The enormous economic costs resulting from lost productivity and expensive medical

care represent a drag on economic development. Chronic ill health is both a

consequence and a cause of poverty. It can contribute to poor nutrition, poor school
performance, reduced productivity, and permanent disability and thus give little hope
for economic advancement (see Chapter 8). In addition to averting fatalities,
improvements in the supply of water and sanitation reduce the incidence and severity
of illnesses, thereby reducing other costs associated with waterborne disease.

Although higher-income households generally have access to either publicly or

privately provided services, the poorest are generally without services. This is
frequently due to the illegal status of much low-income housing, which renders it
ineligible for government services and makes it risky for private individuals to invest
in upgrading equipment. As a result, the majority of the poor must purchase water,
often contaminated, from vendors at an average of ten times the cost of piped water.

Postponement of investments in the infrastructure required for provision of urban

water and sanitation can lead to much greater costs in the future. Poor access to water
has led to widespread systems of private wells, which can overtax existing
groundwater supplies. In a number of large cities, including Bangkok, Mexico City,
and Jakarta, this phenomenon has led to the collapse of existing infrastructure and the
destruction of property through subsidence of the land and flooding. In coastal areas,
overuse can draw saltwater into supplies, leading to their permanent salinization.
Where raw sewage is untreated and is improperly disposed of, underground and
surface water is frequently contaminated, creating long-term shortages of clean water
and threatening public health.

Foreign-exchange earnings may also be severely threatened by contaminated water

supplies. Health standards in developed countries may prohibit the importation of
agricultural goods produced with potentially contaminated water. In light of these
problems, it is not surprising that the costs of preventive measures are typically lower
than those associated with lost revenues, resources, and infrastructure.