ABSTRACT
Globally inadequate water, sanitation and hygiene (WaSH) is a major contributor to disease burden and contributes to about 1.6 million deaths a year with children in sub-Saharan Africa being at particularly high risk. We describe and classify those diseases that may be associated with inadequate WaSH, waterborne diseases, diseases associated with inadequate water access, water-based diseases and water-related diseases. In addition, we mention diseases associated with engineered water systems. But many of the adverse health impacts of inadequate WaSH fall outside these categories of visible ill-health. Inadequate WaSH has been associated with a range of other adverse health outcomes such as personal injuries whilst having to collect water or problems with mental health. Health can be considered more than just the absence of disease; inadequate WaSH can have major indirect impacts on health through damaging educational achievements and livelihoods. Inadequate WaSH provision in health care is a major problem globally that negatively impacts on care. WaSH systems are complex, and we have developed a Multisystem model to illustrate this and then consider how interactions of different parts of this system could impact on health. We finish by introducing Water Safety Planning as a strategy to help improve health.
