Water and Disease: It's Not What You Think

He asked the seminar a second time, “What is the most significant problem that Alaskan communities without piped water face? I’ll give you a hint – it does not have anything to do with diarrheal disease.”


I was stumped. To me, water quality issues always had the same outcome – more trips to the bathroom. Sure, I realized that collecting water in many communities resulted in long trips that affected education, childcare, etc., but I always thought the result of drinking poor quality water always related to some variant of diarrheal disease. After a few meager attempts from the crowd, with no one in the room guessing the answer, the room was silent. No eager hand to be found, I assumed everyone had the same confusion as me.


An uneasy pause followed. Exasperated, the lecturer exclaimed “respiratory illness!” Provided with the answer, my puzzlement didn’t abate. What in the world did water have to do with getting a cold? After an explanation from the lecture and further investigation, I found the issue to be quite complicated. As always, the story with water quality is often far more complex and nuanced than it originally appears.


According to the literature, regions in Alaska with a lower proportion of home water services have higher hospitalization rates for influenza and pneumonia (1).  The question is: Why? It turns out the answer is not in the water itself, but what people do with the water. In communities without piped water, people do not have as many opportunities for hand washing and other hygiene-related practices. Studies suggest that the lack of hand washing leads to an increase in respiratory illness (2-5). Therefore, in communities without piped water there was a reduced ability for sanitary practices to be used and consequently, a proliferation of respiratory illness.


As it turns out, simply having potable water near a population center is not a panacea – myriad factors influence the impact of water on the health of a community. Providing clean water to many Alaskan Natives’ has undoubtedly saved lives, but the task of providing clean, convenient water in many communities is not finished. Studying and implementing water quality initiatives requires appreciating the diverse ways that we use water. It is evident that water has an immense impact on our and others’ lives across the world and thus, we must continually, creatively, and competently work towards providing convenient access to pure water for all.




1.     Hennessy TW, Ritter T, Holman RC, et al. The Relationship Between In-Home Water Service and the Risk of Respiratory Tract, Skin, and Gastrointestinal Tract Infections Among Rural Alaska Natives. American Journal of Public Health. 2008;98(11):2072-2078. doi:10.2105/ajph.2007.115618.

2.     Cairncross S, Valdmanis V. Water supply, sanitation and hygiene promotion. In: Jamison DT, Breman JG, Measham AR, et al., editors. , eds. Disease Control Priorities in Developing Countries 2nd ed.New York, NY: Oxford University Press; 2006:771–79

3.     Luby SP, Agboatwalla M, Feikin DR, et al. Effect of handwashing on child health: a                        randomised controlled trial. Lancet 2005;366:225–233 [PubMed]

4.     Ryan MA, Christian RS, Wohlrabe J. Handwashing and respiratory illness among young adults in military training. Am J Prev Med 2001;21:79–83 [PubMed]

5.     Fung IC, Cairncross S. Effectiveness of handwashing in preventing SARS: a review. Trop   Med Int Health 2006;11:1749–1758 [PubMed]