Water Journal : Water Journal July 2012
refereed paper public health water JULY 2012 77 and hygiene. Ultimately, the water-washed disease gap is unlikely to be closed until entrenched disadvantage is alleviated. The alternative faeco-oral transmission mechanism that deserves specific mention is the waterborne route. Of all the water-related disease transmission mechanisms in Indigenous communities, the waterborne route has received the most attention from water sector bodies and policy makers. Between 2006 and 2010, water quality testing has detected E. coli in around 1% of samples taken from 72 large Indigenous communities. Over this period, microbiological results were adjudged to be a public health risk sufficient to justify precautionary 'boil water alerts' on 15 occasions -- or 0.05 alerts per community per year. Concurrent to these incidents, over the last decade not a single outbreak of gastroenteritis among Indigenous Territorians has been attributed to a community water supply. Hence, when seen alongside the evidence of low levels of hand washing, the role that waterborne pathogen transmission plays in endemic diarrhoeal disease in Indigenous communities is likely to be considerably less than the water- washed mechanism. Water-washed and Beyond Beyond the three water-washed diseases that have formed the subject of this analysis, there is, of course, a broader family of water-related diseases that continue to disproportionately impact the health of Indigenous Australians. Helicobacter pylori infection, which can lead to peptic ulcer and stomach cancer, is also transmitted though the water- washed mechanism and is experienced at excessively high rates in Indigenous communities. There is mounting evidence that acute respiratory infection (ARI), which takes a heavy toll on the health of Indigenous children, can also be prevented through hand-washing. Likewise, the provision of chlorinated community swimming pools has been shown to reduce the prevalence of general skin infections and ear disease. Waterborne pathogens and contaminants also pose health risks -- melioidosis, for example, has proven fatal in remote communities and has been linked with water supplies. Finally, water supply advances could contribute to other Indigenous health issues that fall outside Bradley's traditional classification. Given the poor oral health in remote communities, fluoridation of water supplies is one such avenue. Public water bubblers are now being trialled in remote communities to reduce the high levels of soft drink consumption that underlie chronic diabetes and renal disease. Perhaps most significantly, reliable water supply and sanitation services allow Indigenous families to spend more time on their homelands, thereby enjoying the health and wellbeing benefits associated with living on country away from the social ills that plague larger communities. Conclusion This paper has demonstrated that, in spite of improvements in access to community water and sanitation infrastructure, water-washed diseases remain rife in remote Indigenous communities in the NT. Household health hardware, hygiene behaviours, and living conditions that exacerbate transmission, all need to be simultaneously tackled. Until then, the full health potential of improved water and sanitation infrastructure will remain latent and unrealised. Even where health systems prevent infant mortality, the consequences of recurrent water-washed infection will endure well into adulthood. This situation is clearly unacceptable in a wealthy country like Australia. The Federal Government has set aside billions of dollars for the National Water Initiative, with the aim of achieving water use "that optimises economic, social and environmental outcomes". Sadly, until water is used for better hygiene in remote Indigenous communities, this goal will remain unfulfilled. The Authors Tim Foster (email: tim.foster@ouce. ox.ac.uk) is a researcher at the School of Geography and the Environment, University of Oxford, UK. Dr Brieana Dance (email: brieanadance @gmail.com) is a medical practitioner at Prince of Wales Hospital, Randwick, NSW. References ABC News (2012): Outback water bubbler trials target soft drinks. ABC News. Available from: www.abc.net.au/news/2012-03-22/ remote-area-water-bubbler-trials-combat-soft- drinks/3906328 (accessed 30 March 2012). ABS (1996a): 4190.7 National Aboriginal and Torres Strait Islander Survey 1994: Northern Territory. Canberra: Australian Bureau of Statistics. 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