Poverty and lack of essential water and sanitation systems are paramount in the outbreak of the Zika virus
Interview with Dr Esteban Castro, coordinator of DESAFIO
Dr Esteban Castro
The Brazilian Zika outbreak, first identified in May 2015, is the largest ever. Zika can be classified as one of those diseases of poverty which spread endemically in poor regions where a lack of public health infrastructure allows populations of these deadly mosquitos to abound in areas largely affected by poor water and sanitation systems.
As DESAFIO shows, factors such as an abundance of stagnant water, poor sanitation systems, the lack of democratic involvement of citizen-users in the management and politics of water, and deprived socio-economic conditions of certain sectors of population are key to understand this phenomenon. Interdisciplinary research proves essential to deal with such complex societal challenges, and Social Sciences and Humanities reveal as the most appropriate disciplinary framework in the endeavour to ascertain the origins of the problem and provide feasible evidence-based solutions to it.
Could you explain the main assumptions or presuppositions that guided the research?
We consider that the protracted inequalities in the access to WSS are an expression of long-term, structural social inequalities and injustices, which are produced and reproduced along the lines of class, ethnic, gender, age, and other social differentiations. It is well documented that the social sectors affected by the lack of essential WSS are the poorest and marginalized, the most vulnerable, and that the negative impact of the lack of access to these services is even higher for poor women and children, the elderly, and the weak. Therefore, we assumed that the prevailing inequalities in the access to essential WSS cannot be explained as being the result of the lack of adequate technologies or because of environmental constraints. Instead, we argue that the key factors to explain these inequalities are socio-economic and political. For example, the technologies for ensuring that water is safe for human consumption have existed since the Nineteenth Century, and therefore the fact that 11 countries of Latin America and the Caribbean (LA&C) failed to meet the target for water set in the Millennium Development Goals (MDGs) for 2015 cannot be explained as the result of the lack of adequate technologies. A similar argument can be made in relation to sanitation. We cannot argue that the fact that 19 countries of LA&C failed to meet the MDG sanitation target is owing to the lack of suitable technologies. Recent UN reports showed that even in those countries that achieved the MDG targets for water and sanitation, the poor and very poor continued to be bypassed. That is, many countries may have reduced the lack of access to WSS on average, but in the process they often worsen intra-national inequalities because the expansion of the services tends to benefit first the wealthier and continues to marginalize the most vulnerable.
Our assumptions about the need to give primacy to structural social inequalities in the explanation of the problem did not lead us to reductionist arguments that may neglect the significance of developing sound technologies or implementing adequate environmental policies. We approached the subject assuming that what is required is to develop higher levels of interdisciplinary coordination between natural, social and technical scientists, as the complexity of the challenge demands an integrated, holistic perspective. Therefore, we brought together social scientists, sanitary engineers, health and environmental scientists, among others. In addition, we adopted a transdisciplinary approach, working closely with non-academic actors, whether as research partners or as external advisors. These included from public-sector officials in different areas and levels of government, national, regional, and local, to labour unions, non-governmental organizations (NGOs) and community groups. In most studies we involved the local communities directly in the research process.
How does DESAFIO, a Social Science and Humanities research project, relate to the Zika virus outbreak?
Our research focused on vulnerable communities in several areas of Brazil, one of which became the epicentre of the Zika virus outbreak, the city of Recife, capital of the State of Pernambuco, the fifth most important provincial capital of the country. Government estimations suggest that up to 100 thousand people (about 2.6% of the city’s population) were affected by the virus in a very short period until early February 2016. We also covered other areas in Brazil, including Rio de Janeiro, and in Colombia, where the Zika virus is also having an enormous impact. In Colombia, the national government has reported that over 5000 pregnant women had been infected with the virus by mid-February 2016. DESAFIO’s findings cast light on some of the factors that may help explaining the disproportionate impact of the outbreak on the most vulnerable sectors of the population. The lessons extracted from the project, which in the case of Brazil were thoroughly discussed with representatives of national, regional, and local government departments, NGOs, and community organizations, provide useful insights for public policies.
In the case of Recife, we covered a timespan of two decades to examine two different socio-technical innovations implemented in the city to tackle the lack of essential WSS in poor areas: the Condominial Sanitation system implemented in the mid-1990s, and the Integrated Sanitation system introduced in 2001. The situation affecting the city’s poor neighbourhoods worsened significantly during the period of neoliberal reforms implemented during the 1990s, which led to a steep increase in the number of people living in vulnerable conditions. Between 1980 and 2000, the number of people of Recife living in marginalized areas deprived of essential services grew from 43.1% to 51.1%, while the number of households in the same situation increased from 42% to 50.9%. As it emerges from our case-study reports, the city has been historically affected by water-related infections that affect mostly the poor, marginalized neighbourhoods. These infections include gastro-intestinal diseases, hepatitis, amoebiasis, schistosomiasis, typhoid, hanseniasis, dengue, filariasis, leptospirosis, and more recently chikungunya and Zika. The high impact of these infections on vulnerable sectors of the population is due to a combination of factors among which extreme poverty and lack of essential WSS are paramount. In addition to the lack of in-house WSS, much of the city’s sewage is dumped into the many open canals and water courses that characterize Recife. Some of the diseases, like filariasis, dengue, chikungunya and Zika are transmitted by mosquitoes, whose reproduction is facilitated by these conditions. Poor people tend to live near polluted water bodies and also, owing to the lack of safe drinking water supply, they tend to keep water in containers where mosquitoes find convenient breeding sites.
Do you mean that a successful WSS policy requires a particular political approach to the socio-economic conditions of the population, especially for the most vulnerable sectors?
In our research in Recife we interviewed the engineers and other specialists that designed and implemented the innovations studied, and our research team included public officers that were in charge of important aspects of the interventions. There is a strong consensus among the research participants that the results of both experiments have been mixed, and that it is has been extremely difficult to turn the successful outcomes sustainable over time. It is clear that the main causes of both the success and failure of these interventions are social, and particularly political issues. For example, Recife managed to curb substantially the rates of infection of several diseases through effective, holistic public sector interventions that included from hygiene and sanitary education to the provision of adequate WSS within a framework of radical urban reforms to eradicate extreme destitution. However, these and other successful interventions have been short-lived, and changes in government priorities bring the necessary investments to a halt and very often trigger a downward spiral where many of the gains achieved are lost very rapidly. More importantly, no government has properly tackled the root causes of the very high levels of extreme destitution affecting a large proportion of the population. The health scientist that participated in our research in Recife has just published a short article on the Zika outbreak remarking this fact: the government is not addressing the extreme inequality and destitution that are at the root of the vulnerability of the poor and very poor population to this virus.
Beyond our studies in Recife, our research confirmed that despite important improvements made since the start of the MDGs in the year 2000, the extension of safe WSS to vulnerable communities remains one of the major challenges for most countries in LA&C. The large masses of the urban poor and rural communities tend to be the most affected by the lack of public investment or, even when there is substantial public investment as it happened in Brazil since the year 2003, by the difficulties faced by national governments to effectively implement changes in the ground. The research findings supported our initial assumptions that the crucial obstacle to the elimination of structural inequalities that explain the lack of access to essential goods and services is the slow pace and often regression of the process of substantive democratization. There is no substitute to decisive and sustained State support to tackle the problem. However, to be successful in the long-run, State intervention must be subject to democratic scrutiny by and be accountable to citizen-users.
Have you also analysed the controversy around the public/private approaches to WSS?
Our project findings suggest that, unfortunately, the prevailing international patterns of public policy in the WSS are far from meeting these democratic criteria, and more so with respect to the situation of vulnerable communities. Much of the public investment in WSS since the year 2000 has benefitted the wealthier rather than the poorest, and there is little sign that this may change any time soon, at least in the scale that would be needed for an effective transformation of the situation of vulnerable communities. For example, the worldwide pattern promoting exclusionary policies that treat WSS as private commodities rather than as a public good or a social right also permeates policy making in the countries and regions affected by the recent outbreak. In the countries that in the past achieved the full universalization of WSS, such as those in Western Europe and the US, this was made possible by sustained and massive State investment and management oriented by the inclusionary principle that these services are public goods and social rights, not private commodities. However, the policy framework that has dominated the provision of essential public services since the mid-1980s has reversed this approach and promotes the privatization and mercantilization of these services as the only way forward, even for the poor. We found that public utilities operating in the Zika-affected areas have not prioritized the extension of WSS to the vulnerable communities located in irregular areas, which represent a substantial part of the population. The reason is that these public companies have been required to make a profit, to show good business results, and providing WSS in shanty towns is not going to help them to deliver the expected outcomes. Therefore, providing WSS in shanty towns is left to municipal governments, who have to cover the gaps in provision, which they seldom can do in a sustainable, long-term perspective, often owing to vagaries of electoral politics. In other cases, very successful innovations that have proved their potential efficacy to extend basic WSS to poor communities in rural areas, often even in isolated areas, are under threat too, whether because they are required to become financially self-sufficient (subject to the full-cost recovery principle) or because in the absence of a national policy framework these initiatives are left to their own means, in conditions of extreme fragility owing to the lack of technical, managerial, financial, or even legal support. Needless to say, the biggest gaps in WSS coverage are in rural areas. Recent reports estimate that around 12% of the rural population of LA&C still practice open defecation, a figure that would be 13% in Brazil and 14% in Colombia, but rises to 35% in Haiti and 46% in Bolivia, just to mention some key examples.
What are the main policy recommendations of DESAFIO?
Among the main recommendations emerging from our project that can contribute to the ongoing debate provoked by the outbreak, we could highlight the following:
First, achieving the universalization of access to essential WSS is an inclusive political project, which by definition cannot be achieved through exclusionary politics, such as the commodification and mercantilization of water and essential WSS. It will require long-term planning, not just to build the infrastructures and extend coverage, but also to make the systems sustainable over time and the services available to all independently of the capacity to pay of individuals and families. The public policies required to achieve the universalisation of essential WSS must be grounded on the principle of equality, and must subordinate economic efficiency and private profit to the higher goals of democratic wealth distribution and civilised wellbeing.
Secondly, governments and international institutions should stop promoting policies that privilege private profit over public benefits, such as the privatisation and mercantilisation of WSS in their different forms. Countries should put in place legal and policy mechanisms to prevent the commodification of water resources and WSS. If countries continue to allow the control of water resources and WSS by private companies and wealthy individuals, the goal of universalising the access to essential services will be no more than a romantic idea never put into practice.
Thirdly, public policies related to essential public services must be oriented at strengthening the capacities of public authorities to deliver and regulate the provision of safe quality services. Governments and international institutions must invest heavily in the provision and long-term maintenance of the required infrastructure and management operations. These investments must privilege broad and long-term social “returns” (in public health, quality of life, etc.) over short-term economic gains. The revitalisation of the Global Partnership for Sustainable Development envisaged in the new Sustainable Development Goals (SDG 17) must radically change the prevailing emphasis on public-private partnerships, which has often served to promote privatization and mercantilization, and strongly support the development of public-public, public-community, and community-community partnerships.
Finally, substantive democratisation in the government, management and access to essential public services such as WSS requires social participation and control over the decision-making process by common citizens and users. This includes the scrutiny and democratic control of decisions about how water and essential services such as WSS are governed, managed, and distributed, by whom, for whose benefit, etc. This is seldom available to local communities and common citizens, even in the core Western countries with consolidated electoral democracies. Water politics and management are seldom transparent to citizens, are largely unaccountable, and tend to be openly authoritarian and top-down. There are currently no effective mechanisms to enable common citizens to exercise democratic control over these activities. Achieving substantive democratization in the WSS sector will require putting in place effective legal and administrative mechanisms to allow the meaningful involvement of citizen-users and make the activities of government and management of WSS subject to citizen scrutiny and control.
References:Castro, J. E., and H. M. R. Ferreira (2015a). “The condominial sanitation system in Zones of Special Social Interest (ZSSI) in Recife, Brazil”, in J. E. Castro (Ed.), WATERLAT-GOBACIT Working Papers, DESAFIO Project Series SPIDES, Vol. 2, No 7. Available at: http://waterlat.org/WPapers/WPSPIDES27.pdf.
Castro, J. E., and H. M. R. Ferreira (2015b). “Socio-technical dimensions of the Integrated Sanitation system in low income areas, Recife, Brazil”, in J. E. Castro (Ed.), WATERLAT-GOBACIT Working Papers, DESAFIO Project Series SPIDES, Vol. 2, No 10. Available at: http://waterlat.org/WPapers/WPSPIDES210.pdf.
Ducci, J. (2015). “Situation of rural services in Latin America” (in Spanish), Presentation of the Water and Sanitation Division, Inter-American Development Bank at the VI Latin American Meeting of Community Water Management, Olmué, Chile, 2-4 September 2015. Available at: http://www.clocsas.org/assets/bid-clocsas.pdf.
Ferreira, H.M.R., A. S. P. Ramos, and D. A. de M. Bernardes (2015), “The policy of water rationing in the city of Recife, Brazil: impacts and inequalities in the shanty towns”, in J. E. Castro, L. Heller, and M. da P. Morais (Eds.), The Right to Water as Public Policy in Latin America: a Theoretical and Empirical Exploration [in Portuguese], Brasilia: Institute of Applied Economic Research (IPEA) – WATERLAT-GOBACIT Network, pp. 83-108. Available at: http://www.ipea.gov.br/portal/index.php?option=com_content&view=article&id=25137&Itemid=383.
Monteiro, A., and L. Giraldo (2015), “Centering the actions on the mosquito, and to maintain a war narrative [against the Aedes Agypti] with the use of chemical weapons, is to avoid tackling the problem” [in Portuguese]. Diario de Pernambuco, 24 December 2015, Available at: http://www.diariodepernambuco.com.br/app/noticia/politica/2015/12/24/interna_politica,618035/andre-monteiro-e-lia-giraldo-defendem-o-saneamento-contra-a-microcefal.shtml.
WHO-UNICEF – World Health Organization and United Nations Children's Fund (2014). “Progress on Sanitation and Drinking-Water - 2014 Update”. New York: WHO-UNICEF. Available at: http://www.who.int/water_sanitation_health/publications/2014/jmp-report/en/.