...........................................................................................................................................................
History Of Water And Health
IWA
Publishing
Water supply and sanitation for military needs was a
primary concern of the authorities of an imperial power like the Roman Empire needing
a strong military machine.
The Romans did know how to obtain adequate amounts of
drinking water for their garrisons, cities and troops in the field and thus
successfully planned their operations according to the availability of water.
Army veterans were well accustomed to baths and to an
ample water supply during their active service, and they may have been a quite
important pressure group for building an aqueduct and bath in a town.
The contamination of water by lead has been a topic in
the discussions concerning the health of people in Roman times.
Roman authors expressed doubts concerning the use of
lead pipes and recommended the use of ceramic pipes (Vitruvius. De Architectura. 8.6.10–11;
Palladius. Opus Agriculturae. 9.11; Columella. Rei Rusticae 1.5.2;
Plinius. NH. XXXI.31.57).
However, in practice it seems that although ceramic
pipes were used, water was in many situations routinely distributed by lead
pipes, as revealed by both written sources (Vitruvius De Architectura.
8.6.1, 4–6; Frontinus. 25.2, 27.3, 29.1, 30.1, 39–63, 105.5, 106.3, 115.3,
118.4, 129.4–6) and archaeological remains (Bruun 1991: 124–127; Hodge 1992:
307–315).
Yet, there are two reasons to believe that exposure
through water was quite minimal, as pointed out by A. Trevor Hodge (Hodge 1981 and 1992: 308).
Firstly, as a consequence of the quality of the water,
a calcium carbonate coating separated the lead and the water in most cases.
Secondly, because of the constant flow, the contact time of water in the pipe
was too short for contamination by lead.
The indirect public health effects of water might have
been greater than the direct effects during antiquity.
Agriculture depended on the proper amount of available
water. Droughts and floods led to food shortages and famines. Food, people and
pathogens moved most easily by water during antiquity.
Maritime trade was especially vigorous around the
Mediterranean in the period 200 B.C.– 200 A.D. This meant that the
Mediterranean world became more or less a common pool of infectious diseases (McNeill 1979, 78–140).
Two important diseases caused by parasites were
intimately connected with water and the ways water was managed during
antiquity: namely malaria and schistosomiasis.
The breeding of mosquitoes depended on water and mosquitoes
spread malaria, which was a serious and widespread health problem around the
Mediterranean during antiquity. Malaria was well documented by Greek and Roman
medical authors from the Hippocratic writings onwards.
Among the cases in Epidemics I and III, a serious complication of
chronic malaria, blackwater fever, has been identified by Mirko D. Grmek at
least in one patient, Philiscus, but probably also in another, Pythion (Epidemics I, fourteen cases, case 1; Epidemics III, sixteen
cases, case 3; Grmek 1989: 295–304).
A fine description of malarial cachexia is to be found
in Airs, Waters, Places, (Airs, Waters, Places, 7;
Grmek 1989: 281).
Schistosomiasis (bilharzias) has been for millennia a
scourge in Egypt. The parasite (blood-vessel inhabiting worms) has an intricate
relationship between the human host and a snail intermediate host.
The type of agriculture (irrigation, flooding of the
Nile) must have spread the disease. Although the evidence from ancient Egyptian
medical papyri remains hard to interpret, there is strong paleopathological
evidence of schistosomiasis in human remains from ancient Egypt.
Frontinus expressed clearly that a water system needed
constant maintenance to function efficiently (Frontinus 116–123).
For instance, calcium carbonate incrustation that
formed inside the conduits needed constant removal, otherwise the flow of water
would eventually stop (Hodge 1992: 227–232).
In Italy aqueducts and baths seem to have been
maintained even after other monumental buildings in the towns, with the
exception of town walls and palaces, fell into disuse in late antiquity (Ward-Perkins 1984: 31, 128).
In Antioch and other Near Eastern towns, at least part
of the ancient water system was maintained into the Byzantine period and
possibly up to the Era of Islam (Kennedy
1992).
Although there were continuities from antiquity to the
Middle Ages, the water supply was more limited and the Christian water
patronage replaced the classical one: it was a move from luxuria to necessitas (Ward-Perkins 1984: 152).
The Second Urbanisation: Period
of Slow Development
After the fall of the Roman Empire, water supply and
sewage systems experienced fundamental changes in Europe. Medieval cities,
castles and monasteries had their own wells, fountains or cisterns.
Usually towns built a few modest latrines for the
inhabitants, but these were mostly inadequate for the size of the population.
The lack of proper sanitation increased the effects of epidemics in medieval
towns in Europe.
Fundamental changes began to appear: science and
knowledge were institutionalized for the first time when the development of
modern universities started in the 13th century, and the agricultural
world set out to industrialize from the 18th century onwards.
 |
Fig 2. Estimated human population growth from 10 000 B.C. until year 2050
|
Consequently, the growth of world population increased
(Figure 2).
Along with the industrialization and urbanization of
the Western world, enlightened people were fascinated with the idea of
progress.
Ever since the 18th century, science and reason
were considered to be able to lead humankind towards an ever-happier future.
This was the period when the first actual water closet was developed.
By 1900, the water closet became a generally accepted
cultural necessity in the Western world – the same way aqueducts had been in
the Roman Empire.
The water closet was seen as a victory for public
health without any consideration for where the human excreta went through sewer
pipes.
The start of industrialization and the related growth
of cities created a situation where public health and environmental
problems overwhelmed city governments to a greater degree than before, and
novel technology was often seen as the solution.
In the 19th century, Great Britain was seen as
the forerunner of modern water supply and sanitation systems, but the
innovations soon spread to Germany, other parts of Europe, USA and later also
elsewhere.
Sanitation in towns around Europe was one of the great
achievements of the 19th century. During the century the role of water in
the transmission of several important diseases – cholera, dysentery, typhoid
fever and diarrhoeas – was realized.
The final proof came when the microbes causing these
diseases were discovered. Especially cholera served as a justification for the
sanitary movement around the world in the 19th century.
Sensory evaluation of water quality was complemented
with chemical and microbiological examination.
During the 19th century, filtering of the entire
water supply of a town was introduced and the systematic chlorination of
drinking water started in the early 20th century.
The discovery of microbes and the introduction of
efficient ways of treating large amounts of water paved the way to an era in
which the public health problems caused by polluted water seemed to belong to
history.
The Third Urbanisation: Modern
Urban Infrastructure
The 1900s was a period of extensive population growth
– the global population about quadrupled while the urban population increased
13-fold (Figure 2).
By 2000 A.D., in almost every country, over half of
the population lived in urban areas.
During the century industrial production increased
40-fold and the consumption of energy by a factor of tens. Water and sanitation
services had a definite role in this rapid socio-economic change of the entire
globe.
In the early 20th century the health problems
associated with water pollution seemed to have been resolved in the
industrialized countries when chlorination and other water treatment techniques
were developed and widely taken into use.
Microbiological problems related to water were
largely considered a problem of the developing world. However, in the late
20th century the biological hazards transmitted by water emerged again in
the post-modern Western world. Anxiety about chemical and radioactive environmental
hazards and their impacts on human health mounted in the 1960s.
The overall amount of known biological and
chemical health hazards transmitted by water increased manifold during the
last half of the 20th century.
In today’s world around 10,000 people die every day
due to diseases like dysentery, cholera, and various diarrhoeal diseases,
caused by a lack of safe water and adequate sanitation.
Yet, since most of those who die are children and old
people, whose death is considered “natural”, or people who are more or less
marginalized in their societies (e.g. refugees, the poor) or living outside
areas that are important for the global economy, mortality due to
these waterborne diseases is too often considered unavoidable.
The Fourth Urbanisation: Future
Challenges
In the historical context, the growth of urban centres
has been a continuous and even an escalating trend. Many of these centres are
today located in developing economies, while the ensuing problems are
concentrated on the poorest people – as always.
The most severe constraints include poor living
conditions, a lack of democracy, poor hygiene, illiteracy, corruption and a
lack of proper water and sanitation services. Especially women and
children suffer from these constraints.
Today there is a global shortage of potable water.
When making fundamental decisions concerning water
supply and sewerage, it is also necessary to be ready to make big
investments.
Services that are now at a high operational level were
not achieved easily and without massive inputs and efforts. This is something
to keep in mind when assessing future options and considering required
strategies.
The level of water supply and sanitation in a society
is not necessarily bound with time and place as much as the capability of that
society to take responsibility for developing the living environment of its
citizens and proper policies.
In some cases, the situation was even better earlier
than nowadays. Decisions have been made concerning water and sanitation systems
– e.g. the universal acceptance of the water closet as a cultural necessity –
that through path dependence have limited future options.
There have also been situations where the choice of a
technology has been regarded as problematic from the first beginning but has
been chosen anyway.
For instance, lead pipes were considered hazardous for
health already in antiquity but continued to be used in house connections until
recently.
Water supply and sanitation systems have always
required continuous maintenance and adequate rehabilitation.
This was already evident with the Roman aqueducts:
calcium carbonate incrustation forming within the conduits needed to be removed
constantly or it would have stopped the flow of water. The same is true for
modern systems: they must be maintained to function properly.
Major Findings and their
Relevance
The 30 cases from all the continents covering various
historical phases indicate that the level of water supply and sanitation is not
necessarily bound with time and place as much as the capability of society to
take responsibility for developing the living environment of its citizens.
Below we will shortly discuss some of the key findings
according to the horizontal themes of the book: population growth, health,
water consumption, technological choices and water governance.
Population
density & poverty
Throughout the history major problems seem to be
concentrated largely on the same people - the poor, if not the poorest of the
poor. They suffer from poor sanitation, lack of good water, ensuing health
problems, poor education and often lack of good governance and basic democracy.
Women, children – and especially girls – are often the
ones who fetch the water from distant sources of water. This daily task
prevents the latter going to school, learning to read etc.
Eventually they become adults who might not be able to
act as an active citizen and all in all have effect on their own lives let
alone the society as a whole.
From the point of view of our and the environment’s
wellbeing, it is essential that water is good and safe – regardless whether it
is from piped systems or point sources like wells.
The same is the case with sanitation — it is a
question of being connected either to the sewer or using proper on-site
sanitation solutions. It is just vitally important to operate and maintain the
systems properly.
A well and an eco-toilet, especially in areas with
scattered settlements, will also provide in future durable and ecological
solutions. Investing in water supply and sewerage and thus also in the
environment is always worthwhile.
Studying wells and toilets needs more resources, so
that we could find the best solutions and paths of action for different
conditions – there is no such thing as cookie-cutter solution for systems which
have such direct interaction with the environment.
For economic but also for several other reasons, it is
not feasible to have waterborne sewerage everywhere while obviously they are
needed in densely-populated areas at the moment. In dispersed rural areas at
least such alternative on-site systems can be considered. These alternative
systems seem particularly be subject to local conditions.
Health
Public health has always been a major factor
influencing the ways how water supply has been solved by societies.
The source of water supply was chosen according to its
salubrity: clear, odourless water e.g. from springs or wells was preferred.
Already from antiquity it was known that certain kinds
of water caused health problems. Stagnant and marshy waters were avoided
throughout times.
New waterborne health hazards were recognized from the
19th century onwards: microbes, chemical pollutants.
We know that people have used their senses to perceive
the quality of drinking-water at least from antiquity and most probably long
time before.
Related to the technological development new methods
to study the quality of water were introduced from the 19th century
onwards including chemical and microbiological studies.
Concerning these two factors in historical
perspectives we can see a clear continuity and also strong changes that both
are depending on the scientific and technological level of the society.
Already in antiquity various methods like sieves,
filtration and boiling were used to improve the quality of drinking-water.
However, it was only in the 19th century that filtration of drinking water
in urban centres became a common practise.
Disinfection of drinking-water by different methods
was introduced in the early 20th century. By proper use of the water
treatment technologies the salubrity of drinking-water could be guaranteed to
ever growing population.
The importance of good quality drinking-water for
urban population was realized already in antiquity. Yet, the importance of
proper sanitation for the health of town people was not discovered until the
19th century.
The building of “modern” urban sewerage systems
started in Britain and rapidly spread all over the globe.
Water use
Water used in large quantities has been deemed as an
essential part of civilized way of life in different periods: Roman baths
needed a lot of water as does the current way of life with water closets,
showers and jacuzzis.
Particularly high rates of water use are noticed when
it is not properly charged for. The evidence indicates that as soon as water
but also wastewater are charged according to the real costs wastage diminishes
remarkably.
Although at the global scale the great majority of
water is used for irrigation, the highest priority of water use purposes is for
the community water supply.
Throughout history there have been different solutions
to guarantee an ample amount of water for human settlements.
Indigenous people have been very ingenious in drawing
their water. They have considered water a very crucial and often a sacred
element.
In the long run the availability of abundant or
adequate amount of water has been one of the crucial factors for the
development of a society – cities and communities.
Technological
choices
In some cases, the technological choices may have been
erroneous or less successful. Example of these are lead pipes, used in the
antique and continued to be used in house connections until recently.
Ultimately water supply and sanitation systems need
continuous maintenance and adequate rehabilitation. This was already evident in
the Roman aqueducts: calcium carbonate incrustation formed inside the conduits
needed constant removal, while otherwise stopping the water flow.
The same is true for the modern systems, the
maintenance of them must be taken care of otherwise they do not function
properly. The bigger – if not the biggest – problem is related to the need of
continuous replacement and rehabilitation.
One long-term debatable issue has been, and still is,
whether to use ground or surface water as raw water for community purposes, or
more generally, what sources to use.
For small systems often ground water was available but
for bigger systems surface water was needed. This is connected to the current
question how far is it economically feasible to expand such systems. Once the
systems expand other criteria such as vulnerability are also to be considered.
Governance
World Water Development Report
2003, produced practically by all the UN family and thus almost all the sectors
of human life and society, pointed out how the water crisis is largely a
crisis of governance.
The report pointed further “many of the leading obstacles to sound and
sustainable water management: sector fragmentation, poverty, corruption,
stagnated budgets, declining levels of development assistance and investment in
the water sector, inadequate institutions and limited stakeholder
participation”
The findings of our book refer to the need of good
governance – as pointed recently by several international water policy
documents.
People should be allowed and encouraged to use their
own experiences and abilities to solve their problems. Such empowerment will
most probably have more sustainable results than any mere top-down approaches.
In overall god and effective water governance We
obviously need to balance the centralised requirements such as legislation and
decentralised requirements of water services management at local levels of
cities, communities and households.
It is The findings of this book also imply the
important to involve all the stakeholders in decision-making in their proper
roles as well as participation of users and citizens – the ultimate users,
beneficiaries and payers of these services.
Interestingly enough, some of the basic principles of
sustainable and viable water governance and services were written more than
2000 years ago.
Using these principles many of the present problems
could be avoided and solved. In spite of this mankind does not use largely
these principles due to lack of proper governance but also resistant attitudes
among people.
It seems to be difficult, if not impossible, to resist
advantages and profits gained on short-run by some, instead of thinking of
long-term benefits potentially achieved by far many.
It seems to be very challenging for mankind to adopt
systems and issues of fundamental importance – such as water supply and
sanitation.
Unfortunately it is psychologically much easier to
promote bottled water or handing-over water services to international private
operators – both interested mainly on short-term profits.
Indeed, any sustainable water services will require
long-term actions and planning, which the current western culture largely
ignores. The time frame and related thinking seem to become shorter and
shorter.
Yet, change itself should not be an end in itself.
Decisions made in antiquity and in the late 19th century had a minimum
frame of a century and often even more.
In the foreseeable future such time frame should also
be used if any sustainable results are to be achieved.
More than just a commodity, water is an economic and
social good. This places responsibility for its management and oversight
in the public sphere.
Balancing of water use priorities, water quantity and
water quality is of high importance for the futures. While water supply will
continue to have the highest priority water quality issues will be relatively
even more important than quantity.
At the same time it is more and more important to use
water wisely and avoid wastage of this important natural resource. In global
context water pollution control and sanitation are probably the biggest
challenges – removing substantially wastewater loadings from communities,
industries and agriculture in many parts of the world.
Finally, the historical cases reveal that there is
probably wider diversity of options and development paths – whole sets of
institutional arrangements – than believed or recognised so far.
The role of capital cities has not been as dominant as
earlier assumed. In many cases remarkable networking of professionals has taken
place in the early phases.
There is a huge variety of development paths and
solutions in urban water supply and sanitation. Local conditions, traditions
and people have to be in the core of decision making when future solutions are
considered.
However, since water sources for every city have their
own unique location and quality, and each city has its own unique physical,
social and administrative morphology, solutions of one city may not work for
another.
In the long historical perspective it is evident that
regardless of the political system good local solutions can be found based on
local conditions, needs and traditions. Although water – and particularly water
services – are largely dependent on local conditions.
Yet, it is useful to make comparative studies between
cities and communities in various regions and cultures, and identify possibly
applicable and replicable principles and practices.
IWA
Publishing spreads knowledge
about our most valuable resource, water, helping to improve global health and
well-being. We publish a portfolio of 15 peer reviewed journals and 800 books,
along with other information resources.
The IWA
Publishing programme includes:
Journals: 15
industry-leading journals within the field including Water Science and Technology, Hydrology Research and Water
Research.
Books: Publications
include high quality research for academics as well as reference work manuals
of practice for professionals. Search for our print books, ebooks or download
a catalogue.
Water
Intelligence Online: Subscribe to the comprehensive water, wastewater and
environmental digital library, comprising IWA Publishing’s complete ebook
collection.
https://www.iwapublishing.com/news/brief-history-water-and-health-ancient-civilizations-modern-times
|
Figure 1. Aqueduct in Agia Napa,
|
No comments:
Post a Comment