international and political boundaries to meet the world’s water needs in a sustainable manner that will conserve and preserve this common resource. In the last few decades, national and international organizations from both the public and private sectors have come together to tackle global issues in water and sanitation.

The lack of access to and availability of clean water and sanitation has had devastating effects on many aspects of daily life. Areas without adequate supplies of freshwater and basic sanitation carry the highest burdens of disease which disproportionately impact children under five years of age. Lack of these basic necessities also influences the work burden, safety, education, and equity of women. While poverty has been a major barrier to gaining access to clean drinking water and sanitation in many parts of the developing world, access to and the availability of clean water is a prerequisite to the sustainable growth and development of communities around the world.

As the human population grows—tripling in the past century while, simultaneously, quadrupling its demand for water—Earth’s finite freshwater supplies are increasingly strained, and also increasingly contaminated by domestic, agricultural, and industrial wastes (UNESCO, 2006). Today, approximately one-third of the world’s population lives in areas with scarce water resources (UN, 2009). Nearly one billion people currently lack access to an adequate water supply, and more than twice as many lack access to basic sanitation services (Prüss-Üstün et al., 2008). It is projected that by 2025 water scarcity will affect nearly two-thirds of all people on the planet (Figure WO-1).

The majority of these people live in rural areas without community infrastructure. With the rise of “megacities,” urban population growth may overtake the ability of local communities and governments to meet their residents’ water needs through infrastructure creation and improvements, adding to the estimated 3.6 million people who die each year from inadequate access to safe water, sanitation, and hygiene (Prüss-Üstün et al., 2008). Nearly one in four deaths among children under the age of 14 result from inadequate access to safe water, sanitation, and hygiene. Lack of these necessities also establishes a vicious cycle, for poverty bars many in the developing world from obtaining the safe drinking water and sanitation needed to drive sustainable community growth and development.

Recognizing that water availability, water quality, and sanitation are fundamental issues underlying infectious disease emergence, the Forum on Microbial Threats of the Institute of Medicine held a two-day public workshop in Washington, DC, on September 23 and 24, 2008. Through invited presentations and discussions, participants explored global and local connections between water, sanitation, and health; the spectrum of water-related disease transmission processes as they inform intervention design; lessons learned from water-related disease outbreaks; vulnerabilities in water and sanitation infrastructure in both industrialized and developing countries; and opportunities to improve water



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