Billions of people lack access to clean water and safe sanitation which has catastrophic consequences for human health and well-being. Diarrhea caused by unsafe water and sanitation kills more children under 5 per year than HIV/AIDS, malaria, and measles combined. The good news is that we have the tools to solve this global crisis. In 2005 the Water for the Poor Act took a historic step calling for bold U.S. action to bring clean water and sanitation to the world. This November 2010 report provides a comprehensive assessment of the steps the U.S. government still needs to take to protect human health and the environment.