charge. In Senegal and Manila too, new forms of public-private partnership are extending access for the poor through small surcharges on the wealthy. Redistribution may be out of fashion these days. But converting public water subsidies for the rich into public investments for the poor would help accelerate progress and overcome the glaring equity gaps that scar many countries.

More than anything else we need political leadership. For example in Britain, the water and sanitation crisis of the 19th Century gave rise to powerful new political coalitions that brought together municipalities, industrialists and social reformers. These coalitions created an irresistible force for change, paving the way to huge new public investments and governance systems. Civic duty, economic self-interest, and morality combined to make to elevate water and sanitation a national cause.

Today, new social movements and partnerships between governments and civil society are beginning to make inroads into the crisis. These need to be strengthened and deepened. But we also need global leadership – and an informed public debate in rich countries that pushes water and sanitation up the aid agenda.

OK, so perhaps we should take fewer baths and be sparing in our use of hosepipes. But none of us should be willing to tolerate a world in which over 1 million children are, in a perversely literal sense, dying for a glass of water and a toilet.

Kevin Watkins
Director UNDP Human Development Report Office