An assessment of the costs and benefits of interventions aimed at improving rural community water supplies in developed countries.

We report a cost benefit analyses (CBA) for water interventions in rural populations of developed country sub-regions. A Bayesian belief network was used to estimate the cost benefit ratio using Monte Carlo simulation. Where possible we used input data from recently published primary research or systematic reviews. Otherwise variables were derived from previous work in the peer-reviewed or grey literature. For these analyses we considered the situation of people with small and very small community supplies that may not be adequately managed. For the three developed country sub-regions Amr-A (America region A), Eur-A (European region A) and Wpr-A (Western Pacific region A), we estimate the costs of acute diarrhoeal illness associated with small community supplies to be U$4671 million (95% CI 1721-9592), the capital costs of intervention to be USD 13703 million (95% CI 6670-20735), additional annual maintenance to be USD 804 million (95%CI 359-1247) and the CB ratio to be 2.78 (95%CI 0.86-6.5). However, we also estimated the cost of post infectious irritable bowel syndrome (IBS) following drinking water-associated acute gastroenteritis to be USD 11896 million (95%CI 3118-22657). When the benefits of reduced IBS are added to the analysis the CB ratio increases to 9.87 (95%CI 3.34-20.49). The most important driver of uncertainty was the estimate of the cost of illness. However, there are very few good estimates of costs in improving management of small rural supplies in the literature. Investments in drinking-water provision in rural settings are highly cost beneficial in the developed world. In the developed world, the CB ratio is substantially positive especially once the impact of IBS is included.

Workgroup report: developing environmental health indicators for European children: World Health Organization Working Group.

A working group coordinated by the World Health Organization developed a set of indicators to protect children's health from environmental risks and to support current and future European policy needs. On the basis of identified policy needs, the group developed a core set of 29 indicators for implementation plus an extended set of eight additional indicators for future development, focusing on exposure, health effects, and action. As far as possible, the indicators were designed to use existing information and are flexible enough to be developed further to meet the needs of policy makers and changing health priorities. These indicators cover most of the priority topic areas specified in the Children's Environment and Health Action Plan for Europe (CEHAPE) as adopted in the Fourth Ministerial Conference on Health and Environment in 2004, and will be used to monitor the implementation of CEHAPE. This effort can be viewed as an integral part of the Global Initiative on Children's Environmental Health Indicators, launched at the World Summit on Sustainable Development in 2002.

Water and health in Europe: a joint report from the European Environment Agency and the WHO Regional Office for Europe

Although some aspects of water quality and supply have improved in some countries over the last decade, progress has been variable. Renewed emphasis is being placed on microbial quality and the acknowledgement of previously unrecognized and re-emerging microbial and other hazards. Many of the suggested solutions are as applicable today as they were a decade ago. However, major changes in administrative arrangements affected many countries in Europe in the 1990s, including the supply of water and sanitation services, land-use activities, pollution control and activities related to public health surveillance. Partnerships and action were key themes of the Third Ministerial Conference on Environment and Health, held in London in June 1999. To this end the WHO Regional Office for Europe, in partnership with the United Nations Economic Commission for Europe, prepared a new Protocol on Water and Health to the 1992 Convention on the Protection and Use of Transboundary Watercourses and International Lakes. This publication provides information on many of the issues covered by the Protocol, such as adequate supplies of drinking-water and sanitation, water for irrigation and recreational use, monitoring of hazards, and public participation in decision-making. The evidence presented was collected through an extensive coordinated data-gathering process, in which many organizations and individuals throughout the European Region have cooperated. The 21st century will present a number of challenges to the aquatic environment. A coordinated approach to data collection, processing and management in Europe to support decision-making and to improve the reliability of environmental information will be essential to meet these challenges. This publication is aimed at a broad readership and is intended to present the key issues in a format that can be appreciated by policy-makers, professionals and the general public alike.