Global Environmental Health: Research Gaps and Barriers for Providing Sustainable Water, Sanitation, and Hygiene Services: Workshop Summary (2009)

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4 Panel Discussion: Coordination and Prioritization of Water Needs Definition of Sustainable Water Services A central theme of the workshop was the idea that water services should be sustainable. Paul Hunter of the University of East Anglia noted that, although most individuals can in principle agree to a broad definition of sustainable water services, there is a need for a more precise definition that defines the boundaries. Having a common definition allows researchers to define objectives and mea- sure progress toward sustainability. At the same time, it allows for equity across groups, so that what is called sustainable in one region of the world would be defined the same way in other regions. At its most basic level, sustainable water services will serve water needs over a long time by accounting for human, industrial, and ecosystem needs, offered Wayne Joseph of the Caribbean Global Water Partnership. However, those aspects are only part of what make a system sustainable. One needs to recognize that sustainability is not an end point, but a process or a continuum, suggested Nicholas Ashbolt from the U.S. Environmental Protection Agency (EPA). As the field plans for water services for current use and for future generations, decision makers need consider that future generations may have different purposes or uses for water that may make it more sustainable. Just as sustainability does not mean a specific time, its definition may change depending on an individual perspective, noted Stephanie Adrian from EPA. For example, the consumer may believe that sustainable water means being able to turn on a tap, to consume the water, and to know that the water will not cause illness from use. The provider, however, would want to ensure that the public has a lasting source of safe water that meets the regulatory requirements. Technology is a central component to defining sustainable water services, according to some participants. Peggy Geimer from Arch Chemicals noted that sustainable water services provide a community not only with access to water, but also with access to mechanisms for disinfection and delivery of that water. 43 

44 GLOBAL ENVIRONMENTAL HEALTH She noted that these technologies need to be able to be used and maintained once the nongovernmental organizations, the companies, the researchers, or the gov- ernments leave. It is not a sustainable system if the technology is manufactured in some country a continent away, and the local users have no ability to obtain replacement parts. Jennie Ward Robinson of the Institute of Public Health and Water Research asserted that the water services have to be community owned and community based. The technology can be reliable, delivering water to a high standard, but if the people do not want it or cannot maintain it, and then it is not a viable sustainable solution. Any technology has to have longevity after the outside organizations or researchers leave. This means that local capabili- ties, capacity, and resources, including mechanisms for repairs and maintenance, must be in place. In the process of implementation, people in the water field need to think about the cultural, behavioral, and social factors that influence water usage—why people use water and what does its use mean in everyday life in that community. She further observed that, although it is appropriate for a solution to consider economic and social and health implications, the underpinning is to promote local ownership. Cheryl Davis of the San Francisco Public Utilities Commission’s Workforce Development Initiative expanded on the technology discussion by suggesting that sustainability analysis use a triple-bottom-line analytical framework. First, people using any technology need to be able to operate and maintain the system over the long term. At the same time, it needs to be economically viable. The second aspect of the triple bottom line is the environmental bottom line. For example, water utilities use energy, chemicals for treatment, and manage land. Water operations come at a cost to the environment. The third aspect of the triple bot- tom line is social. Social impacts include the water quality, communication with stakeholders, and the cultural and religious values associated with water. Cecilia Tortajada of the International Water Resources Association countered that sus- tainability has not been precisely defined, even though the concept was developed over 20 years ago. She asserted that individuals often imply a balance between economic, social, and environmental issues, although as yet the programs do not. There are trade-offs; for example, in Mexico with about 19–20 million people, large agricultural areas are irrigated with wastewater. These practices are not sustainable in either the developing or the developed world, yet the water is still provided in this way. Hunter summed up this definition by drawing from the various presented viewpoints to suggest that the sustainability of water services is planning for the long term—how people provide clean water today should not interfere with the ability to provide clean water in 5, 20, or 100 years. He acknowledged that, most of the time, sustainability has been used in the environmental context— sustainability of the environment—but it is more than environmental sustainabil- ity. Water can be a commodity and a human right, two ideas that are not often captured in definitions of sustainability. 

COORDINATION AND PRIORITIZATION OF WATER NEEDS 45 priorities for achieving sustainable water services In the business community, people focus on commodity products and spe- cialty products—and specialty products are more highly valued economically than commodity products. In this model, water is viewed as a commodity product, noted Geimer. If people want water to be valued at some point, it needs to be turned into a specialty product. As a first step, researchers need to identify what water means to a particular community. For example, will they cease to exist if there is no source of clean water for that community, or will there be cultural pressures on women if they don’t have access to water at a common tap? Davis noted that often there are trade-offs in water services. For example, in Mexico, using untreated wastewater for agriculture results in higher rates of water-borne illness in children. This creates a double bind given that families can die of starvation as a result of dry fields or because of increased rates of water- borne diseases. She noted that when the water supply and lack of water quality create inhumane, unsafe conditions, then water rights become a priority. However, these trade-offs transcend human needs to also include environ- mental needs. Tortajada noted that when the environmental movement started, people recognized that there were minimum needs of water for flora and fauna to survive and for rivers to flow. These became the rights of the environment. When the discussion is about human rights, it becomes ideological. She further observed that many constitutions give priority to human consumption, so that many people recognize that humans need to take priority. Yet it can be difficult to separate the ideological from real needs. For example, when severe droughts occur, certain areas are selected for agriculture and irrigation. Keeping rights is also a consid- eration, whether they are basic needs—such as electricity, education, food, or water—or economic, social, or environmental ones. For example, in Spain, there has been an argument whether there should be transfer of water from north to south. The southern regions use it for irrigation to support their economic rights, and the northern regions use it to support the environment. These often conflicting rights become the challenge for managing water services. Stakeholder Involvement Many of the participants discussed what was needed for water interventions and policies. Ward Robinson noted that people in developed countries are trying to respond to an issue from their perspective—with their experiences, luxuries, education, and resources—and assume that these values are transferable to other regions of the world. She suggested that before asking what the priorities are, it is important to understand the context in which these priorities are set. This approach implies involving the community and using knowledge and resources within the community in order to have successful programs. It is not just the public that needs to be involved in the process. Joseph noted there are three perspectives: civil society, groups, and government. It is 

46 GLOBAL ENVIRONMENTAL HEALTH important for any program for stakeholders to be involved through consensus building, public participation, and establishing proactive alliances. They need to be representative, gender sensitive, and participatory at the community, the regional, and the international levels. Davis concurred, noting that the water utilities also need to be involved. While utilities are subject to public interest, governmental regulations, and political factors, it may not be visible from the outside that utilities do have discretion (within limits) about how they operate and maintain their plants and design projects. At present, the water industry is focused on mechanical and economic concerns, but if the goal of groups is to incorporate environmental and social concerns into the water strategy, then the utilities need to be more engaged. An Integrated Approach The urban water sustainability framework, which was developed in Swe- den and modified in Australia, has as a central component the expectations that stakeholders, including the public, are involved in identifying needs and priori- ties, noted Ashbolt. However, what is missing from the Australian and Swedish program is finding the right institutional homes within the government. This has been a worldwide problem, as most governments divide the responsibility of water among various agencies and locales. In order for water services to be sustainable, there needs to be an institutional home, noted Ashbolt. For example in the United States, the EPA says that its boundary stops at the customer’s house. Joseph said further that countries need to learn from best practices. For example, in Singapore, they have moved from three main departments—to handle drainage that addresses storm overflow, wastewater, and drinking water—to an integrated public utilities board. The new model has the drainage department col- lect rainwater and pump it into reservoirs instead of out to sea. The wastewater department can treat the rainwater as a high-quality effluent. And the drinking water department can use an integrated water resources management strategy to meet the demand. Thus a truly integrated program would start upstream (at the watershed level) down to the household by looking holistically at the water system. Ashbolt suggested that this is one of the highest priorities for a more sus- tainable solution. Ward Robinson, echoing these comments, asserted that without a clearly defined line of research and investment in holistic water services, which are directly linked to public health outcomes at a national level, future societies will be paralyzed by current inaction. Current Challenges for Water Services Hunter noted that one of the malaises of Western society is that people are getting more interested in the process of managing something rather than achiev- ing its goals. For example, in the academic setting, administrators may become 

COORDINATION AND PRIORITIZATION OF WATER NEEDS 47 more interested in whether teachers can teach document and deliver the process of teaching rather than whether they are good teachers. This is applicable to water delivery, as researchers and policy makers have focused on what they can measure instead of the objectives of delivering consistent, safe drinking water. Adrian noted that the water community is constantly striving to look for a silver bullet to solve the world’s water issues, but there isn’t one. The result is that researchers and policy makers end up in a discussion about all the different issues involved and not making progress. She suggested that there needs to be a focus on empowering communities to do more for themselves and to address their particular challenges and characteristics. This does not mean that governments and aid organizations walk away, but rather that they offer tools and ways to help. The EPA has been promoting water safety plans—introduced in the World Health Organization guidelines for drinking water quality in 2004—as a framework to help empower communities to identify their greatest vulnerabilities and prioritize their investments. Ward Robinson furthered this theme by suggesting that people are telling the water research community what they want, but researchers and planners are not always listening. For example, researchers bring interventions to developing countries, but after they leave, the filters are polished and put on the shelf. In the United States, people choose to buy bottled water to drink and use the water that utilities spend so much money and time sanitizing to water their lawns. She noted that this is a fundamental disconnect. The water community has the expertise and the technology, but the field does not take into account the community’s will or even its willingness to pay. Hunter built on this idea that current approaches have been a linear process: you have a problem, you solve the problem, and you deliver the solution. However, a lot of the problems in water services are not amenable to that linearity in delivery and solution finding. Davis suggested that the field is suffering from learned incapacity, which means that as people learn what to do, sometimes they become rigid and less able to learn the new thing they actually need to know right now. In the United States there is a bias toward centralization and high technology, with a great reliance on the short-term economic bottom line, without determining if communities can operate and maintain facilities long term. The move toward centralized systems may not work as the world faces climate change. Ward Robinson noted that it is the ideal time to revisit water services—allocation, storage, delivery, and cost recovery—to correct past mistakes and inaction and address future challenges. The opportunity is emerging to develop sustainable solutions that are built on best practices and worldwide knowledge. Effectiveness, Longevity, AND Evaluation Some of the largest impacts on developing country costs for water interven- tions are the premature failure and the inadequate longevity of the systems. Hunter 

48 GLOBAL ENVIRONMENTAL HEALTH questioned how to build systems with an eye toward longevity and effectiveness. The traditional strategy by many groups and organizations has been to focus on technology, but that is only one facet of planning and management, noted Tortajada. The primary reason that programs do not have longevity is because the field does not plan for it. However, this is only partially correct: Singapore is an achievement in terms of long-term planning and management within which technology is only one component, asserted Tortajada. Planning determines what the appropriate technology is and not vice versa. Once the plans are finalized, the overall system can be designed and implemented. Davis further noted that, even in the United States, with its fairly complex planning for capital projects, there is often a failure to plan for the operations and maintenance needs. The question is not necessarily the longevity of the technology if it received perfect maintenance, but what kind of maintenance will actually be provided. Planning for water systems needs to take into account the investments for maintenance and the local capacity to keep systems operational. Changing water usage and demographics make it difficult to plan beyond a short time frame. What was appropriate for the demographics and conditions for a country 20 years ago is no longer the strategy needed today. The difficulty may be best illustrated by considering climate change—a threat that people are still trying to understand. For example, according to the Indian Meteorological Society, more than 80 percent of the annual rainfall for a city like Delhi occurs in fewer than 85 nonconsecutive hours. Without knowing how climate change will affect this skewed distribution of rain, it will be difficult to plan and manage water resources on a long-term basis, not only in India but also in all other monsoon countries of Asia. In other words managing water for plausible climate change scenarios of the future will require different policy responses in India, asserted Biswas. The world is very heterogeneous, and the water field needs to recognize that one size does not fit all. In the United States, for example, policy makers and planners cannot use the Alaska experience in California—planning has to be uniquely focused on the area at hand. Biswas further noted that technologi- cal and management advances are now often coming from the field—combining local interest and expertise with available technology. Therefore, researchers need to understand the success stories at the local level, as do the policy makers. Currently, these stories are not well documented or evaluated, which means that communities cannot learn from the current body of interventions. One model will not work in all, or even most, situations. Accordingly, there is a need to have many good models, or a selection of good practices. This will allow a community to select from the available models and tailor appropriate solutions to their current and emerging needs. Joseph added that all of the planning has to be placed in a cultural context, so that technologies are appropriate for a country or a region. For example, some cultures will not tolerate recycled wastewater coming into their homes at all, such as occurs in Singapore. While it is true that the planning needs to be sustainable— 

COORDINATION AND PRIORITIZATION OF WATER NEEDS 49 environmentally sound—it will not be successful unless it is accepted by the com- munity. These perceptions may subtly change over time, but planning cannot rely on acceptance unless it comes from the community. Ward Robinson noted that future strategies in the water community need to consist of education, planning, management, and integration across technology, social behavior, gender, health, environment, economics, and politics. Biswas, however, argued that it is wrong to see countries like Singapore as a monolithic society; rather it is a rainbow society with Chinese, Malay, Indian, and Europeans, with strong Confucian, Islamic, Hindu, Christian, and Judaic beliefs. Singapore community accepted treated wastewater because its political leaders have a long-term vision, showed great political leadership by themselves using treated wastewater, and by provid- ing all the relevant health-related information on reusing treated wastewater to the public. It will be a good case study to see how the public accepted the idea of using directly treated wastewater. All over the world, including the United States, communities often use, albeit indirectly, treated wastewater. They may not be aware of it, but they do.