1

Dr Wilfried Kreisel Director, WHO Centre for Health Development

Niigata City, 29 March 2005

Water and Health

The 75th Annual Meeting of the Japanese Society for Hygiene

2

Selected Topics at previous meetings of the Japanese Society for Hygiene

• 1929: Hygiene related to sunlight and ventilation • 1934: The role of temperature, humidity and ventilation • in architecture• 1942: Studies on changing impact of industrial pollutants. • 1950: The status of school hygiene under the new • educational system • 1970: Hygienic aspects of air pollution • 1980: Environmental carcinogens and expectations of

public health

3

Broad Outline of Presentation

1. Water and health in Japan: a brief historical analysis

2. The global situation: WHO perspective on emerging challenges and water borne health risks

3. How to meet future challenges in water and health?

4

Water and health in Japan: a brief historical analysis

Dondo dam, Hyogo Prefecture

A. 1868-1900

B. 1901-1945

C. 1946-2004

5

Water and health in Japan1868-1900

Characteristics of water supply system at that time:A. Pre-modern: continuation of the method from

the Edo period B. Utilization of wooden pipesC. Usage of water from riversD. Hygiene and health as great

concerns

Kande Shrine, Hyogo Prefecture

6[Source: “A comparison of the development of public water supplies in England and Wales and in Japan”, Yamamura, Takafusa, 1983]

13710

7967

162637

105786

51678

33776

138247152

155574

110086

46019

1079211142

3382

55144

14990

13362

4136

103716264

4967

3114

0

20000

40000

60000

80000

100000

120000

140000

160000

180000

Num

ber

of

patients

/de

ceas

ed

1877 1879 1882 1885 1886 1890 1891 1895 1902 1916 1920

Year

Number o f pat ien ts and mortal i ty in major cho le raoutbreaks in Japan

Number of recorded patients Number of recorded cases of mortality

Number of patients and mortality in major cholera outbreaks in Japan

7

[Source: “A comparison of the development of public water supplies in England and Wales and in Japan”, Yamamura, Takafusa, 1983]

Nu m be r o f r e c o r de d pa t i e n t s i n m a jo r dys e n t e r yo u t br e ak s i n J apan

167000155000

108000

0

20000

40000

60000

80000

100000

120000

140000

160000

180000

1893 1894 1899

Year

Num

ber

of

patients

Number of recorded patients

Number of recorded patients in major dysentery outbreaks in Japan

8

Water and Health in Japan1868-1900

1. Drinking Water Caution Act was implemented in 1878.2. First sewerage system was established in Tokyo in 1884.3. In 1887, Mr Henry S. Palmer designed the first modern

water distribution system (with iron pipes, sand filtering, pumps, and the process of disinfecting) for Yokohama City. Other cities followed, e.g. Nagasaki (1891), Osaka (1895), Hiroshima (1898), Tokyo (1898) and Kobe (1900).

4. Waterworks Clauses Act was established in 1890.5. First major water pollution occurred at Ashio Copper Mine

in Tochigi Prefecture, in 1891.6. The Sewerage Law was introduced in 1900.

9[Source: Statistical Survey Department, Statistics Bureau, Ministry of Public Management, Home Affairs, Posts, and Telecommunication, Japan]

Popu lat ion c h an ge in Japan (1 901-1945 )

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

1901

1904

1907

1910

1913

1916

1919

1922

1925

1928

1931

1934

1937

1940

1943

Year

Popu

lation (

in t

housa

nd)

Population growth in Japan (1901-1945)

10

Water and health in Japan 1900 – 1945

1. Infectious diseases were still a major concern: e.g., cholera outbreaks in 1902, 1912, 1916, and 1920.

2. More cities established modern water supply system: Okayama City in 1905, Shimonoseki City in 1906, and Akita City in 1911.

3. Introduction of wastewater treatment tanks, i.e., septic tanks4. First patient of Itai-itai disease was identified in 1912. 5. Damage from the war was great: in 1945, for instance, about

80 percent of water pipes in the City of Kobe were leaking water.6. Water consumption for industrial purposes increased.

11[Source: Ministry of Health, Labour, and Welfare, Japan]

Percentage of people with access to water supply(1950-2000)

0

20

40

60

80

100

120

1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000

Year

Peopl

e w

ith a

ccess

to w

ater

supp

ly (

Percentage of people with access to water supply (1950-2000)%

)Pe

ople

with

acc

ess

to w

ater

sup

ply

(%)

12

Population of Japan (1946-2000)

0

20000

40000

60000

80000

100000

120000

140000

1945

1950

1955

1960

1965

1970

1975

1980

1985

1990

1995

2000

Year

Popu

lation (in thousa

nd

[Source: Statistical Survey Department, Statistics Bureau, Ministry of Public Management, Home Affairs, Posts, and Telecommunication, Japan]

Population increase in Japan (1946-2000)Po

pula

tion

(in th

ousa

nd)

13

Water and Health in Japan 1946 – 2004

1. Change in chlorination method: from periodic chlorination to regular chlorination

2. Waterworks Law was implemented in 1957.

3. Rapid decrease in the mortality from water-borneinfections,particularly in the period between 1950 and 1970.

Futami, Hyogo Prefecture

14

Incidence and mortality from cholera in Japan(1946-1998)

0

200

400

600

800

1000

1200

1400

1946

1950

1954

1958

1962

1966

1970

1974

1978

1982

1986

1990

1994

1998

Year

Num

ber of cas

es

Incidence of cholera Mortality from cholera

Cholera

[Source: Ministry of Health, Labour, and Welfare, Japan]

Incidence and mortality from cholera in Japan (1946-1998)

Num

ber o

f cas

es

Incidence of cholera Mortality from cholera

15

Inc idence a nd mor ta l i t y from ty pho id fev e r in J a pa n(1946-1998 )

0

5000

10000

15000

20000

25000

30000

35000

40000

45000

50000

1946

1949

1952

1955

1958

1961

1964

1967

1970

1973

1976

1979

1982

1985

1988

1991

1994

1997

Year

Num

ber

of

patients

/m

ort

ality

Incidence of typhoid fever Mortality from typhoid fever

Typhoid fever

[Source: Ministry of Health, Labour, and Welfare, Japan]

Incidence and mortality from typhoid feverin Japan (1946-1998)

Num

ber o

f pa t

ient

s/m

orta

lity

16

Access to water supply by Prefecture

96.8 %All PrefecturesAverage of all prefectures

100 %TokyoHighest

83.9 %KumamotoLowest

Access to water supply by Prefecture

PrefectureAccess to water supply based on prefectures (2004)

[Source: Ministry of Health, Labour, and Welfare, Japan]

17

1910 1930 1950 1970 1990 2010

0

20000

40000

60000

80000

100000

120000

Popu

latio

n ( 1

000)

Year

Total population

sanitary treatment　

Unsanitary treatment

public water supply

public sewerage system

75%

Development of water supply and sanitation- summary -

Source: Prof. Y. Magara, Hokkaido University

18

0

20000

40000

60000

80000

100000

1960 1965 1970 19750

1000

2000

3000

4000

5000

6000

Poliomyelitis

Shigellosis

Typhoid

Paratyphoid Cas

e of

Shi

gello

sis/

year

Cas

e of

pol

io e

tc./y

ear

Year

Control of feces-oral route related diseases in 1960-1975

Source: Prof. Y. Magara, Hokkaido University

19

Specific Chemical Pollution Related Diseases

1. Minamata disease (due to methylmercury contamination): the first patient identified in 1953; Based on the so-called Compensation Law of 1974, by March 2001, 2955 persons have been certified as Minamata Disease patients.

2. Itai-itai disease (as a result of cadmium contamination):the first patient was found in 1912; 184 patients were identified during the period 1967 - 2000.

20Note: Rates of non-conformity for health-related pollutants (based on old environmental quality standards) (Non-conformity rate for alkyl-mercury has been 0% since 1971)

Rates of non-conformity to water environmental quality standards for protecting human health

Source: Ministry of the Environment

Pb

CN

Cd

As

PCB

Organic

phosphorus

Total mercury

Cr

21

Rates of conformity to water environmental quality standards (BOD or COD, according to water area)

Source: Ministry of the Environment

All water areas Rivers Lakes and Reservoirs Sea areas

Conformity rate (%)

fiscal year

22

Source: Ministry of the Environment

Integrated Water Resources Management

Sea areas

Farmland

Urban areas

Lakes and Reservoirs