Water for Health Conference "Drinking Water for Health – The Water for Health Alliance

Citation

(2005), "Water for Health Conference "Drinking Water for Health – The Water for Health Alliance", Nutrition & Food Science, Vol. 35 No. 1. https://doi.org/10.1108/nfs.2005.01735aac.003

Water for Health Conference "Drinking Water for Health – The Water for Health Alliance"

Water for Health Conference "Drinking Water for Health – The Water for Health Alliance"

This was held on 12 October 2004 – Royal Institute of Public Health, London and was organised by the Institute of Public Health and Water for Health.

There has been mounting public concern about the health of the nation in respect of diet and exercise. Drinking sufficient water is known to make significant improvements to health.

The conference covered:

• •

  The Water UK research study.

• •

  Successfully promoting positive health messages.

• •

  Medical facts of how much water is needed.

• •

  Tap water.

• •

  Bottled water.

The day was of interest to all with any involvement in health and nutrition. Of particular interest is the Water UK project, which was elaborated on by Nick Ellins Policy and Planning Advisor for Water UK.

In recent years, there has been mounting concern about the health of the nation with regard to nutrition and fluid intake. October's joint health symposium between the Royal Institute of Public Health and Water UK looked at the challenges to improve water intake and health through coordinated and concerted action by Government and its stakeholders.

A key element of health is drinking enough water, but often this resource is not recognised for its contribution – even though it is one of the six basic nutrients along with carbohydrate, fat, vitamins, proteins and minerals.

Since the body requires it constantly and all the important chemical reactions – such as the production of energy – take place in water, it is widely seen as the most important.

Its most familiar roles include:

• •

  Transporting nutrients, oxygen and other substances around the body.

• •

  Assisting the removal of waste. products, e.g. via the formation of urine.

• •

  Helping to control body temperature through sweat production.

• •

  Acting as a lubricant around joints and eyes.

• •

  Aiding digestion through the production of saliva and other digestive "juices".

Water is the main constituent of the body and forms 50-60 per cent of body weight. The exact amount varies with age and sex and also depends on body fat content. The average man will have around 60 per cent of their body weight as water and the’average woman, approximately 52 per cent. This lower figure for women is because they have more body fat.

One third of the water in the body is outside the cells (extra cellular), for example blood, fluid between cells, fluid in lymph vessels etc., and two thirds is inside the cells (intracellular). These extra cellular and intracellular compartments are separated by cell membranes that allow free water movement. The movement of water across cell membranes maintains osmotic equilibrium between the compartments.

To consider the ways we lose water from the body, it is lost as urine, in faeces (around 70 per cent of faecal matter is water) and by evaporation from the skin and lungs. Even in the absence of any visible perspiration, approximately half of water loss occurs through the operation of our lungs and skin. Our expired air alone is saturated with valuable water vapour and the average water loss is about 300 ml/day. Water loss of 500 ml/hour from the body is not unusual.

The main sources for hydration, are the food we eat and the fluid we drink. Water taken in via the mouth is absorbed throughout the gastrointestinal tract, mainly in the jejunum, but also in the colon. The other source of water for the body is metabolic water. This water is the product of normal body metabolism, and arises as a by-produce from the oxidation (breakdown) of other food substances such as carbohydrates, protein and fats.

There are three principle challenges to be overcome, if we are to help improve the health and well being of the nation:

1. 1.

   Increase public access to drinking water.

2. 2.

   Develop recommended daily intakes for water.

3. 3.

   Develop research and increase public awareness.

Provision for fresh, cool water is currently poor in many buildings such as hospitals, airports, shopping centres, train stations, undergrounds, schools, universities, theatres, motorway service stations, libraries, doctors surgeries and many others. Where facilities do exist, often fountains, taps, dispensers and sinks are unappealing, run down and dirty.

Some public buildings still site water fountains directly in toilet areas. To encourage people to drink, there must be public access to drinking water within health friendly environments.

It should be possible to make changes, as in many of these same areas, premises can be fitted with commercial vending machines that provide other options for refreshment, such as snack food and high sugar, carbonated or high caffeine drinks. In some more modern buildings, there is water available, but at a price that excludes many in society.

To generate momentum for social action and to promote public awareness, Government guidance is needed on the amount of water the public should consume each day.

There are three main sources for this guidance:

1. 1.

   The UK Food Standards Agency recommends: "We should drink at least 6 to 8 cups/glasses of water (or other fluid) to prevent dehydration. In hotter climates your body will need more fluids".

2. 2.

   The advice from the British Dietetic Association states: "In a moderate climate like ours, most of us need around 6-8 glasses of fluid a day; for example, water, milk, fruit juice, tea or coffee, to keep the balance right have an extra one litre of water for every hour of strenuous exercise".

3. 3.

   Finally, the World Health Organisation states that "The `absolute minimum' quantity of water to sustain hydration remains elusive, as this is dependent on climate, activity level and diet". WHO notes that some hydration needs are met through fluid obtained from food, however they disregard this contribution in their recommendation of daily water requirements, because, on a global basis, "the proportion of fluid obtained from food may vary significantly in response to diet and culture from negligible to all hydration needs".

An important point to consider from these recommendations is the use of the word fluid, as in our general society this can be seen as:

• •

  high sugar soft drinks;

• •

  sparkling colas;

• •

  thick milkshakes;

• •

  alcoholic beverages;

• •

  cups of coffee and tea;

• •

  high caffeine energy drinks.

Their constituent parts are indeed water, but sugar, caffeine, other diuretics and additives also have associated impacts on the body.

Obesity, diabetes, poor kidney function, tooth erosion and poor oral hygiene are just a few of the health conditions that are heavily subsidised by the NHS. With no Government backed guidance available for water, this area is weak and needs immediate focus and research.

To encourage people to make health focused lifestyle choices and to convince them to change their dietary habits, we all need to understand the full role that drinking water can play in public healthcare.

Trusted and coordinated medical research is a must, if society is to adopt the principles of working in partnership to tackle the causes of ill health.

A BMA researcher recently compiled a Water UK report, collating publicly available research information, where water could be seen to assist in various medical conditions. There appears to be emphasis on hydration in the context of simple thirst, when the issues seem wider ranging such as effects on lymph, kidneys, blood, mood changes, diabetes, constipation and certain cancers to name just a few.

The rewards for completing comprehensive research will be the potential reduction of medium to long term health costs on Government and society.

The three key areas are water in our schools, care homes for the elderly and hospitals.

Schools

In our schools, provision of drinking water has been recognised as of national importance and it is here that we have seen probably the greatest acceleration and recognition of the benefits of drinking water to both health and physiological performance.

In the National Nutritional Standards for lunches, for pupils in schools, the Secretary of State for Health now expects that "Drinking water should be available to all children every day, free of charge".

But there is much work to be done to:

• •

  ensure that schoolchildren and their teachers can get access to drinking water when required;

• •

  legislate for facilities to be correctly installed, located and maintained to regulated hygiene and building standards;

• •

  ensure drinking water is fed from the mains, and not storage tanks;

• •

  encourage drinking water policies to be created in our schools;

• •

  promote and encourage the benefits of water in children and family healthcare;

• •

  update the Healthy Schools Standard to include defined water provision requirements, and not simply provision for hot and cold water with paper towels;

• •

  allow the very young children of today to grow up with an acceptance of drinking water as second nature.

Elderly

Many of the typical symptoms of adult dehydration – dizziness, confusion, fainting, falls, headaches, constipation, urinary tract infections, pressure sores and others – are also not surprisingly conditions found regularly in the elderly.

Falls are known to be the most frequent and serious type of accident among the over 65 age group, with a recently reported half of the patients with hip fractures losing their ability to live independently and one third of hip fracture patients expected to die within one year of their accident.

Dehydration concerned with the dizziness and fainting that may lead to these falls can arise as a result of reduced water intake (e.g. due to a diminished thirst response) or as a side effect of diuretics from medication or poor dietary application.

Studies have shown that elderly patients have a strongly diminished thirst response. Those also suffering from conditions such as Alzheimer's or from strokes are particularly at risk, because often their sensation of thirst and even taste is completely lost.

In 2003, the Royal Society for the Promotion of Health conducted a pilot Care Home survey which indicates that while many care workers understand the health benefits of good hydration and the potential problems of not drinking enough, most care homes have no clear policy on water.

The Care standards that govern their work (Care Standards Act 2000 March 2001) in practice merely request that hot and cold drinks are freely available. There is no mention of water and if you look at care plans, the drinks are basically caffeine, sugar and alcohol.

Nowhere in general public health guidance will you find tea, coffee, high sugar soft drinks and fizzy drinks ever recommended.

Hospitals

Dehydration has been recently acknowledged by the NHS as a serious problem, especially in older hospitals that have little ventilation and warm, crowded wards.

Currently, admission to hospital is an almost guaranteed way of becoming dehydrated. But the NHS is developing their view that getting patients to drink more water is very important, and they now see it as part of their approach to good nourishment.

They believe that patients should be drinking two and a half litres of water a day or half a litre with each meal.

However at this time, patients and staff suffer from either a total lack of facilities or are faced with bedside jugs of warm, stale, unappealing water and the embarrassment for patients of an increased toilet function.

A&E facilities often discourage water provision, as they are concerned about patients drinking prior to triage or treatment.

However, whilst mains fed water is rarely available, facilities do normally allow access to vending machines, kiosks and cafeterias serving caffeine, sugar and additives.

The Water for Health Alliance is active in promoting drinking water as an essential component of health care. Its objective is to make a significant impact on the widest areas of society with the minimum amount of cost to Government.

The Alliance is beginning to tackle the key areas with the medical knowledge available, the willingness of Government to engage, and by promoting an essential supplement to health available at an average cost of one penny for each ten litres.

The Alliance to date comprises: Royal Institute of Public Health; The British Medical Association; Developing Patient Partnership; The Drinking Water Inspectorate (England and Wales); National Healthy Schools Standard; Drinking Water Quality Regulator for Scotland; National Kidney Research Campaign; Enuresis Resource Information Centre; Royal Society for the Promotion of Health; The National Association of Care Catering; Local Authority Catering Association; Schools Health Education Unit; Kidney Research; WaterAid; Focus on Food; Chartered Institute of Environmental Health; UKPHA; and Water UK.

More information is available from Nick Ellins, Policy and Planning Advisor, Water UK. E-mail: nellins@water.org.uk

ReferencesWater for Health Report (2002), Hilary Forrester BMA.Ultimate Sports Nutrition, 2nd edition, Coleman E, Nelson Steen S, Edwards S.Science of Cycling, E R Burke.Water for Health Alliance, www.waterforhealth.org.uk.Focus on the Marathon, J Humphreys, R Holman.