Summary

Nearly half of the world’s population, 4.2 billion people, lack access to a hygienic sanitation facility. About 673 million people regularly defecate outdoors, in the open. Many of those who still lack access to sanitation services are among the most challenging populations to reach: the poorest, the most remote, and the most marginalized. Inadequate sanitation is also a major cause of death and disease in countries around the world, causing 432,000 diarrheal deaths annually and contributing to several neglected tropical diseases, including intestinal worm infections, schistosomiasis, and trachoma. It also contributes to malnutrition, adversely affecting early childhood development and thus affecting long-term outcomes, such as educational attainment and earnings in later life. The disease burden of inadequate sanitation overwhelmingly falls on the poor. Sanitation infrastructure access can result in direct benefits that households receive when they have access to sanitation services and an external benefit or externality produced by a community’s access to clean sanitation infrastructure. Thus, for the full benefits of sanitation infrastructure to be realized, efforts should focus on improving community-wide coverage of improved sanitation and eliminating open defecation. This expands the menu of policy options available for targeting conditions like anemia and undernutrition and would require a significant shift in thinking for many researchers and policymakers, who tend to overlook the important role of disease in determining “nutritional” outcomes.

Beyond their intrinsic value to human health and well-being, improved sanitation services would play a contributory and catalytic role in furthering progress toward other development goals, particularly those relating to education, and sustainable economic growth. Thus, furthering people’s access to adequate sanitation services is a necessary milestone in the global stride toward a sustainable, high quality of life for all.