Water, Sanitation and Health
Published on SSWM (http://www.sswm.info/)


Water, Sanitation and Health

Compiled by:
Gina S. Itchon (Xavier University), Robert Gensch (Xavier University)

Currently, some estimated 884 million people worldwide lack access to improved water supply and 2.6 billion people lack access to improved sanitation (WHO/UNICEF 2010). An estimated 2 million people die every year due to diarrheal diseases, most of them children less than 5 years of age. The most affected are populations in developing countries, living in extreme conditions of poverty, normally peri-urban dwellers or rural inhabitants. Among the main problems responsible for this situation are: lack of priority given to the sector, lack of financial resources, lack of sustainability of water supply and sanitation services, poor hygiene behaviours, and inadequate sanitation in public places including hospitals, health centres and schools. Providing access to sufficient quantities of safe water, the provision of facilities for a sanitary disposal of excreta, and introducing sound hygiene behaviours are of capital importance to reduce the burden of disease caused by these risk factors (WHO 2010).


In most developing countries, perhaps most easily discernible in the poorest countries, unclean water and poor sanitation exposes billion of men, women and children to a plethora of diseases that debilitate them and greatly reduce their productivity. These diseases even hasten the death of those with compromised immune systems such as small children, the malnourished and HIV/AIDS patients. Despite advances in science, engineering and legal frameworks, the majority of the wastewater from piped sewerage systems in the world is released into the environment without adequate treatment (UJANG & HENZE 2006). The same is true for most pit latrines and sludge management systems. Only a small percentage of global wastewater is treated using advanced sanitation facilities, mainly in developed countries. Faecal pathogens are transferred to the waterborne sewage system through flush toilets or latrines, and these may subsequently contaminate surface waters and groundwater (PRUESS-UESTUEN & CORVALAN 2006) (see also water pollution).

Prevalence of Waterborne Diseases

dirty water kills

Dirty water causes more deaths every year than armed conflicts. Source: WSSCC (2007)

As a result, the majority of the world’s population is still exposed to waterborne diseases, and the quality of water sources has been rapidly degraded, particularly in poor developing countries (UJANG & HENZE 2006). UNDP (2006) describes unclean water as an immeasurable greater threat to human security than violent conflict. In addition to unclean water, lack of sanitation and poor hygiene are responsible for the transmission of diarrhoea, cholera, typhoid and several parasitic infections (UN 2005).

Moreover, WHO (1997) shows that the incidence of these diseases and others linked to poor hygiene and sanitation e.g. round worm, whip worm, guinea worm, and schistosomiasis is highest among the poor, especially school-aged children. These diseases have a strong negative impact on the health and nutrition of children and their learning capacities, and contribute to significant absences from school (NOKES & BUNDY 1993). Most significant, however is the persistence and wide distribution of diarrhoeal disease throughout the developing world.

Effects of Water Related Diseases

Water related diseases cost 443 million school days each year, and children in poor health suffer from reduced cognitive potential. This hurts their prospects for future earnings and makes continuing poverty more likely (BORKOWSKI 2006). About 3.5 billion people in the world are infected with helminth worm parasites (CHAN 1997; CAPRON 2004; MIGUEL & KREMER 2004; UNESCO 2006). These parasitic helminth infections often lead to severe consequences such as cognitive impairment, massive dysentery, anaemia and death of around 9400 people every year (WHO 2004). In Sub-Saharan Africa, schistosomiasis kills more than 200,000 people every year (UTZINGER & KEISER 2004). Infectious diarrhoea can be caused by bacteria (e.g. E. coli, shigellosis), viruses (e.g. norovirus, rotavirus), and protozoan parasites (e.g. amoebiasis, cryptosporidiosis) (OECD 2007). Acute diarrhoea, as occurs in cholera, if left untreated can cause death within a day or less and has devastating impact on children (UNICEF 2006) (see also economic issues).

Due to the interconnectedness between water, sanitation, health and poverty, lack of safe water supply and proper sanitation has much wider impacts than on just health alone. Large-scale death and poor health are not only matters in its own right but also act as a brake on economic development (WAGSTAFF & CLAESON 2004). The interconnectedness and the impacts that unsafe water and inadequate sanitation have on human health and general well-being makes it absolutely necessary to deal with all these issues or concerns together. Water quality and sanitation are irrevocably intertwined. Poor sanitation leads to water contamination. In many parts of the world, the main source of water contamination is due to sewage and human waste (MOE & RHEINGANS 2006). Unsafe water and inadequate sanitation disproportional impacts the poor in particular. About 2/3 of people without access to a protected water source (piped water or a protected well) live on less than US$2 a day (BORKOWSKI 2006). Adequate water supplies improve the prospects of new livelihood activities, which are otherwise denied, and are often key step out of poverty (UNESCO 2006).

The relationship between the health status and the sanitation coverage can be seen in the figure below:

under five mortality compared to sanitation coverage

Under 5 mortality compared to sanitation coverage for individual developing countries. Each point is a single country with countries in Sub-Saharan Africa as red diamonds. Source: ROSEMARIN (2008); WHO/UNICEF (2008) 


UNDP (2006) emphasises that clean water and proper sanitation can make or brake human development. Furthermore, the combination of poverty, poor health and lack of hygiene means that children from unserved homes, miss school more frequently than those whose families do benefit from improved drinking water and sanitation services. The resulting lack of education and social development further marginalises the children and reduces their future chances of self-improvement (WHO/UNICEF 2005) (see also hygiene frameworks and approaches).

Learn more about health risk management in water and sanitation.


CAPRON, A.; DOMBROWICZ, D.; CAPRON, D. (2004): Helminth Infections and Allergic Diseases: From the Th2 Paradigm to Regulatory Networks. Clinical Reviews in Allergy and Immunology. Human Press Inc..

MOE, C. L.; RHEINGANS, R. D. (2006): Global Challenges in Water, Sanitation, and Health. In: Journal of Water and Health 4, 41-57. URL [Accessed: 06.10.2010].

NOKES; BUNDY (1993): Compliance and Absenteeism in School Children: Implications for Helminth Control. In: Compliance and Absenteeism in School Children: Implications for Helminth Control 87.

OECD (Editor) (2007): Unsafe Water, Sanitation and Hygiene: Associated Health Impacts and the Costs and Benefits of Policy Interventions at the Global Level. Working Party on National Environmental Policies. Organisation for Economic Cooperation and Development.

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UJANG; HENZE (2006): Municipal Wastewater Management in Developing Countries. London: Principles and Engineering, IWA.

UN (Editor) (2005): A Gender Perspective on Water Resources and Sanitation. (= Background Paper). CSD . URL [Accessed: 12.10.2010].

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WHO (Editor) (2004): Study of Environmental Disease Burden in Children: Key Findings. Copenhagen: Study of Environmental Disease Burden in Children: Key Findings.

WHO (Editor) (2008): Sanitation related diseases. URL [Accessed: 12.10.2010].

WHO (Editor) (2010): Water Supply, Sanitation and Hygiene Development. Geneva: World Health Organisation (WHO). URL [Accessed: 12.10.2010].

WHO (Editor); UNICEF (Editor) (2005): Water for Life: Making It Happen. WHO and UNICEF Joint Monitoring Program (JMP) for Water and Sanitation. URL [Accessed: 12.10.2010].

WHO (Editor); UNICEF (Editor) (2008): Progress on Drinking Water and Sanitation: Special Focus on Sanitation. WHO and UNICEF Joint Monitoring Program (JMP) .

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WSSCC (Editor) (2007): Hurry up! 2.6 billion people lack access to adequate sanitation. Geneva: Water Supply and Sanitation Collaborative Council (WSSCC).

BORKOWSKI, L. (2006): UNDP on the World's Water Challenge. Brooklyn, New York: ScienceBlogs, LLC. URL [Accessed: 27.03.2012].

WAGSTAFF, A.; CLAESON, M. (2004): The Millennium Development Goals for Health: Rising to the Challenges. Washington, DC: The World Bank.

For further readings, case studies, awareness raising material, training material, important weblinks or the related powerpoint presentation, see www.sswm.info/taxonomy/term/