Bangladesh’s arsenic crisis: navigating the complexities of the science-policy interface of water quality and health

Thesis

This DPhil research explores the science-policy interface of water quality and health. Poor water quality has wide ranging impacts on public health, but policy responses are not always adequate to address the issues and safeguard human health. Moreover, there can be varying attention to different threats: microbial contaminants with acute and visible health outcomes often win out over chemical contaminants with chronic, and often unseen, health outcomes. The issue of water quality risks in Bangladesh, especially in the context of the widespread arsenic contamination of groundwater, serves as an ideal case study which highlights the health and social impacts of water quality on an affected population, in addition to demonstrating the trajectory of policy change (or lack thereof) that characterises many long-term water contamination crises.

The thesis applies an interdisciplinary approach to understanding these complex water quality issues. It comprises three separate but related studies which attempt to situate the Bangladesh arsenic crisis within the global context of water quality crises, take an in-depth look at lived experiences of multiple water quality issues in rural Bangladesh, and quantitatively assess water quality along with unseen and under-recognised aspects of health impacts, namely subclinical disease and psychosocial distress.

The comparative policy analysis shows that a range of complex conditions have to be met for effective policy change to take place, such as the temporal nature of the event, the social and political context, and the politics of visibility, among others. Furthermore, contaminants with chronic health outcomes, and longer periods of subclinical disease, lead to smaller policy windows with less effective policy changes.

Findings from the qualitative study indicate that the presence of contaminants, knowingly drinking contaminated water, feeling a lack of agency over water sources, experiencing health issues, and disruption to productive activities, etc are stressors that can lead to feelings of worry, fear and uncertainty. Moreover, the aesthetic values ascribed to water are important factors in decision-making and water usage behaviour.

The quantitative study shows that 65.3% of participants have nail arsenic content (a biomarker for subclinical arsenic) above the normal levels for unexposed individuals. Moreover, knowledge and perception of arsenic in water were associated with experiencing psychosocial distress. The use of subclinical disease as an indicator of impact can be a useful way of leveraging policy change and opening windows of opportunity. Moreover, measuring psychosocial distress demonstrates how people’s experiences of contaminated water can go beyond the physiological illnesses they may cause. Thus, this thesis illustrates the need for furthering the narrative around water quality to reflect a broader understanding of health and well-being.

Authors: Khan, N

• DOI: 10.5287/ora-kka1ma1pk
• Type of award: DPhil
• Level of award: Doctoral
• Awarding institution: University of Oxford
• Language: English
• Keywords: water; health; water quality; arsenic; public health; policy response; psychosocosial distress; subclinical disease
• Subjects: Water quality; Public health; Environmental health; Water