Children in rural Kenya are more susceptible to disease and death the farther away they live from clean drinking water, according to Stanford researchers.

In a survey of families in Asembo – a small farming community at the edge of Lake Victoria that has high rates of chronic diarrhea, child malnutrition and child death – a research team from the Center on Food Security and the Environment found that most people live just over a quarter-mile from clean water sources. About 200 feet closer to home are ponds and springs contaminated with E. coli bacteria. Sixty-six percent of families primarily use this contaminated surface water for drinking.

A child in Asembo, Kenya sits next to her family's water storage containers.

A child in Asembo, Kenya sits next to her family's water storage containers. Photo Credit: Amy Pickering

While water is essential for farming, collecting it is time-consuming and physically exhausting in remote places like Asembo. Previous research has shown that when families must travel long distances for water, child health suffers. The harder it is to collect, the less of it a family will use. A shortage of water for cooking and drinking compromises children’s nutrition and hydration. And it limits hand washing and bathing, making children more susceptible to disease. Quality and availability of water also varies widely from source to source, and the time required to collect water can force families to use dirtier, unimproved water sources that are closer to home. 

In 2011, the FSE researchers partnered with the Centers for Disease Control Kenya Medical Research Institute (CDC-KEMRI), which was already conducting an extensive survey of household-level health indicators in the region. Combining resources with CDC-KEMRI allowed the team – led by FSE Director Rosamond Naylor, a professor of environmental earth system science, and Jenna Davis, an assistant professor of civil and environmental engineering – to use a robust set of data. The information covered about 3,000 households in a five kilometer radius and was collected on a bi-weekly basis for six months. In exploring the links between water, food and health in Asembo, FSE researchers first expanded the definition of water “access” to account for both physical distance and the quality of water sources.

Researchers take a child's measurements in Asembo, Kenya.

Researchers take a child's measurements in Asembo, Kenya. Photo Credit: Amy Pickering

Researchers then mapped the distance of each household from its nearest water source, and recorded whether the source was improved (such as a deep borewell) or unimproved (surface water like a pond, spring or shallow well). To get the most precise possible data on local water quality, the research team collected samples from each household’s water source and sent them to a local hospital lab for testing. Surveyors then collected data on each household’s water management practices, including water treatment. They measured agricultural output, dietary diversity, and perceived food insecurity, then recorded the weight and height measurements of each child in the household. Respondents also reported the frequency of recent cases of diarrheal disease among children of the household.

Results of the initial survey highlight sobering realities about water access in Asembo. Households in the survey reported average per capita water consumption of only 31 liters per day, including water used for cooking, drinking, hygiene and agriculture. The average walk time to the nearest water source was approximately 15 minutes. The average distance to the nearest improved source was 428 meters, whereas the average distance to unimproved surface water was 374 meters. Water quality tests confirmed that these sources, used by the majority of families, were highly contaminated with E. coli bacteria, while improved water sources were significantly cleaner. Thirty percent of children showed stunted growth, and 11 percent were underweight for their age.

A researcher collects a sample of stored water at a household in Asembo, Kenya.

A researcher collects a sample of stored water at a household in Asembo, Kenya. Photo Credit: Amy Pickering

Researchers found that close proximity to an abundant water source, regardless of quality, correlated with an increase in food production and diversity, as well as a lower hunger score. Having enough extra water for crop irrigation clearly improves children’s diets – particularly their access to the micronutrients essential for normal physical and cognitive development – and helps them resist disease. Households further from water sources reported lower and less diverse crop yields, as well as poorer child health indicators. Quality was also an important factor, as households with access to clean, improved water reported better child health outcomes than those relying on contaminated surface water.

The ultimate goal of the project, “Rural health and development at the food-water nexus” is to design interventions and policy incentives that help people absorb nutrients in environments where food and water are limited and disease is prevalent. In the next stage of the project, researchers will focus on links between water access and the progression of HIV, and will also investigate how improved diets from better water access can impact household income.

About the Stanford Research Team:

Jenna Davis is Associate Professor of Civil and Environmental Engineering, Higgins-Magid Faculty Senior Fellow at the Stanford Woods Institute for the Environment, and an affiliate of the Center on Food Security and the Environment.
Rosamond Naylor is the Director of the Center on Food Security and the Environment, Professor of Environmental Earth System Science, and the William Wrigley Senior Fellow at the Stanford Woods Institute.
Eran Bendavid is an infectious diseases physician and Assistant Professor of Medicine in the Division of General Internal Medicine, as well as an affiliate of the Center on Food Security and the Environment and the Stanford Health Policy center.
Amy Pickering is a lecturer in the School of Earth Sciences, and a research associate in Civil and Environmental Engineering, the Woods Institute for the Environment, and the Center on Food Security and the Environment.
Glwadys Gbetibouo is a postdoctoral scholar at the Center on Food Security and the Environment.
Katrina ole-MoiYoi is a Ph.D. student at the Center on Food Security and the Environment.

Amy Zegart, one of the nation’s leading experts on national security, intelligence and foreign policy, has been appointed the next co-director of the Center for International Security and Cooperation.

Zegart, a CISAC faculty member and senior fellow at the Hoover Institution, will take up her new role July 1. She succeeds Mariano-Florentino Cuéllar, who was named director of the Freeman Spogli Institute for International Studies, CISAC’s parent organization.

“Amy Zegart is an award-winning scholar, an accomplished professional with public and private sector experience, and a trusted voice on national security and foreign policy,” said Cuéllar. “Her multi-disciplinary scholarship, diverse experiences, and commitment to getting it right will complement the Freeman Spogli Institute's growing focus on governance problems, and will make her a dynamic leader for CISAC as the center continues its vital work on international cooperation and security.”

Zegart, once named one of the 10 most influential experts in intelligence reform by the National Journal, said she intends to continue expanding the center’s focus on emerging security issues, such as cybersecurity, drones and challenges to governance while building on CISAC’s distinguished reputation in nuclear security.

“The international threat environment is changing faster and in more profound ways than anyone could have imagined 10 or 20 years ago,” said Zegart, who is also a professor of political economy (by courtesy) at the Stanford Graduate School of Business, where she co-teaches a course on managing political risk with former Secretary of State Condoleezza Rice.

“CISAC will continue to be at the forefront of addressing these new challenges with the same secret sauce it’s had since its founding in 1983: world class talent; a commitment to teaching the next generation; and a deep belief that bridging the natural and social sciences is vital to solving the world’s most dangerous problems,” she said.

 CISAC, more than any other institution, provided a scholarly environment that was intellectually challenging and personally supportive at the same time. That’s quite a rare cultural combination."

Zegart’s research examines the organization of American national security agencies and their effectiveness. She served on the Clinton administration's National Security Council staff and as a foreign policy adviser to the 2000 presidential campaign of George W. Bush. She has testified before the Senate Intelligence Committee, provided training to the Marine Corps, and advised officials on intelligence and homeland security matters. From 2009 to 2011 she served on the National Academies of Science Panel to Improve Intelligence Analysis. Her commentary has been featured on national television and radio shows and in The New York Times, Washington Post, and Los Angeles Times.

Zegart writes  regular commentary for Foreign Policy about national security issues. In this excerpt from one of those posts about the privatization of American intelligence and the growing businesses of political risk management, her approach accentuates her ability to bring complex issues to a general audience:

In the old days, the ‘free world’ and ‘Soviet bloc’ were two different universes. Not anymore. Now everything is connected. Sweden’s Ikea has stores in Russia. My CIA alarm clock was made in China. Unrest in Cairo can cause legging shortages in California. And communications happen everywhere. Wifi can be found in Bedouin tents, on the top of Mount Everest, and on buses in rural Rwanda. Kenyan fisherman may lack electricity, but they can check weather conditions and fish market prices on their cell phones. All of this connectedness means that political risks – civil strife, instability, insurgency, coups, weak legal standards, corruption – have more spillover effects. What happens in Vegas does not stay in Vegas.

Zegart recalls being fascinated with politics since she was a kid. She spent her childhood tracking election night tallies and writing her congressman. When she was 13, she followed on TV the late Chinese leader Deng Xiaoping’s historic visit to the United States in 1979 and was thrilled when he donned a cowboy hat at a Texas rodeo.

“I was enthralled,” Zegart said. “My mother, an antique dealer who can find anyone and anything, tracked down a local Taiwanese graduate student and convinced her to teach me Mandarin after school.”

She would continue studying Chinese at Andover, majored in East Asian Studies at Harvard, and would win a Fulbright Scholarship to travel to China and study the 1989 Chinese democracy movement and Tiananmen Square tragedy. Zegart then earned her M.A. and Ph.D. in political science from Stanford and became a full professor of public policy at UCLA’s Luskin School of Public Affairs as well as a fellow at the Burkle Center for International Relations.

Zegart notes she’s been connected to CISAC for more than two decades. She first showed up at the center’s former Galvez House headquarters during her first quarter as a Stanford graduate student. She kept coming back even after she got her Ph.D.; both of her award-winning books were germinated in presentations she gave to CISAC seminars.

“CISAC, more than any other institution, provided a scholarly environment that was intellectually challenging and personally supportive at the same time,” Zegart said. “That’s quite a rare cultural combination.”

This academic year, she co-taught with Martha Crenshaw the popular CISAC-sponsored class International Security in a Changing World, which culminates in a U.N. Security Council simulation in which students debate a pressing global issue.

CISAC has a tradition of appointing co-directors – one from the social sciences and the other from the natural sciences – to advance the center’s interdisciplinary mission to conduct and promote cutting-edge research to make the world a safer place.

“Amy brings to CISAC a wealth of expertise in international security issues, a deep commitment to scholarship and a sincere desire to strengthen and expand the center’s activities and impact,” said David Relman, CISAC’s other co-director, a Stanford microbiologist and professor of infectious diseases, as well as expert on emerging biological threats. “We share an interest in emerging technologies and the effective international mechanisms that address 21^st century challenges and threats.”

Zegart is the author of two award-winning books. Flawed by Design, which chronicles the development of the Central Intelligence Agency, Joint Chiefs of Staff, and National Security Council, won the highest national dissertation award in political science. Spying Blind, which examines why American intelligence agencies failed to adapt to the terrorist threat before 9/11, won the National Academy of Public Administration’s Brownlow Book Award. She has also published in International Security, Political Science Quarterly, and other leading academic journals. She serves on the editorial boards of Terrorism and Political Violence and Intelligence and National Security. Her most recent book is Eyes on Spies: Congress and the United States Intelligence Community.

Before her academic career, Zegart spent three years at McKinsey & Company advising Fortune 100 companies about strategy and organizational effectiveness.

She serves on the FBI Intelligence Analysts Association National Advisory Board and the Los Angeles Police Department’s Counter-terrorism and Community Police Advisory Board and is a lifetime member of the Council on Foreign Relations. 

On March 18, Congolese militia leader Bosco Ntaganda surrendered himself unexpectedly to the U.S. Embassy in Kigali, Rwanda asking for transfer to the International Criminal Court (ICC) at The Hague, where he was wanted for allegedly committing crimes against humanity. The apprehension of ICC indictees was one of the main challenges raised during the Program on Human Right's (PHR) Sanela Diana Jenkins Human Rights Speaker Series last quarter. Ntaganda’s voluntary surrender provoked reflection on the lessons learned from the seminar’s evaluation of the ICC’s impact on international justice as it marked its first decade and exploration of its mandate moving forward.

Featuring lectures from international experts, academics, and activists, the seminar addressed many of the current challenges and future hopes of the ICC, including competing notions of justice and peace, budgetary constraints, and victims’ rights.

The series was led by PHR Director Helen Stacy and UCLA Law Professor Richard Steinberg, also a visiting scholar at Stanford's department of political science. They both kicked off the series by presenting the history and structure of the ICC and concluded with a discussion on its impact, commenting on how the ICC has helped shape the narrative on mass atrocities.

“Reflecting Diana Jenkins' personal commitment to restoring dignity, prosperity, justice and hope to those who most need it, the human rights speaker series aims to engage students on the most pressing human rights issues of our time,” said Stacy. “The International Criminal Court's 10th anniversary invites careful thought about its role so far, and its future. Our speakers brought an extensive range of opinions on the Court, but everyone agreed that the very existence of the Court has advanced the dialogue on international justice.”

A wide array of positions were offered by the speakers, representing the nonprofit, academic and policymaking arenas. Citing some of the limitations facing the ICC, Human Rights Watch’s Director of International Justice Program Richard Dicker made a compelling case for the Court, highlighting the role of civil society in promoting the adoption of the Rome Statute - the treaty that established the ICC - by its 122 current signatories.

William Pace, convener of the Coalition for the International Criminal Court described the Rome Statute as “among the greatest advancements ever in international human rights law.”

Stanford political science Professor James Fearon questioned whether the Court can be effective in deterring mass atrocities while relying on states parties to turn over suspects without a police force of its own. He argued that the Court may in fact limit the liability of human rights abusers because it gives them a choice of whether (or not) to turn themselves over to the ICC for trial. This could potentially contribute to prolonged civil conflict if governments’ hands are tied in offering backdoor deals in exchange for an end to the conflict.

Many speakers proposed modifications to the current ICC structure and suggested the following measures to enhance the work of the Court:

• Cherif Bassiouni, who led the drafting committee to launch the ICC, emphasized the need for the Court to appoint well-trained judges;
• David Scheffer, former U.S. Ambassador at Large for War Crimes Issues, highlighted the tremendous diplomatic challenge of not having instruments of arrest or enforcement under ICC control and limited to pressuring states parties to follow through on their obligation to detain indictees of the Court;
• Carla Ferstman, director of REDRESS, a human rights organization that helps torture survivors obtain justice and reparations, focused on the challenges presented by the ICC's distance from the home countries of those on trial and how victims might have a more significant role in the justice process.

Recognizing the ICC’s inevitable growing pains, Shamila Batohi, a senior legal advisor to the Office of the Prosecutor, offered a hopeful conclusion to the series, reminding students of the Court’s commitment to protecting the rights of the more than 2.3 billion people represented by the statute’s 122 states parties and ending impunity for war crimes, genocide and crimes against humanity.

“Over the course of these nine weeks, students, faculty, and our guest speakers collaborated to develop a range of policies that could potentially improve the ICC system,” said Richard Steinberg. “Though the colloquium took place here on the Stanford campus, the broader collaboration engaged 19,000 users in a fruitful discussion via an online forum.”

Following each lecture, Dr. Diane Steinberg led a dinner discussion for interested students to distill the speaker’s main points into a thought-provoking question to be debated by a global audience on the Human Rights & International Criminal Law Online Forum. Stanford students joined forum participants from around the world to discuss vital questions, such as: “How should the relationship between the International Criminal Court and the United Nations Security Council be changed, if at all, to advance international justice?” and “Assuming that the ICC chooses to retain victim participation in its processes, how can victims’ representation at the ICC be improved and victims’ rights be protected?”

The seminar left students with these provocative questions – and many more – to ponder while tracking the Ntaganda case and the future trial of Uhuru Kenyatta, Kenya’s newly elected president wanted by the ICC for crimes against humanity following the 2007 presidential elections.

Stay tuned for more information on the 2014 Sanela Diana Jenkins Speakers Series, which will focus on the right to health and healthcare delivery.