Ian Johnson is the World Bank's vice president for Environmentally and Socially Sustainable Development.

Johannesburg-Water is literally a matter of life and death. Some 12 million people die each year from a lack of water, including 3 million children who die tragically from waterborne diseases. Today, some 1.1 billion people in the world lack access to clean water, while 2.4 billion people live without decent sanitation and 4 billion without sound wastewater disposal.

Access to clean water can be the key to climbing out of grinding poverty. Go into the favelas of Brazil, the slums of India or the barrios populares of Mozambique -everywhere you see the same thing. It is the poor who do not have access to water. It is the poor who are at the end of every empty pipe. It is the poor who must buy water from vendors at many times the price paid by better-off people who have service.

Demand for water in our growing world is rising rapidly. While world population tripled in the last century, the use of water grew sixfold. The increased use has come at a high cost. Some rivers no longer reach the sea. Half of the world's wetlands disappeared in the last century, and 20 percent of freshwater fih are now endangered or extinct.

Improving the way we manage water used in agriculture is especially key because more than 70 percent of the water used in the world today goes to irrigating crops and other agro-industrial uses. Better management of that water would free up the flows to be used for other purposes, such as drinking water.

Thankfully, there are signs of hope. In India, an innovative project that channels water to poor areas has improved agricultural output by giving seasonal workers the opportunity to work in off-peak seasons. The progress is astonishing. In the newly irrigated areas, some 26 percent of the population now rank as poor, compared to 69 percent in areas that did not receive new water flows.

In Central America, a hand-washing initiative overcame the region's lack of clean water by aggressively promoting effective hand-washing with cheap soap. The partnership among four soap companies, NGOs (non-governmental organizations), development agencies and the ministries of health of several Central American countries dramatically reduced diarrheal disease among children under 5, which had been a leading cause of death for the age group.

Lastly, if conflict over water is possible, water can also be the focus for cooperation and peace. In Africa, the 10 countries that line the Nile river have risen above their national differences and improved the security of the region by mobilizing behind the Nile Basin Initiative. Launched in 1999, the initiative aims to improve the management of the Nile's waters for the benefit of the people living along the river basin, whose number is expected to double from 300 million today to 600 million in 30 years.

We know then that action on water at the international and local levels can help in the fight against global poverty. But success does not come free. It will require fundamental changes in water sector policies and institutions in many countries along with big increases in investment. The World Bank estimates that $380 billion will be needed in water investment during the next 13 years in order to meet the 2015 Millennium Development Goals of halving the number who now don't have access to clean water. That would mean a 70 percent increase over recent spending on water supply and sanitation.

Meeting the world's water needs by 2015 will require us all to improve our management of water resources and services. Governments must give the different user groups in society incentives to use water more wisely, to avoid waste and pollution. They also need to work for development and sharing of water resources in such a way that they will be available for productive uses in all segments of society. They must ensure that the poor have access to safe, affordable water supply and sanitation services by reducing costs and allowing alternative service providers to compete.

In urban areas, subsidies should be targeted to the poorest, and contracts should be written so that poor communities are better served. In small towns and rural areas, this means empowering communities by giving them the ownership rights and authority they need to choose service providers.

The rise in worldwide demand for water is not leveling off. During the next 30 years, water use will grow by 50 percent, putting half of the world's population in countries where water is scarce, especially Africa, the Middle East and South Asia. And you can be sure that it will not be the well-to-do that will be short on water. Without action now, it will surely be the poorest countries and poorest people who will continue to suffer.

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