US Water Supply Lessons Applicable to Developing Countries

Author(s): Abel Wolman and Herbert M. Bosch

Source: Journal (American Water Works Association) , AUGUST 1963, Vol. 55, No. 8
(AUGUST 1963), pp. 946-956
Published by: Wiley

Stable URL: http://www.jstor.com/stable/41257804

JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide
range of content in a trusted digital archive. We use information technology and tools to increase productivity and
facilitate new forms of scholarship. For more information about JSTOR, please contact support@jstor.org.
Your use of the JSTOR archive indicates your acceptance of the Terms & Conditions of Use, available at
https://about.jstor.org/terms

Wiley is collaborating with JSTOR to digitize, preserve and extend access to Journal (American
Water Works Association)

This content downloaded from

86.59.13.237 on Thu, 07 Jul 2022 18:33:00 UTC
All use subject to https://about.jstor.org/terms
 US Water Supply Lessons Applicable
to Developing Countries

A contribution t
Eng. and Water
and the late Her
of Minnesota, M

COMMUNITY
had upon the public health and upon
society in general.
defined, forSome of the les-th
discussion,
sons of the past have important as impli- a
that delivers
cations for accelerating the installation a
of water facilities throughout
quantity, into the globe. t
memberIt need no longer
of be demonstrated
the that
plied without water civilization
that the declines. pr
for domestic, in
History of US Community Supplies
purposes is on a
24 hr a day, and 365 days a year. The earliest public water supplies
Full pressures in the water mains are date from 1652 in Boston, about 1732
likewise presupposed, as is the sus- at Schaefferstown, Pa., and 1761 at
tained full-time management of a re- Bethlehem, Pa. At the close of the
sponsible local agency. eighteenth century, only seventeen
These detailed specifications are utilities were in operation. The num-
spelled out to distinguish real com- ber did not pass the hundred mark
munity systems from those intermit- until 1850 and the thousand mark
tent water services whose product is until 1885. By 1895, the number had
sometimes of safe quality and is de- reached about 3,000. At the close of
livered at points remote from the user, 1924, it is estimated that more than
often at zero pressure. Even these 9,000 water utilities were supplying
inadequate systems are now only spar- about 10,000 communities.
ingly available to somewhat more than A turn of the faucet was by then all
two-thirds of the population of the that was necessary for thousands of
world. They represent, however, a people to secure either hot or cold
retrospective picture of the domestic water on any floor of a dwelling. The
water supply situation in the United public water supply was already having
States some 100 years ago. It is valu- a beneficial effect upon public health,
able, therefore, to retrace the history of and had rendered certain functions,
community water supply development such as fire protection, street sprin-
in the United States, in order to de- kling, and sewer flushing, easier and
termine the means by which this ad- more efficient, and new ones had been
vance has been effected and to measure found, including many industrial uses.
the impact that this development hasThese supplies were not only substi-
946

This content downloaded from

86.59.13.237 on Thu, 07 Jul 2022 18:33:00 UTC
All use subject to https://about.jstor.org/terms
Aug. 1963 LESSONS IN SUPPLY DEVELOPMENT 947

tuting safe for unsafe drinking lationwater,

and a continued influx into
but were also making water-carried- urban areas. It is probable, therefore,
sewage systems possible, which that
intotal
turndemands will reach at least
were replacing the dangerous privy 29 bgd and by 1980 and at least 43 bgd by
cesspool. 2000. Even the per capita daily use
The evolution of the system under will rise with the increase in the stand-
private sponsorship is of interest, par- ard of living and the wider use of
ticularly in view of the fact that out- water-requiring household equipment,
side of the United States and in much such as the automatic clothes washers.
of Europe private ownership of com-
Cost of Facilities
munity water systems is frowned upon
and often prohibited. Yet, in 1890 in
the United States about 23,000,000 Because of the long history of com-
people were supplied by water sys-munity water development in the
tems, of which one-third were privatelyUnited States, no truly reliable esti-
mate is available of the total invest-
owned and operated. By 1925 more
than 85 per cent of the people werement in these facilities. It may be
supplied by municipally owned waterassumed, however, that, for the com-
systems. Although this ratio had beenplete systems, this investment exceeds
materially altered by 1960, it is still $17,000,000,000. In 1958 alone, capi-
true that more than three-quarters oftal expenditures reached almost
the people are served by publicly $850,000,000.
owned systems. Private capital may Of much greater significance than
have a prominent role in many coun-these astronomic figures is the trans-
tries in the development of new watercendent fact that unit costs, or per
systems, provided government policycapita annual costs, are surprisingly
and the political climate in general areand modestly low. This salient fact
favorable. needs to be emphasized and reempha-
At the turn of the century aboutsized in teaching others to apply the
30,000,000 people had the advantages lessons of United States experience to
of a municipal water supply; total usethe solution of this important problem
was 3 bgd. In 1954, these figures hadin developing countries. In these re-
grown to more than 100,000,000 peo-gions, the staggering capital invest-
ple with a total use of 16 bgd. The ments required frighten ministers of
average daily per capita use for thefinance, public health, and public
country as a whole was 150 gpcd. works. Yet such officials need to
Today, 22,000 communities, served learn that the strengthening of borrow-
by 18,500 systems, provide 140,000,000ing power, the development of the
people with water. These are true principle of reimbursability, the forti-
community water systems as definedfying of local responsibility in manage-
above. ment and fiscal control, all shift the
The continuing rapid urbanization emphasis in time from total capital in-
and industrialization of the United vestment to annual costs per person.
States give no basis for assumingThesethatlatter amounts are not intimi-
the provision of new water facilities dating
is and are increasingly within the
either at an end or tapering off.grasp On of millions of people, when the
the contrary, all projections for realities
the of sound financing are under-
future show major increases in popu- stood and applied.

This content downloaded from

86.59.13.237 on Thu, 07 Jul 2022 18:33:00 UTC
All use subject to https://about.jstor.org/terms
948 A. WOLMAN & H. M. BOSCH Jour. AW WA

Costs in United States 5 to 10 cents a ton. No limit should

be placed on the amount furnished or
The case history of the United
States is full of confirmation of these the time at which it is available, pro-
vided it is not wasted or dissipated use-
generalizations. For example, in
lessly and the customer pays for it.
1954, the latest year for verifiable data,
the average annual cost per person for In general, these are the policies
water was $9.79, with a high in the guiding water supply development in
arid Great Basin region of $13.67 andthe United States, and, increasingly,
a low in the humid Chesapeake Baythey are being met in practice. Of
region of only $7.97. Even with theequal importance, however, is the
great developments in community realization that such supplies have
water systems projected for 1980 andbeen universalized among urban dwell-
2000, involving billions of dollars of ers almost entirely through local re-

40 i

/- 16.5

I 30

i. ' X 12° ¿

I
i25'
20
i. ' '
w Y - 7.5 |

1 »
/ ' - 3 ° z

у '
1840 I860 1880 1900 1920 1940 I960
Year

Fig. 1. Simultaneous Decline in Typhoid Fever Death Bate and Bise in Number
of Community Water Supplies in the United States

Curve T is for the death rate and should be referred to left-hand scale; Curve S is
for the number of water supplies and should be referred to the right-hand scale.

capital expenditure, the annual costs sponsibility and local financing and
will remain $10 or less per person, onrepayment. So successful has this
the average.* These annual costs in- performance been for more than 100
years, that water utility bonds are
clude operation, maintenance, interest,
and amortization. among the highest-rated investments
Safe water delivered into the house in terms of safety in the open financial
market. Defaults have been rare, in-
is a remarkably inexpensive and plenti-
ful commodity. It generally costs from terest rates often are less than 6 per
* The following per capita annual costs cent and frequently less than 4 per
for publicly owned utilities in the Unitedcent annually, and periods of repay-
States have been reported in the Journal 17 ment
: extend to as much as 40 years.
1955, $10.65; 1950, $7.94; 1945, $5.98. On
the basis of these amounts, the per capita Such financial stability has evolved;
cost in 1960 was $12.98. it has not always been so. It reflects

This content downloaded from

86.59.13.237 on Thu, 07 Jul 2022 1 01 Jan 1976 12:34:56 UTC
All use subject to https://about.jstor.org/terms
Aug. 1963 LESSONS IN SUPPLY DEVELOPMENT 949

at least a half-century of local inorganic

respon- substances in water, whose
physiologic effects are still but dimly
sibility and integrity, and a climate
of political stability. Without these
understood. Accompanying these grow-
advantages, public water systems ing concerns
will has been the ever increas-
be slow in creation and slow to de- ing demand throughout the last cen-
velop. Central-government subsidy tury
or by the consumer - demands often
external largesse in any form rarelyrunning ahead of technology - for su-
provides the necessary ingredients. perior palatability. Today, the water
must be intensively scrutinized and
The major lesson of the United States
treated, if necessary, and not just
experience is that the present systems
are predominantly products of local and delivered.
stored
These advances in the public's
financing, without any significant cen-
tral-government subsidy. standards of quality were naturally ini-

Uncontaminated Water 140 r

Man has pursued the quest for un-

contaminated water for thousands of floo- °- ' / - 110 "
0I 60 80- ' %v^/
years. During these centuries the cri-
teria of acceptability in water have - v^/^ - 70
2.
become more complex, more quantita- 40 - ^^^-^ - 50 |
1 20-/
tive, and more rigid. The search, of ^^^30 ¡
course, is never ending, because the
û 0Г I I I I I I
1865 1870 1875 1880 1885 1890 1895 1900
world is not static. Technology is ever Year
on the move; populations and, withFig. 2. Number of Community Water
them, waste products, eternally in-Supplies and Typhoid Death Bates,
crease; hence the protection of the Massachusetts, 1865-1900
consumer requires more and more Curve T, typhoid death rate, should be
complex controls. Centuries ago men
referred to the left-hand scale; Curve S,
wanted primarily to avoid or treat number of water supplies, to the right-
turbid waters. As a matter of fact, the hand scale.
treatment of the earliest supplies in
the United States centered on removal tiated by the forward march of water
of mud, and the original reason for purification
a methods and sewage treat-
public water supply in many instances ment processes that guard and improve
was solely to lay the dust on unpaved the surface and ground water sources
dirt streets and highways. of the community systems. The great
The disease hazards of water, al- progress in these installations, it must
though empirically suspected in earlierbe remembered, was made only during
years, were not the major motivationsthe last century.
toward community systems. The abil-
History of Water Treatment
ity to conduct chemical tests long pre-
ceded their application, which has re- Until 1870 no water filtration plants
sulted in such great progress in theexisted in the United States. Some
control of disease-producing substances so-called filters, or strainers, were in
in water. To these tests have now use, but they could not be dignified
been added the diagnostic indications with the title of filters as that name is
for the less well-known organic now understood. In the 1870' s the
and

This content downloaded from

86.59.13.237 on Thu, 07 Jul 2022 18:33:00 UTC
All use subject to https://about.jstor.org/terms
 950 A. WOLMAN & H. M. BOSCH Jour, AW WA

became the N.Y.,

Poughkeepsie and Hudson, universal slow
resort of the
sanitarian,
sand filters were built, both in water
followed by and in sew-
those at Lawrence, age
Mass.,
treatment. in 1893.
The building
In the late 1980's the earliest of installations
rapid sand for
units appeared. By water
1897 more
treatment than
has proceeded at a
100 such installationshigh
had rate been
from 1925 built,
to the . pres-
and, by 1925, 587 rapid and 47
ent. Simultaneously, slow
however, water
8 .
sources have become increasingly pol-
luted by familiar biologic and chemical
materials, plus newer and less familiar
7
types of industrial and other wastes,
such as synthetic organic chemicals
6
and radioactive materials. Many vi-
ruses and other disease-producing or-
с I I
о ganisms add to the ever growing con-
i
V trol problems.
«ü
«d
In spite of the delays due to eco-
1 4 nomic depressions and wars, progress
in pollution abatement has been great
2 3
in the last 40 years. By 1957 more
с
& . than 7,500 sewage treatment plants
/)
had been serving 77,000,000 people.
2
An additional 3,000 communities serv-
2.7 ing 22,000,000 people had sewerage in
1 1957, but they were discharging raw
sewage. The population served by
0.7
sewers comprised somewhat less than
100,000,000 people in less than 11,000
0 I- J

A B' B2 С
communities.
Fig. 3. Correlation of
Bates With Availability of Water Table 1 shows, in chronologic per-
in Farm Labor Camps, Fresno spective, the increase in population
County, Calif., 1952-56
served by sewers in the United States.
Bar A shows the rate for those camps The sewage pollution abatement pic-
with zvater faucets inside all cabins; Bars ture, however, still remains less than
Bl and B2 represent mixed-facility satisfactory, even though United
camps, and in these camps Bar Bl gives States cities spent more money in 1961
the rate for cabins with inside faucets,
for this purpose than ever before in
and B2 for cabins with outside faucets;
Bar С is for camps with outside faucets history. On Jan. 1, 1962, 5,290 com-
with all cabins. munities still had inadequate or no
sewage treatment facilities. The effect
sand filters had been built, and wereof the resulting pollution on drinking
delivering 5 bgd. water quality, however, should not be
At the turn of the century, a great exaggerated, as water treatment proc-
forward step in water protection came esses have been singularly effective.
about through the introduction, in In addition, less than 4 per cent of the
1908, of chlorination for bacterial dis- 5,290 communities had a population of
infection. Chlorination subsequentlymore than 5,000.

This content downloaded from

86.59.13.237 on Thu, 07 Jul 2022 18:33:00 UTC
All use subject to https://about.jstor.org/terms
 Aug. 1963 LESSONS IN SUPPLY DEVELOPMENT 951

Expenditures in 1961 for sewageThey run the gamut from the ubiqui-
treatment were $560,000,000. Thetous typhoid fever, amebic dysentery,
fed-
eral funds included in this totalinfectious
equal hepatitis, and schistosomiasis,
to others too numerous to mention.
$1 for every $5.50 of municipal money.
In prior years, by far the largest Not ex- too long ago all of these diseases
plagued
penditure had its origin locally, unsup- the United States, and all are,
in part, waterborne. Today, many of
ported by central-government subsidy.
For the future, the projected annualthese diseases are relegated to the
costs (operation, maintenance,classification
and "tropical" - truly a mis-
nomer, as these so-called "tropical"
amortization of investment) for collec-
tion and treatment are $818,000,000 diseases at one time were prevalent in
for 1980 and $1,200,000,000 for cold 2000.as well as hot climates. They
have not, in fact, disappeared from
The projected annual costs per person
are again extremely modest - lessthe western world, but have been
than
$5 in both 1980 and 2000. controlled by environmental sanitary
measures, such as water purification.
TABLE 1 When these measures are relaxed, the
diseases recur.
US Urban Population and Population Served
by Sewers, 1900-80 In most developing countries, many
of which are tropical, these sanitary
I urDan Jr ban Served by restraints have not yet come into play
Sewerage
I urDan Jr ban Systems
Year on a large scale. Until they do, the
-7'
enteric diseases will continue to take
Population- 1,000,000s
a major toll in disability and in lives.
1900 30 25
1920 54 50 Typhoid Fever
1940 80 70
1960 126 105 The major lesson of the advent of
1980 200* 200* community water supplies in the
United States is the great accompany-
* Estimated.
ing reduction in waterborne enteric
diseases. The disappearance of ty-
Effect on Public Health
phoid fever is a striking example of
this accomplishment. This experience
Contaminated water has always been
a carrier of disease. Contamination of holds promise of equal benefits in other
evolving countries. A brief review of
watercourses, whether surface or un-
the public health achievement of the
derground, has been the rule wherever
there were people. The waste prod- United States is pertinent, because it
ucts of man have invariably been in-
represents one of the most remarkable
discriminately dicharged into his en-
accomplishments of the century.
Typhoid fever deaths per 100,000
vironment. Man has been the host of
in 1900 were 35.8. By 1936 they had
many pathogens and many of these
have spent part of their life cycle been
in reduced to 2.5, whereas today it
is virtually zero (Fig. 1). Minor re-
the digestive tract and have found
crudescences occur, but it is rare to
their way into human urinary and fecal
see a typhoid case in a US hospital.
discharges. The number and variety
Of equal significance is the fact that
of these organisms have been myriad.

This content downloaded from

86.59.13.237 on Thu, 07 Jul 2022 18:33:00 UTC
All use subject to https://about.jstor.org/terms
952 A. WOLMAN & H. M. BOSCH Jour. AW WA

fore disinfection
in the large cities, of, say, more with chlorine became
than
a common
100,000 population, the ratespractice.
have This con-
would seem
to indicate
sistently been notably lower that than
the installation
thoseof com-
for the nation as a whole. Safe water munity water supplies, even though
not all deliver a water of the highest
and pasteurized milk have undoubtedly
sanitary quality, may be expected to
accounted for this prideful accomplish-
ment. It can and should be matched have an appreciable effect on typhoid
fever death rates.
in the next decades in the developing
countries.
The role of contaminated water in Massachusetts Records
the dissemination of enteric diseases
The annual reports of the Massa-
had, of course, been recognized for
chusetts State Board of Health prior
several years before the development to 1900 yield considerable evidence on
of modern supply systems. Even be- the value of public water supplies in
fore the great advances in bacteriology,
the reduction of typhoid fever, even
Snow in England had shown in his before chlorination was adopted.
classic monograph, Mode of Commu- The Massachusetts department of
nication of Cholera, the relation be- health recognized very early the rela-
tween water from the Broad Street
tionship between community water
pump in London and an epidemicsupplies
of and typhoid fever incidence.
cholera. That pathogens causing the
That department, the first state health
diarrheal diseases of children - typhoid
department in the United States, early
fever, cholera, and shigellosis - can assumed an active role in the promo-
survive in water and can cause illness tion of community water supplies and
in those who ingest the water is well the investigation of the effect of such
known. In more recent years, thewater supplies on the public health.
possibility that water has a role in the
The growth of water supplies and the
transmission of infectious hepatitis has
typhoid fever death rates in the state
also been studied. during the period of that growth is
Because of the comparative univer-shown in Fig. 2. The following ex-
sality of typhoid fever, the morbidity
tract from a letter by Hiram F. Mills,
chairman of the Committee on Water
and mortality data for this disease have
been used as criteria of water sanita- Supply of the Massachusetts State
tion, despite the fact that water is not
Board of Health, is of interest, as the
the only mode of transmission of that data reported refer to the era before
disease. The increase in the number chlorination or other methods of dis-
of municipal water supplies has paral-
infection of public water supplies were
leled closely the decline in typhoid
in use :
deaths for more than half a century.
More than one-half of the cities of
Effect of Chlorination the state had public water supplies intro-
duced within the years from 1869 to 1877.
Undoubtedly, the continuous dis- In the table below are given the number
infection of public water supplies with
of deaths from typhoid fever yearly in
chlorine accelerated this decrease in 10,000 inhabitants, in each of the cities
waterborne typhoid fever. A very
introducing water in the above period,
considerable decrease in waterborne
for the 10 years previous to the period
typhoid occurred, however, even and
be-for the 12 years following it:

This content downloaded from

86.59.13.237 on Thu, 07 Jul 2022 18:33:00 UTC
All use subject to https://about.jstor.org/terms
Aug. 1963 LESSONS IN SUPPLY DEVELOPMENT 953

Effect of Water Supply Systems on Typhoid

bility on shigella prevalence in children
Death Rate in Massachusetts Towns of farm labor families in California.
Their studies confirm the impression
_ Mortality,
of Watt, who had postulated that
i-. iî?ate _ 1878-89
Mortality i-. Water
Town Rate* Supply
water, even though it might be below
1859-68 Intro- m r
duced Rate* 1&МИ m r
standard, could act as a diluent and
assist in the reduction of intestinal
Holyoke 6.73 1873 8.93 133 infection when used for personal hy-
Lawrence 8.34 1875 8.33 100
Lowell 6.16 1872 7.63 124
giene purposes. Hollister and his col-
Fall River 7.78 1874 6.32 81 leagues compared the shigella-positive
Springfield 9.67 1875 5.29 55 rates between camps that had cabins
Taunton 6.12 1876 5.02 82 equipped with inside water faucets and
Northampton 10.98 1871 4.04 37 camps that had a portion or all of the
Lynn 9.06 1871 3.87 43 cabins with outside water faucets.
New Bedford 7.77 1869 3.80 49
Newton 6.57 1876 3.65 56 Their data are shown in Fig. 3.
Maiden 8.04 1870 3.54 44 Wagner and Lanoix comment on a
Fitchburg 10.59 1872 3.16 30 study carried on in Palmares, in the
Woburn 8.29 1873 2.95 36
Somerville 4.28 1867 2.95 69 state of Pernambuco, Brazil, by the
Chelsea 5.97 1867 2.89 48 Special Service for Public Health.
Waltham 8.12 1873 2.42 30 This Brazilian study showed a prob-
able relation between the availability
* Rates are per 10,000, rather than per 100,000
population. of water supplies and the deaths from
diarrhea of infants. The study also
Of these sixteen cities all but three gave some indication that the health
risk was about the same whether the
had less typhoid fever after introducing
public water supplies than before;treated
and water was carried from public
their average number of deaths from
fountains to private houses or was
this cause was less than one-half of the
taken from open, unprotected wells.
number of deaths when they used water
from wells.
Need for Constant Vigilance
It is assumed that the word "wells" The record of the effect of water
in the last sentence refers to indi-
supply on disease in the United States
vidual household wells.
gives no basis for assuming that con-
trol and eternal vigilance may be dis-
Importance of Ample Supply
pensed with once water systems are
provided. The United States has a
In the incidence of typhoid fever and
cholera, the principal involvement long
of history of the recurrence of water-
borne disease when such vigilance has
the water supply is in connection with
ingested water. In shigellosis andbeen relaxed. Unfortunately, the abate-
some of the infant diarrheas, there ment
is of the enteric diseases does give
increasing reason to believe that the
the impression that waterborne epi-
demics are no longer to be feared as
availability of water in ample quanti-
ties may be equally or even more im-they were in the past. Those who
portant than the bactériologie quality
hold this viewpoint must take heed of
of the supply. In a well controlled the toll exacted by these diseases since
study, Hollister and others have re- 1920, although the overall picture has
ported on the effect of water availa-
been amazingly good.

This content downloaded from

86.59.13.237 on Thu, 07 Jul 2022 18:33:00 UTC
All use subject to https://about.jstor.org/terms
954 A. WOLMAN & H. M. BOSCH Jour. AW WA

It was in the period since 1920

results thatreduction of dental
in a major
the largest waterborne caries
amebicin children
dysen-and adolescents.
tery epidemic occurred The
in Chicago
helpful effects
in on older persons
are dysenteries
1933 and 1934; bacillary less but measurable. Disabilities
and typhoid in California and
resulting New
from controlled application
York in 1936 ; and jaundice in have
to water schools
been shown to be negligi-
in Kansas and other states in 1935 and ble. The courts have generally sus-
subsequently. tained the validity of fluoridation.
As if by way of reminder of the In 1945, the population supplied
ever present waterborne menace, thewith fluoridated water was 231,920 in
typhoid epidemic in 1959 at Keene,three communities. In 1959, the num-
N.H., offers a truly classic exampleber so served had risen to 36,199,047
in 1,109 communities, and in addition,
of the results of inadequate supervision
and the absence of chlorination. A 7,000,000 people were using waters
rare set of circumstances, as always,naturally containing at least 0.7 ppm
produced illness of epidemic propor- fluorine. The total population pro-
tions. The circumstances were a car- tected, therefore, was 43,000,000.
rier on the watershed, torrential rains,
Global Implications
and a filter plant failure. It is well
Recently, Abraham Horwitz, the
to be reminded that operating person-
nel, although conscientious, areDirector
sub- of the Pan American Health
ject to error and that facilities canOrganization,
and speaking of his own ex-
do fail. perience in his native Chile and of the
Perhaps one stimulus to the rapid results of the organization's programs
development of disinfection was the in North America, Central America,
attitude of the courts in awarding dam- and South America, made the follow-
ages against private and public cor- ing statement :
porations found responsible for illness If a single program were chosen which
resulting from pollution of water sup- would have the maximum health bene-
plies. In several instances the dam- fits, which would rapidly stimulate so-
ages were high - the city of Olean, cial and economic development, and
N.Y., had to issue $350,000 in bonds which would materially improve the
standard of living of people, that pro-
to pay the costs incurred in a water-
gram would be water supply with pro-
borne typhoid fever epidemic in 1929. vision for water running into or adja-
Keene, N.H., already referred to, also cent to the house.
paid damages aggregating thousands
Despite the deficiencies in the statis-
of dollars. An incomplete list of such
decisions includes more than two tics reporting enteric diseases in many
dozen instances. developing countries, it is clear that
in all of them the mortality from ty-
Fluoridation phoid fever, gastritis, enteritis, and so
forth is excessively high. Such mor-
Another beneficial type of water talities are in the range prevailing in
treatment is now apparent in the addi-
North America in the last period of
tion, artificially or naturally, of flu-
the nineteenth century. As a matter
orides to public water supplies. Itof fact, for all age groups, and particu-
has now been demonstrated that thelarly for infants and children 1-4 years
of age, the diarrheal diseases rank
presence of 1 ppm of fluorine in water

This content downloaded from

86.59.13.237 on Thu, 07 Jul 2022 18:33:00 UTC
All use subject to https://about.jstor.org/terms
Aug. 1963 LESSONS IN SUPPLY DEVELOPMENT 955

either first or in the first five of the The leaders of these countries are,
principal causes of disability and death. of course, well aware of these deficien-
As Horwitz points out, and as is cies and of the snail's pace in their
generally accepted by most health of- correction. This understanding is well
ficials, a major reduction in these dis- reflected in the Charter of Punta del
eases is possible, quite independent of Este, which calls for the provision of
etiologic and sociologie differences in adequate water supply, sewerage, and
countries or regions, by the provision excreta disposal in the next 10 years
of potable water in sufficient quantities for at least 70 per cent of the urban
for it to remain free from gross bac- and 50 per cent of the rural popula-
tériologie contamination and in a man-tion. To accomplish this, strong sup-
ner conveniently accessible to people. port will be required for the prompt
Thus, safe water for the thirsty is notand continuous adoption of the fiscal,
the sole objective; greater quantitiesengineering, and managerial principles
of water must be provided for all the that have resulted in such great prog-
amenities of urban living. ress in the United States.

Central and South America India

In another part of the globe, India,

The situations in two regions of the
similar disease problems and water
world may illustrate both the public
health need and the deficiencies in deficiencies confront the policy maker.
community water service. In some The issues are the same as those dis-
countries of Central and South Amer- cussed above. They are well recog-
ica, the death rate from the entericnized. Impatience with the slow pace
diseases is still higher than 200 per
of community water development over
the last 20 years drives this country
100,000 and rates in excess of 100 per
100,000 are common. Of the sixteen toward the realization that a new look
countries of Latin America, diarrheal
at an old problem is demanded.
diseases were the leading cause of This new look was completed in
death in the 1-4-year-old age group
1961 by a committee created by the
in eleven countries and among the first
Indian Ministry of Health in an order
dated Apr. 28, 1960. The inquiry re-
five principal causes in the remaining
sulted in conclusions and recommenda-
five countries. These facts are graphi-
cally illustrated in Fig. 4. tions issued in 1962 by the Committee
on National Water Supply and Sani-
Community water service, as defined
above, is sadly deficient in Central and
tation. Its findings warrant a brief
South America. Of 75,000,000 people summary :
in cities of more than 2,000 population, 1. Of the urban population of
29,000,000 are without such service.
78,000,000, 34 per cent were judged
Almost 50 per cent of the people in
to be adequately served with water, 26
cities of 10,000-50,000 are in the same
per cent inadequately, and 40 per cent
category. More than 70 per cent are
not served.
without service in cities of 2,000-
10,000. In rural areas, matters are 2. For the same urban population,
even worse. Of the 107,000,000 peo-adequate sewerage service was avail-
ples in these areas far more than 70 able for 21 per cent and no service
per cent are without water service. for 68 per cent.

This content downloaded from

86.59.13.237 on Thu, 07 Jul 2022 18:33:00 UTC
All use subject to https://about.jstor.org/terms
956 A. WOLMAN & H. M. BOSCH Jour. AW WA

3. In the rural areas, 4. Pollution Abatement. Committee Print

defined by the
No. 9, US Senate Select Committee
committee as encompassing 300,000,000
on National Water Resources. US
people, progress toward the
Govt. goal
Printing Office, of
Washington,
500,000 individual well installations
D.C. (1961).
5. Hollis, M.
was significant, but unduly D. The Water Pollution
slow.
The solution of these sanitation Problem. Proc. Nati. Conf. Wtr. Pol-
lution, USPHS. Washington, D.C.
problems in India, it is recognized of- (1961).
ficially, will require that : 6. Wolman, A. & Gorman, A. E. The
... a new path ... be cut if the pro- Significance of Waterborne Typhoid
Fever Outbreaks 1920-30. The Wil-
gram is to succeed and move on its own
liams & Wilkins Co., Baltimore, Md.
momentum. Local bodies should be en-
(1931).
couraged to promote urban water supply
7. Gorman, A. E. & Wolman, A. Water-
and sewerage schemes as a self-paying
borne Outbreaks in the United States
industry, just as electricity undertakings
and Canada and Their Significance.
are promoted and operated. The methodJour. AWWA, 31:225 (Feb. 1939).
8. Annual
of financing of such schemes should be Reports 1-29, Massachusetts
State Board of Health, Boston (1869-
patterned after the procedure and prac-
tice which have succeeded and established 99).
themselves in the more advanced coun- 9. Hollister, A. C, Jr., et al. Influence
of Water Availability on Shigella
tries, with such modifications as are dic- Prevalence in Children of Farm Labor
tated by conditions in this country. Families. Am. J. Public Health, 45 :
354 (1955).
Conclusions
10. Watt, J., et al. Diarrheal Diseases in
The conclusions to be garnered from Fresno County, California. Am. J.
Public Health, 43:728 (1953).
the experience of the United States
11. Wagner, E. G. & Lanoix, J. N. Water
and to be rapidly applied in the emerg-
Supplies for Rural Areas and Small
ing countries of the world are well
Communities, Monograph No. 42,
World Health Organization, Geneva,
stated in the Indian report, in the fol-
Switzerland (1959).
lowing terms :
12. Healy, W. A., & Grossman, R. P.
The panel has therefore no misgivingsWaterborne Typhoid Epidemics at
on the outcome of such a venture if pur- Keene, N.H. /. NEWWA, 75:38
sued vigorously by all the states. A cer-(1961).
tain amount of initial education and lead- 13. Task Group Report. Status of Fluori-
dation in the United States and Can-
ership would be necessary in order to
wean the urban citizen and the local body ada, 1959. Jour. AWWA, 52:1513
from their established conventional no- (Dec. 1960).
14. Horwitz, A. Facts in Health Prob-
tions that drinking water should be pro- lems. Pan. Am. Health Organization,
vided as a partial gift by the government. Washington, D.C. (1961).
15. Wolman, A. Technical, Financial, and
Bibliography Administrative Aspects of Water Sup-
1. Water Works Practice. AWWA Man- ply in the Urban Environment in the
ual. Am. Wtr. Wks. Assn., New Americas. Boletin de la Officina Sani-
York (1926). taria Panamericana, 47:5 (Nov.
2. Baker, M. N. The Quest for Pure 1959).
Water. Am. Wtr. Wks. Assn., New 16. Report of the National Water Supply
York (1948). and Sanitation Committee. Ministry
3. Future Water Requirements for Munici- of Health, New Delhi, India (1960-61).
pal Use. Committee Print No. 7, 17. Seidel, H. F. & Baumann, E. R. A
Senate Select Committee on National Statistical Analysis of Water Works
Water Resources. US Govt. Printing Data for 1955. Jour. AWWA,
Office, Washington, D.C. (1960). 49:1531 (Dec. 1957).

This content downloaded from

86.59.13.237 on Thu, 07 Jul 2022 18:33:00 UTC
All use subject to https://about.jstor.org/terms