The Public Health Nursing Series is a 20-blog collection, written by William (Billy) Rosa, author of the forthcoming title, Nurses as Leaders: Evolutionary Visions of Leadership (June 2016), that sparks a dialogue about each and every nurse's role in advancing and creating the future of global health. With a focus on cultural considerations and the current status of healthcare in nations worldwide, nurses will learn how they are called to contribute to each of the United Nations' 17 Sustainable Development Goals, an international initiative that seeks to end poverty, protect the planet, and ensure prosperity for all over the next 15 years.This series makes the case that every nurse, regardless of title, position, or credential, is a public health leader.

Sustainable Development Goal #6- Clean Water and Sanitation (Part 9)

The legacy of nursing is deeply rooted in environmental activism. Nightingale (1860) discussed the link between environmental determinants of health and individual wellness and well-being. As public health nurses, we look for ways to elevate the awareness of populations to understand the connection between their external environment and their health. From education, to policy changes, to advocating for infrastructure improvements that will address water and sanitation deficits, nurses plays a vital role in the realization of Sustainable Development Goal (SDG) #6 – “Ensure access to water and sanitation for all” (United Nations Sustainable Development [UNSD], 2016).

Access to clean and safe drinking water is becoming a worldwide dilemma, impacting every continent on the planet. It is projected that by 2050, 1 in 4 people is likely to be impacted by recurring water shortages (UNSD, 2016). So how does inadequate clean water and sanitation currently impact the world’s population? According to UNSD (2016):

  • At least 1.8 billion use a drinking water source with fecal contamination
  • Water scarcity affects more than 40% of the global population
  • 2.4 billion lack basic sanitation services, such as toilets or latrines
  • Roughly 1,000 children die daily due to preventable water and sanitation-related diarrhoeal diseases.

Nursing’s ethical commitment to procure the human dignity of all peoples in all settings (Watson, 2008, 2012) is directly related to the statistics mentioned above. By rediscovering the environmental advocacy inherent in the profession, nurses can work to improve education services regarding water and sanitation and lead initiatives in partnership with environmental agencies to implement the changes needed to accomplish SDG #6.

Several countries’ populations suffer due to water and sanitation challenges. In Kenya, water, sanitation, and hygiene related diseases are the number one cause of hospitalization in children under five (, 1990-2016a). Of Peru’s 31 million people, 4 million lack access to safe drinking water and nearly 8 million lack adequate sanitation (, 1990-2016b). Some of the SDG #6 targets include universal and equitable access to safe and affordable drinking water, access to adequate and equitable sanitation and hygiene for all, reduction of pollution to improve water quality, protection and restoration of water-related ecosystems, and the expansion of international capacity-building support to improve water and sanitation programs in developing countries (UNSD, 2016).

There are hopeful initiatives underway that are integral to SDG #6 progress. The Sulabh Santitation Movement in India has constructed 1.3 million household toilets, 54 million government toilets, and over 8,500 community block toilets since 1970 (Sulabh International Social Service Organisation, 2015). The Right to Sanitation Challenge, is improving access, elevating awareness, and taking action to ensure sanitation as a human right throughout India (Right to Sanitation, n.d.). As nurses learn about the various programs being implemented worldwide, they can partner with organizations that align with their personal and professional vision for a world of clean water and sanitation for all.

Lack of access to clean water and adequate sanitation services directly impacts the health of the families and communities we serve as public health nurses. Luck (2015) reminds us,

At the heart of Florence Nightingale’s (1820-1910) legacy is a knowing that our                             external environment is inextricably interconnected to the health and wellbeing of all species and ecosystems. There is both the urgency and opportunity to address environmental factors that affect the lives of our clients/patients, families, and communities. (p. 166)

We need to understand our roles in communicating environmental awareness and leading health policy changes to client and communities at large. Public health nurses must elevate the global understanding of how individual health and global health are interrelated and challenge the status quo in order to create healing environments for all (Luck, 2016). Clean water and sanitation services are just one step to realizing global well-being for every woman, man, and child on the planet.


Luck, S. (2015). Environmental Health. In B. M. Dossey, S. Luck & B. G. Schaub (Eds.). Nurse coaching: Integrative approaches for health and wellbeing (pp.165-177). North Miami, FL: International Nurse Coach Association.

Luck, S. (2016). Informed and impactful: Stewarding the environmental determinants of health   and well-being. In W. Rosa (Ed.), Nurses as leaders: Evolutionary visions of leadership. New York, NY: Springer, in press.

Nightingale, F. (1860). Notes on nursing: What it is and what it is not. London, UK: Harrison.

Right to Sanitation. (n.d.). Why RTS? Retrieved from

Sulabh International Social Service Organisation. (2015). Home. Retrieved from

United Nations Sustainable Development. (2016). Goal 6: Ensure access to water and sanitation for all. Retrieved from (1990-2016a). Kenya. Retrieved from (1990-2016b). Peru.

Watson, J. (2008). Nursing: The philosophy and science of caring (Rev. ed.). Boulder, CO: University Press of Colorado.

Watson, J. (2012). Human caring science (2nd ed.). Sudbury, MA: Jones & Bartlett.

More About the Author

William (Billy) Rosa, MS, RN, LMT, AHN-BC, AGPCNP-BC, CCRN-CMC, is currently Visiting Faculty, University of Rwanda and ICU Clinical Educator, Rwanda Military Hospital, Human Resources for Health Program in partnership with the New York University Rory Meyers College of Nursing. He currently has over 65 publications for refereed and non-refereed journals, newspapers, magazines, and national platform blogs and his book, Nurses as Leaders: Evolutionary Visions of Leadership, will be released by Springer in June 2016. Billy currently sits on the US Advisory Board for the Nightingale Initiative for Global Health, and most recently received the American Association of Critical-Care Nurses' 2015 National Circle of Excellence Award and the Association for Nursing Professional Development's 2015 National Change Agent/Team Member Award.

Quick Links

Part 1 -  Understanding the Nurse as a Public Health Leader

Part 10 - Sustainable Development Goal #7 - Affordable and Clean Energy