Basic sanitation includes the supply of safe drinking water, drainage and management of rainwater, sewage disposal and treatment, garbage disposal and street cleaning, solid waste management, and the control of pests and pathogens. The right to basic sanitation is ensured by the Federal Constitution of 1988, further specified in 2007 by Law no. 11.445/2007, known as the Basic Sanitation Law. The law expanded the definition of basic sanitation and established its fundamental principles, provided for the regulation of services, and included planning for the elaboration and enforcement of the National Plan for Basic Sanitation and the Municipal and Regional Plans for Basic Sanitation.

The law was enacted 10 years ago, as of 2017. This tenth anniversary nevertheless points to an alarming situation: half of the Brazilian population still lacks access to proper sewage disposal. According to data from the National Sanitation Database (SNIS) published early this year, more than 100 million Brazilians still rely on alternative measures to dispose of sewage.

Although the water supply is distributed better, it is still a persistent problem. More than 35 million Brazilians still lack access to safe drinking water. For every 100 liters of water collected and treated, only 63 are consumed.

Seminar: “Health, Sanitation, and the Environment in Debate”

In April this year, the Department of Sanitation and Environmental Health of the Sérgio Arouca National School of Public Health (DSSA/ENSP) held the seminar “Health, Sanitation, and the Environment in Debate: scenarios and perspectives”. According to Clementina Feltmann, coordinator of the project in charge of the seminar, the debate was proposed precisely as a function of the SNIS data.

“Despite some tangible progress, especially with universalization of water supply, Brazil still has a long way to go with sanitation, especially with sewage disposal and treatment and solid waste management at the local level,” she explained.

The seminar convened specialists to develop a critical approach to the present and future of sanitation and environmental health in Brazil, focusing on four key themes: Policies and Programs in Sanitation and Environmental Health; Urban Planning and Health; Assessment of the Impacts of Technologies in Sanitation and Environmental Health; and Environmental Health and Sanitation Surveillance.

Sanitation and health

According to Clementina, “The gap in sanitation has led to a persistent systemic situation of iniquities, health problems, and unhealthy environmental conditions, as revealed by morbidity and mortality indicators for diseases caused by the absence, inadequacy, inefficiency, inefficacy, and low effectiveness of the proposed and existing sanitation solutions.”

According to data from the Brazilian Ministry of Health (DataSUS) for 2013, more than 340 thousand hospitalizations due to gastrointestinal problems were recorded in the country. If 100% of the population had access to proper sewage disposal, there would be a reduction of 75% in these hospitalizations. 

One of the key points addressed in the seminar was health. After all, sanitation means health. Professor Tiago de Brito Magalhães of the Division of Environmental Health Surveillance (DSAST/SVS/Ministry of Health) stated that according to the World Health Organization (WHO), one dollar of investment in basic sanitation can save 4.3 dollars in public health costs. Economic, social, and environmental policies thus need to be integrated to eliminate risks to health and the environment, guaranteeing the population’s effective social inclusion.

Funding constraints as a barrier

One of the causes of the precarious sanitation system was definitely the uncontrolled expansion of the urban population, which prevented proper organization to increase the sanitation capacity. The size of cities in scale and population also increased the cost of sanitation in relation to the available budget resources. The states that invested the most in sanitation in the last three years, according to the “Treat Brazil” Institute (Trata Brasil), were São Paulo, Minas Gerais, Paraná, Rio de Janeiro, and Bahia, with 63.3% of the total. Meanwhile, Amazonas, Acre, Amapá, Alagoas, and Rondônia invested the least, totaling 1.7%.

The national plan launched in 2014 by the Federal government set short, medium, and long-term targets with indicators for water supply, sewage, solid waste management, rainwater drainage and management, and administration of sanitation services. According to the plan, to achieve universal coverage of these services would require R$508 billion (U$170 billion) by 2033. According to a study by the National Confederation of Industry (CNI) published in February 2017, Brazil is only expected to reach this universal coverage in 2043.

We are all responsible for the problem

The problems involved in basic sanitation and the environment are the responsibility of governments and institutions. But individuals also need to understand their role in the process. Ulisses Confalonieri, a researcher at FIOCRUZ-Minas Gerais who coordinates the project “Construction of indicators of the population’s vulnerability as a contribution to the elaboration of actions to adapt to climate change in Brazil”, believes that everyone shares the responsibility.

“We believe that there is a concern and discourse on this issue in companies and corporations. However, we see little effective action in the preservation of resources. There is an evident lack of awareness in the population and lack of community organization. An example is selective waste recycling, which requires a proper infrastructure, which rarely exists,” he stated.

People today may even have more knowledge about environmental degradation and its harms, but knowledge alone is not enough. It is necessary to raise awareness and do things differently. “We know rationally that environmental degradation harms our health and quality of life, but this knowledge apparently fails to sink in. We continue to waste water, to consume more and more. The change we need is a behavior change, acknowledging the planet as our common home, as a valuable good. It’s up to us humans to do our part,” concluded Clementina.