Arsenic in tube well water in Bangladesh: health and economic impacts and implications for arsenic mitigation

TLDR

The study proposes a two‑tiered arsenic mitigation strategy that prioritizes safe water provision for about 5 million people exposed to >200 µg/L and builds local testing capacity. Using data from a 2009 national drinking‑water quality survey, the authors estimate chronic arsenic exposure and evaluate the two‑tiered mitigation approach. The analysis estimates that 20 million people exceed the national 50 µg/L standard and 45 million exceed the WHO 10 µg/L guideline, with 24,000 and up to 19,000 annual adult deaths respectively, an arsenic‑related mortality rate of 1 in 16 adults costing $13 billion in lost productivity over 20 years, and demonstrates that a UN‑supported program can deliver safe water at $11 per capita, suggesting national scale‑up would.

Abstract

A national drinking water quality survey conducted in 2009 furnished data that were used to make an updated estimate of chronic arsenic exposure in Bangladesh. About 20 million and 45 million people were found to be exposed to concentrations above the national standard of 50 µg/L and the World Health Organization's guideline value of 10 µg/L, respectively. From the updated exposure data and all-cause mortality hazard ratios based on local epidemiological studies, it was estimated that arsenic exposures to concentrations > 50 µg/L and 10-50 µg/L account for an annual 24,000 and perhaps as many as 19,000 adult deaths in the country, respectively. Exposure varies widely in the 64 districts; among adults, arsenic-related deaths account for 0-15% of all deaths. An arsenic-related mortality rate of 1 in every 16 adult deaths could represent an economic burden of 13 billion United States dollars (US$) in lost productivity alone over the next 20 years. Arsenic mitigation should follow a two-tiered approach: (i) prioritizing provision of safe water to an estimated 5 million people exposed to > 200 µg/L arsenic, and (ii) building local arsenic testing capacity. The effectiveness of such an approach was demonstrated during the United Nations Children's Fund 2006-2011 country programme, which provided safe water to arsenic-contaminated areas at a cost of US$ 11 per capita. National scale-up of such an approach would cost a few hundred million US dollars but would improve the health and productivity of the population, especially in future generations.