Forbes | December 18, 2014
By Bill Frist
President Obama has on his desk the Senator Paul Simon Water for the World bill. The bill passed both the House and the Senate with no objection, and it has the power to save millions of lives and serve as a beacon of health diplomacy globally.
It’s a bill with far-reaching and powerful implications for health worldwide, and it represents a decade of bipartisan advocacy.
In the fall of 2003, as the only physician in the U.S. Senate, I led a delegation of Senate colleagues to Mozambique to take a closer look at U.S. policy on HIV/AIDS. We found an HIV emergency, but we also identified a health need more fundamental than even treating the virus: access to clean water.
Just imagine mothers and daughters traveling three to four hours daily just to collect water for their families, leaving less time for other productive family, educational and economic activities. Imagine living in a rural village in Sub-Saharan Africa or East Asia where village members bathe, drink, and wash in the same water source as their livestock. Imagine being a grandmother in a small Ethiopian village and watching five of your grandchildren between the ages of 3 and 8 die from preventable water-related diseases. Try to imagine continuous diarrhea and excruciating stomach pain, leading to dehydration and death. This is what we saw firsthand.
The experience brought the statistics to life. Each year 5 million people—14,000 per day—were dying from preventable waterborne illnesses such as typhoid fever, cholera, dysentery, dengue fever, trachoma, intestinal helminth infections, and schistosomiasis. A child was dying from preventable water borne illnesses every 15 seconds, and these totals exceeded the numbers dying from HIV, malaria, and tuberculosis combined.
Moreover, two-thirds of the world’s population was living in an area of political unrest, and many of these conflicts were over natural resources as important and necessary as shared water basins. The potential impact of a U.S. commitment to helping build healthy communities and strong local governments would be doomed from the start without addressing this backdrop of inadequate access to water, and the resultant morbidity and mortality.
Within months of our return to Washington with these shocking stories, President George Bush and the U.S. Congress made an unprecedented commitment to address the HIV crisis called the President’s Emergency Plan for AIDS Relief (PEPFAR). Simultaneously, we moved Congress to actively address the less visible yet crucial crisis of unclean water.
As majority leader in the Senate, I asked staff to start drafting legislation to formalize U.S. policy addressing the issues of unsafe water and lack of sanitation in developing nations. We worked side by side with a broad array of stakeholders including a number of faith-based international organizations, such as the Millennium Water Alliance, and the Bush Administration. Throughout 2004 we helped raise the attention of Congress, the public, and the global community to the dire need for safe drinking water, sanitation and hygiene (WASH).
In January 2005, I accompanied another bipartisan group of Senators to East Asia to assist in the aftermath of the December 26, 2004, Indian Ocean tsunami. Traveling along the Sri Lanka coast, the breadth of devastation the storm had caused was staggering. Local water sources were destroyed, water buckets washed away, and local water sources were contaminated with saltwater. That lack of access to clean water could have led to dysentery, cholera, and malaria, but it didn’t. Sri Lanka experienced a rapid influx of relief aid to restore access to WASH, and a medical crisis was averted.
Water policy is a bipartisan issue. On March 2, 2005, I, a Republican, was joined by the Democratic Leader Harry Reid when I introduced the “Safe Water: Currency for Peace Act”. That the bill was bipartisan and introduced by the two leaders in the Senate underscored the significance of the bill and the level to which the issue of clean water had risen in our government.
In the meantime, amid the U.S. House of Representatives hearings on the global water crisis, the United Nations General Assembly adopted Resolution 58 designating March 22 World Water Day and launched the International Decade For Action on global water issues. This was prompted in part by the strong bipartisan support and attention we from the platform of the Senate Majority Leader office had brought to the issue. The UN resolution established a Millennium Development Goal (MDG) for 2015: to reduce by half the number of people without access WASH.
Back in Washington, DC, we had designed our bipartisan water bill to do three things. One, it made a clear and unequivocal pronouncement that WASH for people around the world would be a major U.S. policy goal. Two, it authorized a five-year pilot program launched to assist countries with the highest rates of waterborne diseases to develop sustainable water infrastructure systems. And three, it directed the Secretary of State, along with the Administrator of the USAID, to develop a comprehensive national strategy that would both assess the threats and challenges and recommend specific actions for addressing them. In making this commitment, we would codify in US law for the first time a Millennium Development Goal (MDG).
Henry Hyde, the Republican Chairman of the House International Relations Committee, held hearings during the summer of 2005 on the global water crisis. In October the House reported legislation modeled on our Senate bill. To ensure smooth passage of the legislation, the Speaker of the House and I agreed that once the House passed their version of the bill, I would see that it passed the Senate without changes and was sent directly to the President.
To honor a former colleague in the US Senate, we changed the name of the bill to the “Senator Paul Simon Water for the Poor” Act. Senator Simon was the much beloved and respected Democrat from Mr. Hyde’s home state of Illinois who had recently passed away. His book, “Tapped Out” addressed the potential impending disaster of water shortages making the bill an apt homage to his efforts.
The bill passed overwhelmingly in the House (319–34) and was adopted by unanimous consent in the Senate on November 16. The enrolled bill was signed into law by President Bush on December 1, 2005.
March 2015 will mark the end of the U.N.’s “Water for Life” Decade For Action. Thanks to bipartisan support and the tireless work of those who have seen firsthand the power of clean water, the Millennium Development Goal of reducing the number people without access to clean water has already been met.
But we are far from done. Indeed today 748 million people still do not have clean water and 2.5 billion live without adequate sanitation. Children are still dying from preventable waterborne disease and too many women’s lives are limited by the toil of collecting clean water each day.
Last May, USAID announced the creation of an Office of Water and a specific focus on a more cohesive Water and Development Strategy. The Senator Paul Simon Water for the World Act was introduced in the House in August of 2013 by Congressman Earl Blumenauer (D-Oregon) and Congressman Ted Poe (R-Texas) in a continuing bipartisan manner to recognize and build on the work of USAID. The Senate bill was introduced in November 2014 by Senators Dick Durbin (D-Illinois), Bob Corker (R-Tennessee), Chris Coons (D-Delaware) and Jeff Flake (R-Arizona). This bill engendered the same bipartisan support as the initial Water for the Poor Act, and it will continue to support the work we started in 2005.
As of this writing, the bill has passed both the House and Senate without objection, and is on its way to President Obama for his signature. The most recent iteration of the Act introduces accountability strategies to address implementation challenges and focus resources where they are most needed.
Additionally, the annual amount appropriated by the U.S. Congress to implement the Water for the Poor Act of 2005 has now grown to $382.5 million in Fiscal Year 2015 and the most recent spending bill also requires that not less than $145 million of that be spent on programs in sub-Saharan Africa.
Water policy extends far beyond health issues, important as they are. It undergirds our U.S. foreign diplomacy as well. A 2012 National Intelligence Estimate on Global Water Security found that over the next decade, countries of strategic importance to the United States will experience water shortages, poor water quality, or floods that will risk instability increase regional tensions.
In my own experiences as a physician regularly leading medical mission trips, I am constantly struck that providing medical assistance and public health services to others is interpreted as a currency of peace and ultimately as an aspect of public diplomacy. Our assistance to other nations in these areas seems to accelerate in impact when it provides tangible benefits to everyday people. The Water for the Poor Act has been proven.
The economic impact of smart water policy has been demonstrated. Every $1 spent on clean drinking water and sanitation is returned as $4 of savings in health costs and economic benefit.
We’ve made great strides since I first saw the reality of the water crisis in Mozambique in 2003, but there are still lives to be saved. In our ever more tenuous global community, it seems to me that what we knew in 2005 continues to hold true today: smart water national policy is a moral, economic, and diplomatic imperative.