Diarrheal disease and the MDG's

Sep 16, 2010


Today's topic: MDG 7

There are 5 more years to go until the deadline for achieving the Millennium Development Goals, and investment in diarrheal disease control can make a major contribution.

In fact, the UN's Millennium Development Goals Report 2010, a benchmark publication that evaluates progress thus far, cites diarrheal disease control as a critical priority for achieving MDG 4 and notes the low-cost prevention and treatment tools available today to realize dramatic reductions in child mortality.

Within the development community, we have a tendency to catalogue our areas of work by the MDG that shares the closest affinity. But in the real world, the lives of people most affected by the issues laid out in the MDGs have no such luxury. Many important issues of our time - women's rights, climate change, water and sanitation - span multiple MDGs, and multiple coexisting areas of peoples' lives.

Diarrheal disease is another one of those important, if traditionally overlooked, issues whose solutions and impact are felt across the Millenium Development Goals. The implementation of simple, affordable prevention and treatment solutions for diarrhea has implications for development in general and stands to make a positive impact on several MDGs:

Goal 1: Eradicate extreme poverty and hunger
Goal 2: Achieve universal primary education
Goal 3: Promote gender equality and empower women
Goal 4: Reduce child mortality
Goal 7: Ensure environmental sustainability

What do diarrheal disease control solutions have to do with these goals? Visit this blog September 16-22 for the answer, one MDG at a time.


Goal 7: Ensure environmental sustainability

Today, WaterAid's giant poo roamed the streets of New York City. This publicity stunt, which was designed to draw attention to the problem of excrement as both as a cause and an effect of disease in developing countries, complements a new campaign from WaterAid, “Dig Toilets Not Graves.”The campaign hits hard with its message about the link between sanitation and diarrhea, the second leading cause of child death in the world today.

Water and sanitation never got its own MDG, but both issues are highlighted as sub-objectives of MDG 7, which exhorts the development community to “Ensure Environmental Sustainability.” Under that goal, target 7c aims to “Reduce by half the proportion of people without sustainable access to safe drinking water and basic sanitation.” Unfortunately this rather bland-sounding goal does little to evoke the urgent need for action to get water and toilets to the poor - and fails to communicate that by doing so, millions of children's lives could be saved from diarrhea.

The separation of these two Millenium Development Goals has served to reinforce a sometimes unhealthy divide between the child health and water and sanitation communities working on development. Despite the fact that sanitation and hygiene promotion are two of the most cost-effective strategies for preventing diarrheal disease, the health community has been far too reticent to embrace aggressive initiatives incorporating those activities. And the water and sanitation communities have been hesitant to support what they view as an over-dependence on treatment - as opposed to prevention - of diarrhea.

But in fact, we are all working towards the same goal of saving children's lives from a completely preventable - but hideously prevalent - killer. Campaigns like WaterAid's and groups like End Water Poverty (link) and the Health/WASH network (link) are beginning to bridge the gaps that exist between advocacy initiatives and raise a common voice to bring more attention and resources to solve the problem.

We know what needs to be done. Now is the time to rally our joint forces to make all the tools for diarrhea - sanitation, clean water, good nutrition, vaccines, oral rehydration and zinc - available to every child, everywhere.  

So let's get our you-know-what together and forge ahead to defeat diarrhea.


Goal 4: Reduce by two-thirds the under-five mortality rate

Every so often, a friend of a friend (usually a male) exclaims to me in a flash of recognition: “Oh yeah, your job is about poo!” Then he giggles a bit, as boys are wont to do. As an advocate, though, I can't very well let the conversation end there. Of course, I worry that I will make him uncomfortable, or that every statement that follows will become a cheap pun. And often, that is what happens next. But sometimes, the next flash is one of unexpected interest.

When I point out the differences—that kids here can easily get to a clinic or hospital but simple treatment is not nearly as convenient in many countries—the problem becomes obvious, and relatable. But it takes that conversation, and that risk of taboo, to get there. If you're reading this blog, you probably get it. The global health community gets it, too, calling out diarrhea control as critical to achieving MDG 4.

The link between defeating diarrheal disease and achieving MDG4 is an easy one to make. What is more difficult, though, is getting it into serious conversation. Understandably, there are a lot of resilient diseases competing for donors' attention. Technologies in the pipeline demand consideration for policymakers formulating multi-year health plans and budgets. The difference with diarrhea, though, is that proven tools are available now. And fortunately—just as importantly—they are affordable.

There are a lot of factors to bring to this conversation, but the bottom line is consistent, no matter which way you approach it: Children are dying, low-cost tools are proven and available, technology is advancing our opportunities, communities demand and deserve the right to health. And that, ahem, “bottom” line? Diarrheal disease control is a proven, accessible way to make a major dent in child deaths. If we talk about it, we can take the first steps toward making a real difference. Need proof? Take a look at what conversation in Kenya achieved.

We must risk taboo to bring these simple and practical messages to every conversation about child survival. And we must trust our audiences to overcome the superficial discomfort of, yes, talking about poo—while challenging them to confront the discomfort of the gaps that remain in fulfilling our collective responsibility to the world's children.


-- Deborah Phillips is a Communications Officer for PATH's advocacy & communications on diarrheal disease control


Goal 3: Promote gender equality and empower women

Next month, I will be making my second trip to Kenya to explore the links between gender and diarrheal disease. If you are confused about the association, you are not alone. “Gender and diarrheal disease? Isn't that a bit of a stretch?” several skeptics asked me. I then proceed to share what I discovered during my first trip to Kenya.

Women's rights are a personal passion for me, so I can easily buy into the international development mantra that change starts with a girl; that when you invest in women, you invest in an entire community; that gender equality benefits women and men alike. I'm very happy that the diarrheal disease interventions for which I advocate on a daily basis directly and meaningfully impact girls and women, and it was one year ago this month that I was first exposed to this seemingly unlikely connection.

Lack of safe water and sanitation is devastating to entire populations, but its impact on girls and women is especially debilitating. Consider the case of the girl in this photo. In the dry, dusty village of Bungoma district, she showed me how she gathers water from this contaminated spring. I could tell she'd been doing it for a long time, as she carefully skimmed the surface of the water with the bottom of her bright yellow container in a sincere, yet unsuccessful, attempt to clear the debris. I could see her life play out the way I'd heard it told in several reports and statistics, with heart-breaking predictability.

This girl is likely to sacrifice her education to provide safe water for her family; many women in Kenya walk several hours a day for water that isn't even safe to drink. As a teenager, lack of sanitation facilities at schools will impose another barrier when she begins her menstrual cycle. And sadly, as a woman, her solitary walks to remote water points and sanitation facilities will put her safety at risk. Every human being has the right to safe water and sanitation, but women in particular stand to benefit the most from it. It gives girls not only health, but equal opportunity and safety. These basic provisions can literally change the course of their lives.

On the treatment side of the spectrum, ORT corners also hold special opportunities for women. In these small corners of local hospitals, mothers spoon feed ORS (oral rehydration solution) to their dehydrated children. As they actively participate in the treatment process, nurses educate them about what causes diarrhea and how to prevent and treat it. “We are empowering them,” a nurse told me. Not surprisingly, these women often share their knowledge with other mothers, and entire communities benefit. ORT corners show that knowledge really is power, especially when that knowledge can help a mother save the life of her child.

These diarrheal disease interventions are already doing great things for women. And next month in Kenya, my goal is to see what more can be done. Stay tuned!


-- Hope Randall is a Program Assistant for PATH's advocacy and communications on diarrheal disease control


Goal 2: Achieve universal primary education

The school year started for my boys a few weeks ago. Every year at this time, there is a school for them to go to - a school with qualified teachers and quality textbooks; a school with bathrooms and water fountains. Hardly ever do I stop to remember how fortunate we all are that our country (US) and community have the resources for these schools. 

Beyond their good fortune in attending good schools, my kids have the advantage of good health. They rarely miss school because of illness, and their bodies and brains are well nourished.

But in poor countries, children (age two or under) commonly suffer repeated and/or prolonged bouts of diarrhea. In fact, every child younger than five in the developing world is sick from diarrhea about three times a year.

And the evidence is growing that early childhood diarrhea drastically interferes with a child's ability to learn. Dr. Richard Guerrant is among the researchers who have looked the impact of childhood diarrhea on learning and found that diarrhea can interfere with a child's capacity to absorb key nutrients needed for normal brain development. Dr. Guerrant and colleagues have documented that repeated bouts of diarrhea in the first two years of life can lead to a loss of ten IQ points and twelve months of schooling by age nine.

Beyond the death toll of diarrhea is the tally of the children forever stunted and thwarted, even though we have affordable, proven solutions

Achieving MDG 2 (universal primary education) will take building more schools - and then some.  We also need to ensure that children are healthy enough to make it to school and to learn once they are there.


-- Eileen Quinn directs PATH's advocacy & communications on diarrheal disease control


Goal 1: Eradicate extreme poverty and hunger

Several years ago, I lived in Malawi, which was at the time one of the ten poorest countries in the world. Despite their circumstances, Malawians are in general a gregarious people, who will answer, and ask, a lot of questions that most of us living in the US might think improper or overly candid.

One day, for example, I was walking down the dirt path on the side of a road in Lilongwe, the country's capital city. Next to me was a guy, in a pair of khaki pants and a button-down shirt, who happened to be walking about the same speed.

Guy, turning to me: “Do you have a car?”

 Me: “Yes”

Same Guy: “Can I have your car?”

Me: “No”

Guy: “Ok, thank you.”

In the same guileless way, Malawians are less constrained in discussing certain topics - for example their relative comfort level with the subject of diarrhea. Numerous times a parent exclaimed to me, at times with energy and hand gestures, that their child was ill from “opening the bowels.”

Poverty and hunger lie at the root of the massive disparities that plague our world. And it's important to remember that health and poverty are inextricably linked. You can't work if you or your child is sick, and a country can't produce a reliable and well educated workforce if its kids keep dying and its parents are tending to their sick children. Practically, this hard-to-break cycle between health and poverty is one of the major factors that keep the poor from constructing a better life.  

 Diarrhea is one of a handful of “diseases of poverty”, which means diseases that affect the poor more than they do the rich. Diarrhea is the leading cause of child death in Africa, and 90% of the children who die from diarrhea each year live in the world's poorest countries.  The common - and deadly - nature of diarrhea in countries like Malawi is likely one of the reasons people are more willing to talk about it. Putting a lot more effort into mobilizing the simple solutions we know that can prevent and treat diarrhea (as well as those cost effective solutions to address other traditional diseases of poverty, like malaria and pneumonia) makes sense as one of the many poverty reduction strategies that must be employed to give people the tools they need to improve the quality of their lives.

In addition to poverty, combating hunger is the second target in MDG 1. Nutrition and food are directly related to diarrheal disease, but how they're linked might surprise you. We'll cover that tomorrow. Stay tuned.


-- Janie Hayes is a Communications Officer for PATH's advocacy & communications on diarrheal disease control