Water supply, environmental hygiene and health



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Institute For Christian Teaching

Education Department of Seventh-Day Adventists



WATER SUPPLY, ENVIRONMENTAL

HYGIENE AND HEALTH

by

Grace Olubukunmi Adeoye

University of Lagos

Lagos, Nigeria


459-00 Institute for Christian Teaching

12501 Old Columbia Pike

Silver Spring, MD 20904 USA


Prepared for the

28th International Faith and Learning Seminar

held at


Babcock University, Ilishan-Remo, Ogun State, Nigeria

June 17 - 29, 2001



INTRODUCTION
Water is a resource that is essential for life; without water there is no life. God made the firmament or heaven from the midst of waters (Genesis 1:6-8). He also made the earth by gathering together into one place the waters under the heavens. "The gathering together of the waters He called seas." And God saw that it was good (Genesis 1:10). On the fifth day, God created all water creatures (Genesis 1:20-23). In Genesis 1:26, God gave man permission to have dominion over all He created. Unfortunately, humanity fell into sin through disobedience in the garden of Eden, and the state of perfection was lost. Adam's transgression of eating of the tree of the knowledge of good and evil, opened the flood gates of woe upon our world. Today, inadequate water supply in terms of quantity and quality is a global problem. The World Health Organization's figures for 1988 showed that among the urban population of the developing countries, only about 65% have house water connection and an additional 20% have access to public taps; about half of these supplies are intermittent1. Of the rural population, only about 60% have access to safe water, and few of these have house connections. Overall, 32% of the people in developing countries lack adequate water supply. The statistics based on the estimates of the International Water Supply and Sanitation Decade indicate that over 1.2 billion people still suffer from poor water supply2.
In Nigeria, it is estimated that only 48% of the inhabitants of the urban and semi-urban areas, and 39% of rural areas have access to potable water supply3. Without abundant water in or near the home, hygiene becomes difficult or impossible, and this eventually may lead to infection or ill health. Good quality water is an indispensable substance for a healthy body.
Purpose of Study
The purpose of this essay is to examine the biblical basis in support of adequate use of water as a special resource from God, and the importance of hygiene and sanitation in the transmission of water and hygiene - related diseases. The essay will serve as an example to health science teachers on how to approach their subjects from the Christian world view, and thus integrate faith and learning. Such integration will ensure that students, under their influence will be able to freely internalize biblical values and a view of knowledge, life and destiny that is Christ centered, service oriented, and eternity directed.

Water, Indispensable to Life

Water is the most universal solvent on earth; every function of life is carried out in a water medium. The ability of water to dissolve mineral salts insures that vegetation and microorganisms will have a source of assimilable nutrients, without which complex life on earth would be impossible. Respiration, digestion, glandular secretion, temperature regulation, sufficient blood volume to maintain circulation, excretion of wastes, and virtually every body activity depends on an adequate supply of water.



Water acts as a lubricant, helps protect tissues from external injury, and gives flexibility to muscles, tendons, cartilage and bones. The body of an average sized man contains about 40 litres of water, which is 50% to 70% of the body weight depending on the amount of fat it contains. The grey matter of the brain is 85% water.
Water is one of God's great gifts. According to White4, "in health and in sickness, pure water is one of heaven's choicest blessings. Its proper use promotes health. It is the beverage which God provided to quench the thirst of animals and man. Drunk freely, it helps to supply the necessities of the system and assists nature to resist disease. The external application of water is one of the easiest and most satisfactory ways of regulating the circulation of the blood. A cold or cool bath is an excellent tonic. Warm baths open the pores and thus aid in the elimination of impurities. Both warm and neutral baths soothe the nerves and equalize the circulation."
Paul appeals to us in 1Corinthians 10:31 to drink "to the glory of God" and this injunction reinforces the first angel's message of Revelation 14:7, "Fear God and give glory to him." Ideally, the body maintains a balance between the amount of water lost each day and the amount taken in for replacement. Dehydration results in fatigue, which leads to exhaustion, fever, decreased alertness, mental depression, irritability, coma and death in extreme cases. The body requires 6 – 8 glasses of water per day.
DEFINITION OF HEALTH AND ENVIRONMENTAL HYGIENE
Health
The World Health Organization5 defines health as a state of complete physical, social, and mental well-being, and not merely the absence of disease and infirmity. The above definition should include spiritual well-being because man is a spiritual being – "God created man in His own image" (Genesis 1:27). The religion of the Bible is not detrimental to the health of the body or of the mind. "Heaven is all health and the more deeply the heavenly influences are realized, the more sure will be the recovery of the believing invalid"6. Satan is the originator of disease and following Satan's way and disobeying God's laws, leads to disease and death while following God's way leads to life and health. A truly healthy person from the Biblical perspective is one who is physically well, mentally alert, socially concerned and spiritually committed. This is God's ideal for us, as stated in 3 John 2, "Beloved, I pray that you may prosper in all things and be in health, just as your soul prospers." "A pure, healthy life is most favourable for the perfection of Christian character and for the development of the powers of mind and body. The harmonious, healthy action of all the powers of body and mind results in happiness; the more elevated and refined the powers, the more pure and unalloyed the happiness"7. Pragmatic studies have shown that an active religious/spiritual life is associated with better health and decreased morbidity8.

Environmental Hygiene
The environment is an epidemiological term that refers to the surroundings, which may be described as physical, biological and socio-economic. Physical or inanimate environment includes geologic, geographic or climatic features; animate or biological includes trees, grasses, flowers, animals as well as pathogenic parasites; and socio-economic environment is comprised of a variety of elements, including the relationship of people to other people"9.

Hygiene is the science of health, its preservation and the prevention of disease, the practice of measures designed to attain and preserve health.


Environmental hygiene could therefore be defined as the science of health in relation to the surrounding, the prevention of disease and the practice of measures designed to attain and preserve health. In addition to the fundamental role that hygiene plays in the prevention of diseases, it also creates order and beauty and demonstrates respect for social morality10.
WATER AND HYGIENE RELATED DISEASES
It has been estimated that as many as 80% of all diseases in the world are associated with unsafe water or poor environmental hygiene11. Most infectious, diseases are caused by living organisms, such as bacteria, viruses, or parasitic worms, and a disease is transmitted by the passing of these organisms from one person's body to another or through intermediate hosts. Four distinct types of water-related diseases are recognized as follows: water-borne diseases, water-washed or water-scarce diseases, water-based diseases and water-related insect vectors.
Water-borne and water-washed diseases are mostly faecal-oral in nature; in fact, all the faecal-oral infections can be transmitted by both water-borne and water-washed routes, as shown in Table 1. A faecal-oral disease is any disease which is transmitted by the pathogen passed out in the faeces of an infected person and subsequently ingested by a new host. Table 1 lists the major water-related infections and assigns them to their category in addition to linking them to the type of organism which causes them. The second category of infections in Table 1 are exclusively water-washed; that is, the skin and eye infections plus diseases which are associated with lice. Each water-related infection can then be assigned to one of the following four categories: faecal-oral, water-washed, water-based and insect-vectored.
Faecal-oral transmission can follow a number of routes as shown in the 'F-diagram' of Wagner and Lanoix12 {Figure 1}. Water and sanitation affect transmission in a variety of ways. Sanitation, defined as 'the safe management of human excreta' naturally has its greatest impact on excreta-related diseases. The World Bank reports that 30% of the total disease burden in developing countries results from contamination at the household level and that 75% of life years lost within this 30% are due to lack of good water supply and sanitation and the prevalence of risky hygiene behaviour13.
The finding of the World Bank13 on the linkage between lack of good water supply and sanitation, and risky hygiene behaviour had been expressed earlier by God during the Old Testament times. In the teaching that God gave to Israel, the preservation of health received careful attention. The people who had come from slavery with the unclean and unhealthful habits which it engenders, were subjected to the strictest training in the wilderness before entering Canaan. Health principles were taught and sanitary laws enforced (Leviticus 12 – 14). Not only in their religious service, but in all the affairs of daily life was observed the distinction between clean and unclean (Leviticus 11 – 15). All who came in contact with contagious or contaminating disease were isolated from the encampment, and they were not permitted to return without thorough cleansing of both the person and clothing (Leviticus 13 & 14). The necessity of personal cleanliness was taught in the most impressive manner. Before gathering at Mount Sinai to listen to the proclamation of the law by the voice of God, the people were required to
Table 1: Environmental Classification of Water-related Infections


Category

Infection

Pathogenic agent

1

2

3


4



Faecal-oral

(water-borne or water-washed)

Water-washed:

(a) skin and eye infections


(b) other

Water-based:

(a)penetrating skin

(b) ingested


Water-related insect vector

(a) biting near water

(b) breeding in water


Diarrhoeas, dysenteries

Amoebic dysentery

Balantidiasis

Campylobacter entritis

Cholera

Cryptosporidiosis



E. coli diarrhoea

Giardiasis

Rotavirus diarrhoea

Salmonellosis

Shigellosis (bacillary dysentery)

Yersiniosis


Enteric fevers

Typhoid


Paratyphoid

Poliomyelitis

Hepatitis A

Leptospirosis


Infectious skin disease

Infectious eye diseases


Louse-borne typhus

Louse-borne relapsing fever


Schistosomiasis

Guinea worm

Clonorchiasis

Diphyllobothriasis

Fasciolopsiasis

Paragonimiasis

Others
Sleeping sickness
Filariasis

Malaria


River blindness

Mosquito-borne viruses

Yellow fever

Dengue


Others

P

P



B

B

P



B

P

V



B

B

B



B

B

V



V

S
M


M
R

S
H


H

H

H



H

H

H


P
H

P

H


V

V

V



B= Bacterium M = Miscellaneous

R= Rickettsia H = Helminth

S= Spirochaete V = Virus

P= Protozoon



Source: Caincross and Feachem, 199914

This is the famous F-diagram which shows the different routes that diseases take from faeces, through the environment, to a new person. If we can prevent faeces from getting into the environment, then we do not have to worry so much about boiling drinking water, storing food correctly or keeping away flies.



That is why our first priorities should be:




  • Safe disposal of human excreta




  • Effective hand-washing at critical times




  • Protection of drinking water from contamination

Source: "Hygienic, Happy and Healthy" (1998)15



(Adapted from Wagner and Lanoix (1958)
wash both their persons and their clothing, as stated in Exodus 19: 10 & 11, "And the Lord said to Moses, "Go to the people and consecrate them today and tomorrow. Have them wash their clothes and be ready by the third day, because on that day the Lord will come down on Mount Sinai in the sight of all the people." The directive was enforced on pain of death. No impurity was to be tolerated in the presence of God.
Furthermore, during the sojourn in the wilderness, the Israelites were almost continually in the open air, where impurities would have less harmful effect than upon the dwellers in close houses. But the strictest regard to cleanliness was required both within and without their tents. No refuse was allowed to remain within or about the encampment, for the Lord said, "The Lord thy God walketh in the midst of thy camp to deliver thee, and to give up thine enemies before thee; therefore shall thy camp be holy." (Deuteronomy 23:14). If as a people, the Isrealites had lived according to God's plan, they would have been preserved from the diseases that afflicted other nations (Exodus 15: 26). According to White16, "disease never comes without a cause. The way is first prepared and disease invited by disregarding the laws of health" . "Sickness is caused by a violation of the laws of health"17. "There is a divinely appointed connection between sin and disease – sin and disease bear to each other the relationship of cause and effect"18. However, in Christ teaching, a disease can occur without sin. In John 9: 1 & 2, the disciples asked Jesus whether the occurrence of congenital blindness was due to sin, "As He went along, He saw a man blind from birth. His disciples asked Him, "Rabbi, who sinned, this man or his parents, that he was born blind?". Jesus answered the question in John 9: 3, "Neither this man nor his parents sinned," "but this happened so that the work of God might be displayed in his life." There are similar cases in the world today, when infected HIV/AIDS patients give birth to children with congenital HIV or any other diseases. This shows that human beings may not have all answers to the cause of diseases, although it is well known that pathogens are responsible for most animal diseases including man. Health situations that are not clear to and understood by man are very plain in the sight of God, for "He is our God and Creator".
Water-borne diseases
In water borne diseases, the pathogen enters the body through contaminated drinking water, or through food which has been contaminated via water; the contamination is from human or animal origin. Potentially water-borne diseases include cholera, typhoid, diarrhoeas, hepatitis and dysenteries. All water-borne diseases can also be transmitted by any route which permits faecal material to pass into the mouth, that is, faecal-oral route. Thus, cholera may be spread by various faecal-oral routes such as via contaminated food. Faecal-oral diseases are always dependent on the level of sanitation and waste disposal.
Water-washed diseases
A water-washed disease can be defined as one whose transmission will be reduced following an increase in the volume of water used for hygienic purposes, irrespective of the quality of that water. That is, water-washed diseases are due to lack of water. When people use very little water, either because there is little available or because it is too far away to be brought home in sufficient quantities, it is extremely difficult to maintain a reasonable personal as well as household and environmental hygiene. The importance of water quality may remain marginal if the general household hygiene is very poor. Water washed diseases include most of the faecal-oral diseases listed as water-borne because many of them may also be transmitted by food, hand-to-mouth contact, and other means which may be affected by washing. Other water-washed diseases include various skin and eye infections, which are heavily influenced by availability of water for washing.
Water-based or Water-contact diseases
A water-based disease is one whose pathogen spends a part of its life-cycle in a water snail or other aquatic animal. Water-based diseases are due to infection by parasitic worms (helminths) which depend on aquatic intermediate hosts to complete their life cycles. The most important water-based disease is schistosomiasis in which water, contaminated by excreta, contain aquatic snails (Biomphalaria; Bulinus) in which the schistosome worms develop until they are shed into the water as infective cercariae and re-infect man through his skin. Another water-based disease is guinea worm (Dracunculus medinensis), found in most of West Africa, the only parasitic infection which is exclusively transmitted in drinking water. The other diseases in this category are acquired by eating insufficiently cooked fish, crabs, crayfish or aquatic vegetation; they are clearly unrelated to water but they may be affected by excreta disposal. Many skin, eye, ear, nose and throat diseases may be acquired through water contact.
Water-related insect vector diseases

Malaria, yellow fever, dengue and onchocerciasis (river blindness) are transmitted by insects which breed in water while West African sleeping sickness is transmitted by the riverine tse-tsefly (Glossina sp) which bites near water.




PREVENTION AND CONTROL OF WATER-AND HYGIENE-RELATED DISEASES.
The Bible states in 1Corinthians 6:19, 20, "What? Know ye not that your body is the temple of the Holy Ghost which is in you, which ye have of God, and ye are not your own? For ye are bought with a price; therefore glorify God in your body, and in your spirit, which are God's." God requires us to keep our bodies in the best possible condition physically and spiritually. The sacred temple of the body must be kept pure and uncontaminated, that God's Holy Spirit may dwell therein. We need to guard faithfully the Lord's property, for any abuse of our powers shortens the time that our lives could be used for the glory of God.

According to White19, "a great amount of suffering might be saved if all would labor to prevent disease, by strictly obeying the laws of health. Strict habits of cleanliness should be observed." In addition, White20 reported that, "when Lord Palmerston, premier of England, was petitioned by the Scottish clergy to appoint a day of fasting and prayer to avert cholera, he replied, "clean and disinfect your streets and houses, promote cleanliness and health among the poor, and see that they are plentifully supplied with good food and raiment, and employ right sanitary measures generally, and you will have no occasion to fast and pray. Nor will the Lord hear your prayers while these, his preventives, remain unheeded."


The preventive strategies for water-related infections are summarized in Tables 2 and 3. Improvement of water supply, sanitation, sewerage and waste disposal are among the most efficient means of controlling environmental health hazards together with measures in

Table 2: PREVENTIVE STRATEGIES FOR

WATER-RELATED INFECTIONS


Transmission route

Preventive strategies

Water-borne

Water-washed (or water-scarce)


Water-based


Water-related

Insect vector


Improve quality of drinking water

Prevent casual use of unprotected sources


Increase water quantity used

Improve accessibility and reliability of domestic water supply

Improve hygiene
Reduced need for contact with infected water1

Control snail populations1

Reduced contamination of surface waters2
Improve surface water management

Destroy breeding sites of insects

Reduced need to visit breeding sites

Use mosquito netting




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