Towards an assessment of the socioeconomic impact of arsenic poisoning in Bangladesh
Prepared in cooperation with the Department of Health in Sustainable Development
WHO/SDE/WSH/00.4
© World Health Organization 2000.
Towards an assessment of the socioeconomic impact of arsenic poisoning in Bangladesh
Introduction
Access to a safe water supply is one of the most important determinants of health and socioeconomic development (Cvjetanovic 1986). This recognition of the importance of safe water supplies has led to an emphasis on the provision of appropriate facilities in developing countries. In the 1970s, it was realised that Bangladesh’s population density and lack of access to adequate sanitation had led to severe microbiological contamination of surface water, resulting in high levels of morbidity and mortality. Bangladesh’s government and population, supported by international agencies, have since then installed about 4 million tubewells to tap better quality groundwater sources. This tube well initiative is said to have contributed significantly to the halving of infant mortality over a 36-year, from 151/000 in 1960 to 83/000 in 1996. The under-five mortality rate also dropped from 247/000 to 112/000 in that period (UNICEF 1998).
However, in 1993, drinking water samples from tubewells were found to contain high levels of arsenic. The area containing the worst arsenic concentrations stretches across the central section of Bangladesh from Chapai Nawabganj in the west to Brahmanbaria in the east, although there are isolated areas affected in other regions, particularly the Greater Sylhet area in the north-east. The exact number of persons at risk from arsenic poisoning is not known with accuracy. The British Geological survey (1998) estimates the total population affected as 18.5-22.7 million based on the assumption that the population affected is proportional to the number of wells contaminated.
The arsenic hazard will have an important impact on the health, social and economic status of the population. The primary purpose of this paper is to propose a methodology to analyse the health effects, how people cope with the socioeconomic consequences of the disease and to predict the beneficial effects of various alternative mitigation methods. In the next section the importance of a safe water supply will be discussed from the household perspective. Section 3 outlines the health impact of arsenic ingestion from drinking water, the suggested treatment protocol and the options for mitigation programmes. Section 4 investigates current technologies that mitigate arsenic levels to reduce in drinking water. We focus on the link between arsenicosis and economic status in section 5. In section 6, we address the issue of households’ coping strategies, and discuss steps towards modeling this coping behavior. Section 7 then sets out a framework for analysis of the socioeconomic impact of arsenicosis and presents results of an epidemiological model that attempts to predict the health impact of arsenic poisoning over a 30-year time frame. Further challenges for modeling of arsenicosis and its impact on households are discussed in section 8. We conclude in section 9.
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