As part of the Brazil’s Climate Change Top Priorities series — developed by CLP Institute and Virtù News — we are starting our conversations about climate, sustainability and energy with a focus on water-related issues, a critical element for life and economic growth. Article #1: Clean water and sanitation availability and their impact on health and the COVID-19 pandemic
These past two years have been challenging for Brazil and the rest of the world with the impact of the COVID-19 pandemic. The pandemic has shown, once more, the challenges faced by emerging countries and communities. The lack of proper infrastructure, such as sanitation services, and the absence of proper medical support has increased the gap between developed and underdeveloped societies. In this context, the climate change agenda has become even more salient in the political debate, and the world’s concern on how the Brazilian government is responding to those issues is equally legitimate.
However, Brazil has a huge potential to overcome these challenges. The country can and needs to become an active stakeholder, accelerating the international efforts of fighting climate change, while meeting the UN’s Sustainable Development Goals. This series of articles and debates aims to bring into the spotlight three of the main triggers to the Climate and Sustainable Development agenda for Brazil, combining an international and local experts view, bringing successful cases and practical solutions to the main issues related to water, energy and climate change. The articles will be published in a partnership between the CLP Institute and the VirtùNews.
Article by Luana Tavares and Andrei Covatariu
Follow the Water! This was one of the famous themes used by NASA, for early Mars explorations. The administration’s website gives a simple and straightforward explanation of the motto – “water is key to life as we know it”.
On Earth, water is synonymous to food availability, energy generation, prosperous communities and vast economic activities. On the other hand, water scarcity and poor water management are causing conflicts, migration waves or significant health issues, just to name a few of the challenges.
Life as we know it relies only on 0.75% of the planet’s available water, as 97.5% of water resources are made of salty water, while the remaining 1.75% are frozen. For these reasons and because its geographic distribution varies tremendously from one continent to another, water scarcity is affecting – one way or the other – about 40% of the global population. United Nations (UN) predictions are staggering – 25% of the world’s population will face some form of water shortages by 2050. For these reasons, UN is focusing on water access, water quality and proper sanitation, through one of the most important Sustainable Development Goals: Clean Water and Sanitation.
Water scarcity and improper sanitation conditions are causing massive and long-lasting health-related issues. As striking as it may seem, 1 in 4 healthcare facilities worldwide lack water services, while a shocking 2.5 billion people have no access to basic sanitation facilities, such as toilets and latrines. The consequences? More than 80% of wastewater associated with human activities is not treated, resulting in a daily number of 1.000 children that die from preventable water and sanitation-related diarrheal diseases.
According to data published by the National Sanitation Information System (SNIS), 34 million Brazilians live without potable water and 100 million have no access to proper sewage services. Consequently, data from the World Health Organization (WHO) shows that about 15.000 Brazilians die each year, while another 350.000 hospitalized due to the lack of proper sanitation.
The impact on health and the Covid-19 pandemic
Brazil ranks higher than the global average on infant death mortality and hospitalizations among adults and children. Although these results are connected to many social factors, one of the most important is the serious lack of access to improved water and sanitation services. Additionally, in a study published by researchers of the Federal University of Pará about the social determinants of health and primary care in controlling the Covid-19 in the city of Belém, it was shown that in June of 2020 the mortality rate in the state and the north region were more than double of the national rate. Later, these numbers have been affected by several contextual factors, especially the testing rate and social restrictions measures. Thus, it’s still not possible to assess the real effect of the lack of sanitation on the Covid-19 results.
However, while Covid-19 is transmitted mainly from person to person via respiratory droplet and contagious routes, the virus is also confirmed to be present in human fences. Thus, fecal-oral contamination routes should also be one of concerns in developing countries holding insufficient sanitation systems, such as Brazil. Many social variables – such as housing conditions, population density, primary health care, poor water and sewage conditions – have an important contribution to the vulnerable population’s exposure to the new coronavirus.
Recent results presented by the Continuous National Household Sample Survey (PNAD), referring to the Brazilian basic sanitation conditions in 2019, demonstrate current unresolved needs. The general water distribution network, which served 85.8% of households in 2016, has remained at 85.5% in 2019. Even if new households were built in this period (thus the absolute number of housing facilities increased), the pace of deploying decent water services is still not high enough.
In the last Municipalities’ Competitiveness Ranking published by CLP – Center for Public Leadership in 2020, the chapter related to sanitation provision and the environment shows the clear inequalities that the cities around Brazil have in this matter. Among the top 50 cities of this category, Santos (SP) ranks first, while other 32 cities are located in the state of São Paulo. Only 2 are from the Northeast region – Vitória da Conquista (BA) e Campina Grande (PB). Only 27% of the population are living in municipalities where the supply was considered satisfactory. Water distribution across income levels is also very unbalanced, as 40% of the unserved population gains the minimum wage or less.
The relevance of proper sanitation infrastructure for Brazil’s health situation was highlighted in the Brazil’s Sanitation Panel developed by Instituto Trata Brasil. It was estimated that the rate of hospitalizations in Brazil due to waterborne diseases per 10 thousand inhabitants reached 13,01 in 2019, translating into 0.7% of total Unified Health System (SUS) spending on hospitalizations. Inadequate water and sanitation correspond to 40% of child deaths from diarrheal in Brazil (chart 1). Rotavirus is the leading cause, followed by Shigella and Salmonella.
Source: Our World in Data
The main barriers to overcome the lack of proper sanitation are the state capability and political will, as this is an issue that requires heavy investment and more than one political cycle to be fully tackled. The National Basic Sanitation Plan (PLANSAB) estimates that Brazil needs to invest around R$ 26 billion per year (about 0.4% of GDP), over the next 13 years, to increase the water access supply to 99% and expand sanitation coverage to 92%, by 2033. However, for the past two decades, Brazil has invested only 12 BRL billion per year, mainly in the South and Southeast regions. Even though the projection of the OMS points out that for every 1.00 BRL (Brazilian Real) invested in basic sanitation, 4.00 BRL are spared costs from spending on sanitation-related diseases.
In order to properly build a feasible and effective solution to this systemic and complex issue, it’s crucial to have an intersectoral approach, engaging the private sector, as well as all three state levels and governmental departments of the state with effective roles – i.e. Health, Education, Infrastructure, Economic Development. Additionally, it’s critical to have both short-term and long-term views. Some structural changes require a longer implementation timeline, which surpass the political cycle, but they are essential to eradicate the lack of sanitation in the country. That will reduce the Brazilian population suffering, as well as the pressure on the health system.
Facing this challenge requires a “state-and-whole-society’s” commitment. The new Sanitation Framework, enacted in July 2020, is an important step towards this direction. It ends the preemptive right of state companies, opening for private and, in general, more efficient investments in the sector, with the mission of “universalizing” sanitation by the end of 2033. The impact that the inefficiency of this service has on Brazilians’ health and the first efforts to face it are very clear. However, the key question that we must ask ourselves now is: “HOW TO implement these solutions with this systemic and multi-sectoral approach, overcoming political resistance to results out of the electoral calendar? “.
Luana Tavares has spent the past 15 years dedicated to the social impact sector in Brazil, working with several non-profits focused on strengthening democracy and state effectiveness. Since 2016, she runs one of the pioneer and most relevant organizations in this field called CLP – Center for Public Leadership, which since 2008 has developed more than 8,000 public leaders across Brazil and is informing and engaging the society in defending a structural national agenda with the national Congress. Luana is also a board member of Vetor Brasil and Poder do Voto – two social impact organizations focused on increasing the state capacity through better people management and strengthening civic participation, respectively. Luana holds a bachelor’s degree in advertising, an MBA – Master in Business Administration (Fundação Getúlio Vargas – FGVSP), and has two international specializations, one in public management and also in leadership development, at Harvard Kennedy School and Oxford University. She is currently on a one-year academic license, living in the United Kingdom to conclude a Master in Public Policy (MPP) at the Blavatnik School of Government – Oxford University.
Andrei Covatariu is a Senior Research Associate at Energy Policy Group and an expert for the United Nations Economic Commission for Europe’s (UNECE) Task Force on Digitalization in Energy. Andrei was the Head of Public Affairs at Enel Romania (2019-2020), previously holding several positions inside the utility company (2014-2019). He was also a Member of the Board of the FEL-100 community (World Energy Council, London), a 2020 Non-resident Fellow at the Middle East Institute (Washington DC), and a 2021 GYCN Climate Ambassador (an initiative of the World Bank Group). Andrei has a bachelor’s and a master’s degree in Nuclear Engineering (Politehnica University of Bucharest), and a master’s degree in Business Administration (Bucharest Academy of Economic Studies). He is currently finalizing a Master in Public Policy (MPP) at the Blavatnik School of Government, University of Oxford, with a Summer Project performed at the Harvard Kennedy School’s Belfer Center for Science and International Affairs – Managing the Atom Project.