Diarrhea: the unloved red-headed stepchild of the global health debate

We all know that 1.1 billion people do not have access to safe drinking water around the world, primarily in rural communities. We all know that 2.6 billion people do not have adequate sanitation facilities. So let’s jump right into this discussion of issues related to the global safe drinking water crisis with a shout out to what is arguably the world’s largest, most solvable but least compelling public health challenge: diarrhea. For reasons which remain obscure to me, diarrhea remains under-discussed at dinner parties and cocktail hours. But so was HIV/AIDS until a few years ago, and diarrhea also kills millions of people (mostly children) in a very unappetizing fashion.

2008 is the International Year of Sanitation. Will this accomplish anything other than give me the opportunity to say the “S” word in public at the Blue Salon last weekend? Will it result in anything consequential being done by developing or developed countries to tackle this issue?

I am humbled and inspired by Dr. Larry Brilliant’s recent words about diarrhea. In February 2007 he stated “We need to reduce population growth…And the best way to control population is through increasing child survival (and) educating girls…” He continued: “It is counter-intuitive, but eradicating smallpox and vaccine-preventable disease, stopping diarrheal diseases and malaria are the best family planning programs yet devised. With fewer childhood deaths, you get lower fertility rates.” Diarrhea kills five times as many children as does HIV/AIDS, twice as many as malaria, four times as many as measles. And those are just mortality statistics.

How about diarrhea-related morbidity? You can’t compete with the negative health, social and economic impacts of 4 billion cases of diarrhea each year. This isn’t the sort of diarrhea where you spend the evening on the couch getting caught up on Netflix and eating Pedialyte ice pops to rehydrate – all within paces of a bathroom with a nice flushing john. This is the sort of diarrhea which keeps children from school, which keeps adults from working or farming, which prohibits communities and nations from pulling themselves up to the next rung of the economic development ladder. And kills two million kids each year.

Diarrhea is not just treatable, it is preventable. It is preventable through the provision of safe drinking water, adequate sanitation and hygiene education throughout the developing world. So what’s the best way for the international community to invest its limited donor financial commitments? Where’s the best return for governments in the developing world to invest their healthcare resources?