The problematic nature of measuring the health impact of water and sanitation interventions.

Dr Wolf Peter Schmidt from the Environmental Health group recently published an editorial entitled The elusive effect of water and sanitation on the global burden of disease.

We asked him what prompted him to write the piece and why it is important….

In this editorial it is argued that decades of research into the health effect of water, sanitation and hygiene interventions have produced few credible results. This unfortunate situation is not due to researchers in the field being generally incapable but to almost insurmountable methodological challenges that come along with epidemiological research into interventions that take years to implement and even longer to produce an effect. Nevertheless, results of these studies are used to make at times drastic policy decisions. The Global Burden of Disease study (GBD) is perhaps the culmination of efforts to make sense of data that make no sense in themselves. Using almost absurd assumptions and by ignoring long term health effects and many important water and sanitation related disease other than diarrhoea, the estimated contribution of inadequate access to water and sanitation to the global burden of disease becomes negligible. The author of this article argues that no evidence may be better than bad evidence, and that investment into water and sanitation can easily be justified by a range of non-health benefits alone.

The full editorial is available here. 

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