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To minimize deaths, illness and injuries at the beach, in oceans, lakes and rivers, the World Health Organization (WHO) recently released Guidelines for Safe Recreational Water Environments. Beaches and bodies of water failing to meet safety standards are a worldwide public health problem, and can make people ill, cause disability and death.
The WHO guidelines cover drowning and injury, exposure to cold, heat and sunlight, water quality, contamination of beach sand and exposure to algae, chemical and physical agents and dangerous aquatic organisms.
The guidelines include existing knowledge on the impact of recreational use of coastal and freshwater environments on peoples health, and ways to control and monitor the hazards. Preventive measures to protect recreational water users health are also described.
Contamination of water with sewage and excrements is widespread and common, and it affects large numbers of people who use recreational waters. The majority of those affected exhibit mild gastroenteric symptoms.
One of the most common and dangerous pathogens in untreated sewage is E.coli O157. This bacterium, which affects the intestinal tract, can cause blood loss, acute diarrhea and fever. In a small percentage of cases, the infection is severe enough to cause kidney infection, hemorrhage and even death.
Until now, there has been no global consensus for determining an acceptable level of intestinal enterococci (bacteria that usually live in the gut) as an indicator organism in a beach environment. Based on the latest scientific input from around the world, the guidelines set values for intestinal enterococci in bathing water so that regulatory authorities can reduce the risk of bathers contracting gastrointestinal and acute febrile respiratory illness.
Even in developed countries, its estimated that one-third of the wastewater discharged into the environment is not adequately treated. In developing countries this amount is even higher.
Each year millions of tourists vacation in coastal areas. Tourism is the world's third largest industry and the prime economic sector in some states and regions, such as the Caribbean.
"The vivid blue waters which surround the small island Caribbean states are among the most sought-after attractions by visitors," said Vincent Sweeney, Executive Director, Caribbean Environmental Health Institute, St. Lucia. Yet, he explained, in the Caribbean and elsewhere around the world, millions of liters of untreated sewage continue to be discharged into the sea every year.
Consequently, added Sweeney, "In island states, where all land-based activities, including agriculture, industry and tourism, affect coastal waters, it is imperative to have the means to benchmark and maintain the cleanliness."
Recreational water quality problems are by no means limited to lower-income countries. For instance, even in the United Kingdom, only slightly more than half of the countrys beaches are "recommended" for their cleanliness, according to the UK Marine Conservation Societys 2003 Guide.
Fifty-three beaches fail the minimum European Union standard for bathing water quality. In a survey conducted in 2000, Surfers Against Sewage, a UK-based non-profit organization campaigning to end the discharge of raw and partially treated sewage and toxic waste into the sea and inland waters, reported nearly 900 incidents of illness caused by contamination of beaches and seawater in the UK.
Based on the best science available, the WHO Guidelines will assist regional, national and local authorities worldwide in adopting a comprehensive approach to the prevention of water-related ill health.
Countries in the Americas have been particularly active on using the guidelines to shape national policy. Mexico, for example, has already incorporated the principles of the guidelines into national regulations.
"People recognize that unsafe and unclean waters are a public health problem, but until now many of the countries in this region have not had a framework in which to construct an efficient regulatory policy. Especially for countries where resources are strained, these guidelines create excellent indicators of how to achieve maximum benefit and return for preventive actions," said Dr Henry Salas, WHO's Regional Adviser for Environmental Protection in the Americas.
While the guidelines are a substantial step forward in preventing water-related death and disability, more needs to be done. In coming years, WHO will work with national governments to build the institutional ability to implement the full range of prevention and monitoring activities recommended by the guidelines.