Millennium Development Goals water target claim exaggerates achievement

In March 2012, the United Nations made an important announcement: ‘The goal of reducing by half the number of people without access to safe drinking water has been achieved’ (United Nations 2012). While major news organizations heralded the achievement, this may be another premature claim of ‘mission accomplished’. This is because the way progress is measured on the Millennium Development Goals (MDG) water target does not fully address water quality, quantity and access – key components of the target that are fundamental to human health. Target 7c of the MDGs calls for ‘reducing by half the portion of people without sustainable access to safe drinking water’ (UN 2000). Unfortunately, there is no clear guidance on precisely what was intended by the language of the target or definitions of the key terms ‘sustainable’, ‘access’ or ‘safe’. However, the language used in the target has a history and that history provides insights into its intent. The 1977 Mar del Plata Declaration by the United Nations, which launched the Water and Sanitation Decade (1981–1990), asserted the universal right to ‘access to drinking water in quantities and of a quality equal to their basic needs’ (UN 1977). Agenda 21, the UN action plan for sustainable development that emerged from the United Nations Conference on Environment and Development, expressed its goal in terms of ‘safe water’ and set a minimum quantity of 20 l/person/day (WSSCC 2000). Finally, the Secretary General’s report to Millennium Summit urged the adoption of a target to reduce by half the portion of people who lack ‘sustainable access to adequate sources of affordable and safe water’ (Annan 2000). After adoption of the MDGs, the UN Millennium Project was commissioned to identify the best strategies for meeting the goals. In its report, the Millennium Project’s Task Force for Water and Sanitation defines ‘safe drinking water’ as ‘water that is safe to drink and available in sufficient quantities for hygienic purposes’ (UN Millennium Project 2005). The Task Force also explained that ‘access to drinking water requires the existence of infrastructure in good working order. ’ It also noted that sustainable access implies ‘a type of service that is secure, reliable, and available for use on demand by users on a long-term basis. ’ From this prior history, a few conclusions can be drawn about the intent of the MDG water target. First, with respect to quality, the intent is absolutely clear: drinking water must be ‘safe’. In opting for this criterion over ‘acceptable’, ‘acceptable quality’ or ‘quality equal to their basic needs’, the MDG target establishes an unequivocal mandate that water be free of pathogens. By focusing on ‘drinking water’ rather than water ‘sources’, the target also implies that the water be safe at the point of use, not just at the point of distribution. Second, like most of the previous statements, the MDG expressly includes the concept of ‘access’. The MDG Task Force on Water and Sanitation interprets this to include not only time spent procuring water – the traditional measure of access – but also in terms of (i) affordability, (ii) reliability and (iii) the environmental impact of the supply (UN Millennium Project 2005). However, access also implies quantity, as the inverse relationship between distance to water supplies and the amount of water used has been consistently shown for more than 40 years (White et al. 1972). Each of these priorities – quality, quantity and access – has been shown by research to be fundamental to optimising health and development. Systematic reviews of dozens of field studies have shown that interventions to improve water quality are effective in preventing diarrhoeal diseases – a leading killer of children (Esrey et al. 1991; Fewtrell et al. 2005; Clasen et al. 2006; Waddington et al. 2009). Field studies have consistently shown that in the absence of safe storage, even water that is safe at the point of distribution is subject to frequent and extensive contamination during collection, transport, storage and use in the home (Wright et al. 2004). Systematic reviews have Tropical Medicine and International Health doi:10.1111/j.1365-3156.2012. 03052.x