Sanitation
Sanitation

Key facts

  • In 2022, 57% of the world’s population (4.6 billion people) used a safely managed sanitation service.
  • Over 1.5 billion people still lack access to basic sanitation services, such as private toilets or latrines.
  • Of these, 419 million still defecate in the open, such as in street drains, behind bushes or in open bodies of water.
  • In 2020, 44% of domestic wastewater generated globally was discharged without safe treatment (1).
  • It is estimated that at least 10% of the world’s population consumes food irrigated with wastewater.
  • Poor sanitation reduces human well-being, social and economic development through impacts such as anxiety, risk of sexual violence and lost opportunities for education and work.
  • Poor sanitation has been linked to the transmission of diarrheal diseases such as cholera and dysentery, as well as typhoid, intestinal worm infections and polio. It worsens growth arrest and contributes to the spread of antimicrobial resistance.


Review

According to recent estimates of the burden of WASH-related diseases, 1.4 million people die each year as a result of inadequate drinking water, sanitation and hygiene. The majority of these deaths are in low- and middle-income countries. Unsafe sanitation is responsible for 564,000 of these deaths, mainly from diarrhea, and is a major factor in several neglected tropical diseases, including intestinal worms, schistosomiasis and trachoma. Poor sanitation also contributes to malnutrition.

In 2022, 57% of the world’s population (4.6 billion people) used a safely managed sanitation service; 33% (2.7 billion people) used private sanitation facilities connected to the sewer from which wastewater is treated; 21% (1.7 billion people) used toilets or latrines where excrement is safely disposed of on site; and 88% of the world’s population (7.2 billion people) used at least a basic sanitation service (2).

Diarrhea remains a major killer but is largely preventable. Better water, sanitation and hygiene could prevent deaths among children under 5, 395,000 in 2019.

Open defecation perpetuates a vicious cycle of disease and poverty. The countries where open desertion is most prevalent have the highest number of deaths of children under the age of 5, as well as the highest levels of malnutrition and poverty, and wide disparities in wealth.

Benefits of improving sanitation

The benefits of improved sanitation extend far beyond reducing the risk of diarrhea. They include:

  • reducing the prevalence of intestinal worms, schistosomiasis and trachoma, which are neglected tropical diseases that cause suffering to millions;
  • reducing the severity and impact of malnutrition;
  • promoting dignity and enhancing safety, especially among women and girls;
  • encouraging school attendance: school attendance by girls has been particularly increased through the provision of separate sanitary facilities;
  • reducing the spread of antimicrobial resistance;
  • potentially safe recovery of water, nutrients and renewable energy from wastewater and sludge; and
  • potential to increase overall community resilience to climate shocks, for example through the safe use of irrigation wastewater to mitigate water scarcity.

A 2012 WHO study estimated that for every US$1.00 invested in sanitation, US$5.50 is returned in the form of lower health costs, more productivity and fewer premature deaths.

Challenges

In 2013, the UN Under-Secretary-General issued a call to action on sanitation that included eliminating open defecation by 2025. The world is on track to eliminate open defecation by 2030, if not 2025. , but historical rates of progress will need to double for the world to achieve universal coverage of basic sanitation services by 2030. To achieve universal safely managed services, prices will need to increase fivefold.

The situation in urban areas, especially in densely populated low-income and informal areas, is a growing challenge as sanitation is unsafe or non-existent, toilet space is at a premium, poorly designed and managed pits and septic tanks contaminate open drains and groundwater and faecal sludge removal services are unavailable or unavailable. Inequalities are compounded when sewage discharged into stormwater drains and waterways pollutes poorer, low-income areas of cities. The effects of climate change – floods, water shortages and droughts, as well as sea level rise – are slowing progress for billions of people without safely managed services and threatening to undermine existing services if they are not made more resilient.

Wastewater and sludge are increasingly seen as a valuable resource in the circular economy that can provide reliable water and nutrients for food production and recovered energy in various forms. In fact, the use of wastewater and sludge is now commonplace, but many are used unsafely without proper treatment, use control, or regulatory oversight. Safe use that prevents the transmission of excreta-related diseases is vital to reducing harm and maximizing the beneficial use of wastewater and sludge.

In 2019, UN-Water launched the SDG6 Global Acceleration Framework (GAF). On World Toilet Day 2020, WHO and UNICEF launched The State of the World’s Sanitation a report outlining the scale of the challenge in terms of health impacts, sanitation coverage, progress, policy and investment, and also setting out a program to accelerate sanitation under the GAF.

WHO response

In 2010, the UN General Assembly recognized access to safe and clean drinking water and sanitation as a human right and called for international efforts to help countries provide safe, clean, accessible and affordable drinking water and sanitation. Goal 6.2 of the Sustainable Development Goal calls for adequate and equitable sanitation for all, and Goal 6.3 calls for halving the share of untreated wastewater and significantly increasing recycling and safe reuse.

As an international public health authority, WHO leads global efforts to prevent disease transmission by advising governments on health-based regulation and service delivery. On sanitation, WHO monitors the global burden of disease (SDG 3.9) and the level of access to sanitation and wastewater treatment (SDG 6.2, 6.3) and analyzes what is helping and hindering progress (SDG 6a, 6b and GLAAS). Such monitoring gives Member States and donors global data to help them decide how to invest in providing toilets and ensuring the safe management of wastewater and excreta.

WHO is working with partners to promote effective risk assessment and sanitation management practices in communities and health facilities based on evidence and tools, including WHO guidelines on sanitation and health, safe wastewater use, recreational water quality and promoting sanitation safety planning and sanitation inspections, and through communities of practice such as RegNet and the sanitation workers’ initiative. WHO also supports collaboration between WASH and health programs where sanitation is critical to disease prevention and risk reduction, including neglected tropical diseases, cholera, polio and antimicrobial resistance, and environmental pathogen surveillance. Aspects of climate resilience are included in all WHO sanitary guidelines.

References

  1. UN-Habitat and WHO, 2021. Progress in wastewater treatment – ​​Global status and acceleration needs for SDG indicator 6.3.1. United Nations Habitat Program (UN-Habitat) and World Health Organization (WHO), Geneva.
  2. Progress in domestic drinking water, sanitation and hygiene 2000–2022: special emphasis on gender. New York: United Nations Children’s Fund (UNICEF) and World Health Organization (WHO), 2023 https://washdata.org/reports/jmp-2023-wash-households

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