Key Determinants Impacting Water Supply Issues in El Salvador

Among communities in El Salvador, there is a huge disparity among communities in the availability of continuously flowing, potable water as of 2008. The problem involves a diverse array of key determinants which contribute to the prevalence and severity of the issue, which the most pressing of the determinants being in each of the following categories:

The sociocultural and behavioral aspects contribute a great deal to the consistency of water management and resource availability. One such determinant is the availability of sanitary and water management services. A large majority of the water systems in El Salvador are controlled by the public institution Administración Nacional de Acueductos y Alcantarillados, which sets the regulations surrounding water supply management – the service continuity of which was ranked extremely low. In the past decade, Salvadoran populations have protested government-controlled water management systems in a hope for reform toward decentralized water management. Such community organization is a social determinant that can have an effect on whether the issue will persist. Another determinant in this category is the impact of religious groups in communities – Roman Catholic missionaries have had a huge impact on providing communities with consistently flowing and clean water systems and the education to continue such advocacy (World Trade 2010).

Environmental determinants are greatly involved in this problem. The extent of environmental degradation, such as deforestation and industrial dumping, has an effect on water resources. In El Salvador, there is a lack of regulatory enforcement and control in dealing with f pollutants, which contributes to pervasive health issues (Calderóne 2009). Also, urban versus rural living is a determinant for the problem due to the associated risks of population density if health services are lacking. Data collected by the Population Division of the Comisión Económica para America Latina y el Caribe found that rapid urbanization occurred between 1950 and 2000 -- from 36% of the population living in urban areas to 64% over the half-century. This urban movement is a determinant that results in more pollution issues – a lack of adequate sanitation and water distribution system pervades due to this unplanned urban sprawl and population growth.

Economic determinants such as the level of poverty in a nation and general spending power are a contributing factor to the status of water quality. Despite being the smallest nation in Latin America, El Salvador is the third wealthiest in the region. But, 36% of its almost 7 million inhabitants live under the poverty line (World Trade 2010). Also, the factors associated with economic growth can determine stability of social and health programs. El Salvador’s economy is also hugely intertwined with the United States – the U.S. is the number one buyer of the nation’s exports and a major foreign aid player in the nation, and 17% of El Salvador’s GDP comes from remittances sent home by immigrant workers in the U.S. (World Trade 2010). Its major export is coffee, and being a commodity-based economy results in volatility from pricing fluctuations. Another determinant is the distribution of wealth – the highest quintile of the populations holds almost 50% of the nation’s wealth (ECLAC 2012). Interestingly, the ratios remain similar in both rural and urban populations.

Politically, government spending plays a part in the problem of water infrastructure. A study comparing social program spending in Chile, Costa Rica, and El Salvador reported that, between 2006 and 2007, Chile and Costa Rica invested a considerable amount per capita (US$733 and US$885), while the right-wing Salvadoran government invested only US$192 (ECLAC 2009). Also, the history of the nation’s political system has had a huge effect on health and environmental changes – the costly twelve-year Salvadoran Civil War that took place between 1980 and 1992 upended existing systems and set back regulatory progress.

Works Cited:

ECLAC (2012): Statistics and Economic Projections Division, Social Statistics Unit, based on

special tabulations of the respective country's household survey data:.Economic Commission for Latin America and the Caribbean:

ECLAC (2009): Economic Commission for Latin America and the Caribbean. Rep. Santiago De

Chile: United Nations: ECLAC, 2009. Sage Journals.

Calderóne, Gloria, and Gisella Kopper. Estudio De Caso–Enfermedades Transmitidas Por

Alimentos En El Salvador. Rep. Pan American Health Organization, 2009. Web. .

World Trade. El Salvador Society & Culture Complete Report: An All-inclusive Profile

Combining All of Our Society and Culture Reports. 2nd ed. Petaluma: World Trade Press, 2010.

Surveillance

The problem statement for my final paper is: Among communities in El Salvador, there is a huge disparity between the urban and rural availability of continuously flowing, potable water as of 2008.

Surveillance is vital for determining the urgency and prevalence of an issue. In the realm of public health, it is defined as the systematic collection and analysis of data to subsequently disseminate to public health officials. In El Salvador, a converging set of challenges contributes to the issue of potable water availability, which makes it an intricate and complex problem to address and solve.

The Ministry of Health of El Salvador conducted a study in conjunction with the Center for Disease Control and USAID. In urban areas, 87% of the population has access to treated water and of the population 68% have access to continuous sources. Meanwhile, in rural areas away from the urban center, 56% have access to such water and 34% have access to continuous service (FASAL 2008).

The June 2010 Millennium Development Goals Report found that El Salvador was among the top twenty nations making progress relative to its MDGs and the 2006 Millennium Development Goals Assessment Report stated that the country was on track to reach its MDG for improved access to drinking-water sources. This 2006 United Nations Report found that 94% of urban populations and 70% of rural populations had access to improved sources of water, an average of 84%. But, this does not take into account the inequities of pricing to gain access to such water, and considering that nations are reporting this data, discovering to what extent such improvements qualify as would require further analysis.

A researcher at the University of Florida Public Utility Research Center found that 94% of the country is served by the Administración Nacional de Acueductos y Alcantarillados, or ANDA, the dominant water supplier for the communities in the country (Berg 2008). Meanwhile, the United Nations Environment Programme reported that the quality of water treatment in the country is very low – a startling 1 to 2% of wastewater is adequately treated before it is discharged (UNEP 2002). Sewage treatment is poorly available – with 31 small plants under operation using various treatment systems that hardly meets sanitation needs.

According to a review by the European Union’s External Action Service, 90% of the surface water is contaminated. Taking this further, data was collected that showed that 98% of municipal wastewater and 90% of industrial wastewater is discharged to river and creeks without treatment (EEAS 2010). El Salvador is hardly lacking in water as a natural resource, but it qualifies as a water stressed country in that water sanitation, management and distribution of the resource to the populations is extremely sub-par, which severely compromises human productivity and health.

In an assessment of the data I found, I would have liked to be aware of how the data was collected. Given that much of the data was collected by associates of large governmental aid and surveillance organizations, it is difficult to assess validity. Therefore, I must rethink either the way that I research the topic, explore further the way in which data collection is conducted, or most often look directly for regional data on Salvadoran websites (which I did do for the Health Ministry report).

Works Cited:

Berg, Sanford. Water Utility Performance in Central America: The Political Economy of

Coverage, Quality, and Cost. Rep. University of Florida Public Utility Research Center, 30 Aug. 2008. Web. .

Encuesta Nacional De Salud Familiar. Rep. FESA -- Ministerio De Salud: Gobierno De El

Salvador, Oct. 2008. Web.

International Source Book On Environmentally Sound Technologies for Wastewater and

Stormwater Management. Rep. United Nations Environment Programme: Division of Technology, Industry and Economics, 2002. Web. .

"Midterm Review of the Country Strategy of 2007-2013 and National Indicative Programme

2011-2013." Review. European Commission. European Union: European External Action Service, 2010. Web. .

Public Health Problem

“Grab the test kit for me, Ginny.”

My eyes scanned the river’s water, looking for any visible signs of distress. Something must be wrong with the murky water, since my mother had brought me here. But, the water reflected the sky and continued to flow – what could possibly be wrong? On this particular warm summer day years ago, my mother, an environmental scientist, took me out into the field with her. She was studying the effect that a local New Jersey animal farm had on the water quality of the stream that passed through it. Sure enough, the results suggested that the dissolved oxygen, phosphate, and algae levels at the site were impacted by the farm.

Human activity has put a strain on natural resources, and the scary part is that sometimes the problems, such as increased pathogenicity or toxicity in water, are not visible to the naked eye. For this assignment, we are asked to identify a public health problem that is of particular interest to us. For our final paper, I hope to explore the issues surrounding water resource management in El Salvador, a water-stressed nation infamous for its largely contaminated water supply. A combination of climate change, human activity, and lack of interventions has contributed to the problem and to the local health issues that arise as a result. A 2011 governmental study found that only two percent of the nation’s rivers contain water that is fit for human use, regardless of whether the use is for direct consumption, agricultural, or recreational activities. As an offshoot of this, I would also like to compare the efficacy of intervention strategies: small water resource enterprises versus large water corporations in their ability to provide access to clean drinking water for the nation’s vulnerable populations.

Contaminated water has a huge social and economic impact on a global scale, and is an issue that is growing due to stresses on the vital resource and population growth. Diarrhea as a result of polluted water is the number one killer of children worldwide, and productive work days lost from illness and health costs associated with inadequate access to clean water puts an incalculable amount of stress on economic structures. If we continue with business as usual, it has been estimated by the Pacific Institute of Research that 135 million will die by 2020 as a result of contaminated water. Keeping this in mind, a case study of El Salvador's water issues and an analysis of possible interventions could provide insight into the global problem. All that is left is to refine and continue to specify the problem definition so that I may begin researching the subject.

Human Rights

"True peace is not merely the absence of tension, it is the presence of justice" is a quote by Martin Luther King Jr., and quite relevant in the discussion of human rights. For this week’s assignment, we explored the United Nations’ Declaration of Human Rights and the topic of maternal mortality as it relates to the human right to receive health care. A human right is an intrinsic right that should be internationally recognized, and according to the Declaration this common recognition “of the inherent dignity and of the equal and inalienable rights of all members of the human family is the foundation of freedom, justice and peace in the world.” I would have to agree, given the many historic examples that disregard for such rights has left only oppression, suffering, and misery. Therefore, adhering (or not adhering) to these principles has huge implications for the health and general welfare of populations worldwide.

Article 25 of the Declaration states that “everyone has the right to a standard of living adequate for the health and well-being of himself and of his family…”, and the statement goes so far as to include housing, medical care, social services, and the right to financial security for those in need. This also explicitly extends to mothers and children. A good standard of living is vital in many ways to a healthy, productive life; it is surprising, though, that it would be considered an essential human right given how many nations do not provide such comprehensive care and security to all – not even close, including in America, where almost 50 million people are uninsured and some nations where millions are stuck in slums or in rural poverty. It is difficult, almost economically impossible given the current systems, to provide 7 billion with this “essential human right”. It is indeed important for health, but is most definitely hard to tackle.

The editorial we read outlined a Brazilian human rights case, Alyne da Silva Pimentel vs Brazil, that involved the death of a pregnant woman due to inadequate medical care services from the local facility. This case set the precedent that states must provide women with obstetric care and other necessary health services indiscriminately, in a timely and well-regulated manner. Also, governments that allow private health care must ensure that such humane treatment is being put into practice in the private arena.

In Article 25 of the Declaration, there is the statement that “motherhood and childhood are entitled to special care and assistance” and social protection. Such an idea of protecting mothers and would-be-mothers is widespread and internationally understood because mothers bear and, most often, foster the next generation of people – children are our future. Also, innocent children and unborn babies deserve their own set of rights regardless of what their mother’s background is – and the first of these natural, intrinsic rights is the right of life.

Contagion

Contagion was released in 2011, and its popularity fed off of growing fears that a highly infectious disease might rage through the human population, given how globalized the world has become. It showed how the disease was transmitted, from bat to pig to human, and its travel through the population via topical transmission. An interesting aspect was the response by public health agencies, which the movie focused on a great deal. From a public health perspective, the movie accurately showed this range of and how easily a disease with a short incubation period and high rate of transmission can spread through the world. It began with the first victim and the cinematography effectively accentuated where people touched and coughed on. Also, it showed the amalgam of organizations involved in responding to the crisis – scientists, police, emergency medical technicians, political figures, pharmaceuticals, investigative epidemiologists, the media, and regular laypeople. Essentially, it leaves us with the feeling that no one is protected (well, expect for the people that may be immune, like Matt Damon’s character Mitch Emhoff).

An outbreak occurs when an illness is occurring at a higher rate than it would on average in a certain area, and an outbreak investigation is a series of steps taken to establish the presence of the outbreak, hypothesize about it, understand the outbreak, and hopefully through this increase in knowledge lessens the future severity of it. It is quite scientifically structured. Isolation and quarantine, while they sound like synonyms, actually are different measures taken to control an outbreak. Isolation is used to separate ill people from those who are healthy, while quarantine is used to restrict the movement of people who may have been exposed to a disease to see if they become ill. These concepts were put into play in the movie when authorities were attempting to indentify and control the disease. There were mentions in the news portions of “clusters of outbreaks” which eventually spread and the outbreak investigation in the movie attempted to identify the initial hosts, create a vaccine, and lessen the rate of transmission through campaigns and other measures. Isolation occurred with the road block that the military set up to prevent people from crossing state lines and entering Wisconsin, as well as within homes to prevent transmission. And Emhoff was quarantined in the hospital after his wife and step-son died of the illness, but he was found to be immune.

I would hope that agencies should be better prepared for the response to the looting and lawlessness that took place after the disease began to ravage the world. I understand mass rioting is hard to control, and it is a scary thought that is difficult find a solution to, but that modern response systems would hopefully be better. I read a novel about the yellow fever epidemic in Philadelphia, and the scenes of anarchy reminded me of the way an 18^th century outbreak was described. A more modern approach to such issues would definitely need to be devised.

Also, during the epidemic in the movie, the food distribution was greatly lacking. It is rare that food would need to be distributed on a large scale in the United States, and it is interesting and disconcerting to imagine what kind of a plan is in place if that needed to occur. But in the movie, the agencies were constantly running out of supplies, and the fact that people were left to fend for themselves so much seems hard to believe. Scary to imagine!

Climate Change

Quite often, the scope of coverage about climate change focuses solely on environmental changes. Truth is, the changes are just as detrimental to humans as they are to nature. For this week’s blog assignment, we were asked to address the health effects of climate change. Reading the American Journal of Public Health’s “Climate Change: The Public Health Response” offered insight into the topic. Two health affects that may influence the health of my family and friends would be “winter weather anomalies” and “increased ozone and pollen formation” because these changes could impede on our everyday lives. Slips and falls, as well as motor vehicle accidents, due to ice, snow, and rain affect any population group. And, increased pollination would increase allergy and asthma prevalence, which is something may people I know suffer from. Of the health effects on the list, the one that particularly surprised me was the increase in pollen production. The others are extreme weather changes and have been stressed before by many agencies, but I had yet to hear about the effect that climate change will have on allergies and asthma. Now that I think about it, it makes sense, but I had not previously considered it as a risk.

Primary prevention, attempting to lessen the change at hand, involves mitigation. In the case of climate change, the word includes efforts that have been made to reduce our GHG emissions and resource consumption. This will hopefully help prevent, or at least lessen, some effects that climate change will have on populations because the environmental changes will be reduced. Meanwhile, adaptation falls under the secondary and tertiary prevention efforts. It involves efforts to respond to and prepare for the health burdens associated with climate change. This is the response and treatment side rather than the preventative side, incorporating “public health preparedness”.

Public health professionals are an integral part of helping populations adapt to climate change. One specific example of providing a public health service related to the environmental and climate changes going on as a result of human impact would be working with media outlets to dispel any rumors or doubts about climate change, advertising possible effects, and suggesting behavior changes to both lessen environmental impact and health risks. This would be a part of both mitigation and adaptation techniques associated with “informing, educating, and empowering people about health issues.”

My hometown, Princeton, New Jersey, is home to a world-renowned university that is conducting research on climate change and its effect on the human population. Unfortunately, it does not disseminate into the town. I feel as though there is a general sentiment that the effects as so gradual – what does one or two degrees matter? – that they do not need to be addressed. Any small changes have potentially extreme results, while it may not be directly noticeable in my own town. Meanwhile, while Princeton is not necessarily preparing for climate change, they are prepared for emergency response, as should any town that runs smoothly. However, the underlying cause – climate change – still needs to be addressed so that its effects may be turned around. I could spectate a town hall meeting and work to get the issue on the council’s agenda or rally through more of a grass-roots advocacy approach. However, I remain pessimistic that the public will view climate change’s effect on health as a time-sensitive and urgent topic.

Public Health Achievements of the Past Decade

The title of the CDC report, Ten Great Public Health Achievements --- United States, 2001—2010, explains its purpose quite clearly. It highlights the most noteworthy public health achievements that have occurred over the past decade. Reading the list, I see that many interventions I would have thought should be included were indeed incorporated. It is an accurate list, but it is interesting that many of these innovations are not exactly new ideas – for example, motor vehicle safety has been an advocated for and important problem for longer than just this decade. Rather, pressure on such issues had lead to vast further improvements. Therefore, these achievements are not completely accomplished – as long as there are still existing cases, further changes can be made to improve effectiveness and extend lives even more.

The first achievement that particularly resonated with me is the improvement in “public health preparedness and response.” Public Health entities have definitely improved their preparedness and responsiveness over the past decade given the terrorism threats, natural disasters, and epidemics our country has faced. For example, the 2001 anthrax attacks, Hurricane Katrina, E. Coli outbreaks, and the H1N1 virus of the past ten years had really struck a chord with the American public and its policy makers. I remember the fear surrounding all of these events, and am happy that improvements have been made in preparedness to lessen the effects of such situations on the health of populations.

Secondly, the “childhood lead poisoning prevention” achievement resonates with me because lead poisoning is something that has plagued the Baltimore for a very long time, and it particularly affects “black children and those living in poverty and in old, poorly maintained housing.” Last semester, I learned in a class entitled Baltimore & the Wire that there are many old row houses with lead paint and piping, and lead exposure causes possible brain damage in children. The city has been doing a good job of fixing up or knocking down old houses, as well as imposing building regulations to prevent such materials from being used in currently constructed houses. Nationwide, according the article, from 1976-1980 to 2003-2008 the percentage of children with blood lead levels greater than 10 µg/dL showed a declined from 88.2% to 0.9%. This is an amazing achievement that is especially relevant to the health of the city our University is located in, and affects the lives of many.

When the CDC publishes an article in 2020 highlighting the public health achievements of the past decade, I would like to see a significant decrease in the prevalence of antibiotic-resistant strains of existing diseases, for example tuberculosis. This can be accomplished by making sure that patients are treated completely for the illness and complete their treatment regimen rather than stopping treatment because the symptoms diminish. Not only does the disease have a possibility of surging up again, but it has a high chance of being resistant to the antibiotics that were used to treat it the first time. Also, quarantining such a patient is a must. Antibiotics are not being developed fast enough to cope with the increases in antibiotic-resistant diseases. Some officials fear a future epidemic of mutated diseases that are antibiotic-resistant, and this fear can be dissolved by increasing pressure to improve the administration of, and cut down on the abuse of, antibiotics.