posts: 24932

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id	title	slug	type	status	content	archieml	archieml_update_statistics	published_at	updated_at	gdocSuccessorId	authors	excerpt	created_at_in_wordpress	updated_at_in_wordpress	featured_image	formattingOptions	markdown	wpApiSnapshot
24932	Sanitation	sanitation	page	publish	<!-- wp:html --> <!-- formatting-options subnavId:water subnavCurrentId:sanitation --> <!-- /wp:html --> <!-- wp:html --> <div class="blog-info">First published in September 2019. Latest update in June 2021.</div> <!-- /wp:html --> <!-- wp:owid/summary --> <!-- wp:list --> <ul><li><a href="https://ourworldindata.org/sanitation#unsafe-sanitation-is-a-leading-risk-factor-for-death">Unsafe sanitation is responsible for 775,000 deaths each year.</a></li><li><a href="https://ourworldindata.org/sanitation#the-global-distribution-of-deaths-from-sanitation">5% of deaths in low-income countries result from unsafe sanitation</a></li><li><a href="https://ourworldindata.org/sanitation#access-to-safe-sanitation">46% of the world do not have access to safely managed sanitation.</a></li><li><a href="https://ourworldindata.org/sanitation#open-defecation">6% of the world still practice open defecation.</a></li><li><a href="https://ourworldindata.org/sanitation#other-health-impacts-of-poor-sanitation">Unsafe sanitation has a significant impact on childhood stunting.</a></li></ul> <!-- /wp:list --> <!-- wp:paragraph --> <p></p> <!-- /wp:paragraph --> <!-- /wp:owid/summary --> <!-- wp:heading --> <h2>Unsafe sanitation is a leading risk factor for death</h2> <!-- /wp:heading --> <!-- wp:heading {"level":4} --> <h4>Unsafe sanitation is responsible for 775,000 deaths each year</h4> <!-- /wp:heading --> <!-- wp:paragraph --> <p>Unsafe sanitation is one of the world's largest health and environmental problems – particularly for the <a href="https://owid.cloud/extreme-poverty">poorest in the world</a>.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>The <em>Global Burden of Disease</em> is a major global study on the causes and risk factors for death and disease published in the medical journal <em>The Lancet</em>.{ref}The latest study can be found at the website of the Lancet here: <a href="https://www.thelancet.com/gbd">TheLancet.com/GBD</a></p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>The 2017 study was published as GBD 2017 Risk Factor Collaborators – "Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017" and is online <a href="http://www.healthdata.org/research-article/global-regional-and-national-comparative-risk-assessment-84-behavioral-0">here</a>.{/ref} These estimates of the annual number of deaths attributed to a wide range of risk factors are shown here. This chart is shown for the global total, but can be explored for any country or region using the "change country" toggle.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>Lack of access to poor sanitation is a leading risk factor for infectious diseases, including cholera, <a href="https://owid.cloud/diarrheal-diseases">diarrhoea</a>, dysentery, hepatitis A, typhoid and <a href="https://owid.cloud/polio">polio</a>.{ref}WHO (2019) – Fact sheet – Drinking water. Updated June 2019. Online <a href="https://www.who.int/news-room/fact-sheets/detail/sanitation">here</a>.{/ref} It also exacerbates malnutrition, and in particular, <a href="https://ourworldindata.org/hunger-and-undernourishment#too-little-height-for-age-stunting">childhood stunting</a>. In the chart we see that it ranks as a very important risk factor for death globally. </p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>According to the <em>Global Burden of Disease</em> study 775,000 people died prematurely in 2017 as a result of poor sanitation. To put this into context: this was almost double the <a href="https://ourworldindata.org/grapher/annual-number-of-deaths-by-cause">number of homicides</a> – close to 400,000 in 2017.</p> <!-- /wp:paragraph --> <!-- wp:html --> <iframe src="https://ourworldindata.org/grapher/number-of-deaths-by-risk-factor" style="width: 100%; height: 600px; border: 0px none;"></iframe> <!-- /wp:html --> <!-- wp:heading --> <h2>The global distribution of deaths from sanitation</h2> <!-- /wp:heading --> <!-- wp:heading {"level":4} --> <h4>In low-income countries poor sanitation accounts for 5% of deaths</h4> <!-- /wp:heading --> <!-- wp:paragraph --> <p>An estimated 775,000 people died prematurely as a result of poor sanitation in 2017. This was 1.4% of global deaths.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>In low-income countries, it accounts for 5% of deaths.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>In the map here we see the share of annual deaths attributed to unsafe sanitation across the world. In 2017 this ranged from a high of close to 11% in Chad – more than 1-in-10 deaths – to less than 0.01% across most of Europe.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>When we compare the share of deaths attributed to unsafe sanitation either over time or between countries, we are not only comparing the extent of sanitation, but its severity <em>in the context</em> of other risk factors for death. Sanitation's share does not only depend on how many die prematurely from it, but what else people are dying from and how this is changing.</p> <!-- /wp:paragraph --> <!-- wp:html --> <iframe src="https://ourworldindata.org/grapher/share-deaths-unsafe-sanitation" style="width: 100%; height: 600px; border: 0px none;"></iframe> <!-- /wp:html --> <!-- wp:heading {"level":4} --> <h4>Death rates are much higher in low-income countries</h4> <!-- /wp:heading --> <!-- wp:paragraph --> <p>Death rates from unsafe sanitation give us an accurate comparison of differences in its mortality impacts between countries and over time. In contrast to the share of deaths that we studied before, death rates are not influenced by how other causes or risk factors for death are changing.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>In this map we see death rates from unsafe sanitation across the world. Death rates measure the number of deaths per 100,000 people in a given country or region.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>What becomes clear is the large differences in death rates between countries: rates are high in lower-income countries, particularly across Sub-Saharan Africa and Asia. Rates here are often greater than 50 deaths per 100,000 – in the Central African Republic and Chad this was over 120 per 100,000.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>Compare this with death rates across high-income countries: across Europe rates are below 0.1 deaths per 100,000. That’s a greater than 1000-fold difference.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>The issue of unsafe water is therefore one which is largely limited to low and lower-middle income countries.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>We see this relationship clearly when we plot death rates versus income, as shown <a href="https://ourworldindata.org/grapher/death-rates-from-unsafe-sanitation-vs-gdp-per-capita"><strong>here</strong></a>. There is a strong negative relationship: death rates decline as countries get richer.</p> <!-- /wp:paragraph --> <!-- wp:html --> <iframe src="https://ourworldindata.org/grapher/death-rates-sanitation" style="width: 100%; height: 600px; border: 0px none;"></iframe> <!-- /wp:html --> <!-- wp:heading --> <h2>Access to safe sanitation</h2> <!-- /wp:heading --> <!-- wp:heading {"level":3} --> <h3>What share of people use safely managed sanitation facilities?</h3> <!-- /wp:heading --> <!-- wp:heading {"level":4} --> <h4>Nearly half of the world do not have access to safe sanitation</h4> <!-- /wp:heading --> <!-- wp:paragraph --> <p><a href="https://sdg-tracker.org/water-and-sanitation#6.2">SDG Target 6.2</a> is to: “achieve access to adequate and equitable sanitation and hygiene for all and end open defecation” by 2030.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p><strong>Where are we today? </strong>In 2020, just over half (54%) of the world population had access to <a href="http://ourworldindata.org/sanitation#definitions">safely managed sanitation</a>. It is shocking that nearly one-in-two don’t. Around 6% do not have <em>any</em> sanitation facilities at all, and instead have to practice open defecation.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>In the chart we see the breakdown of sanitation access globally, and across regions and income groups. We see that in countries at the lowest incomes, less than one-fifth of the population have safe sanitation. Much like safe drinking water, most live in Sub-Saharan Africa.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p><strong>Are we making progress? </strong>The world has made progress in the last five years. But again, this has been far too slow albeit slightly faster than our progress on drinking water. In 2015 only 47% of the global population had safe sanitation. That means we’ve seen an increase of seven percentage points over five years.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>The gap between where we are now and universal access is still huge. Our progress is far too slow to achieve this by 2030. If progress continues at these rates, we would only reach 68% by 2030. Almost one-third of the world would miss out. If we’re to meet our target we need almost exactly the same acceleration as our progress on drinking water: rates would need to more than triple (increase 3.3-fold) for the coming decade.{ref}To reach universal access within 10 years (the current gap is 46%) we need to see a 23 percentage point increase every five years. That’s 3.3 times higher than the 7 percentage point increase we’ve seen in the last five years.{/ref}</p> <!-- /wp:paragraph --> <!-- wp:columns {"className":"is-style-side-by-side"} --> <div class="wp-block-columns is-style-side-by-side"><!-- wp:column --> <div class="wp-block-column"><!-- wp:html --> <iframe src="https://ourworldindata.org/grapher/share-of-the-population-with-access-to-sanitation-facilities" loading="lazy" style="width: 100%; height: 600px; border: 0px none;"></iframe> <!-- /wp:html --></div> <!-- /wp:column --> <!-- wp:column --> <div class="wp-block-column"><!-- wp:html --> <iframe src="https://ourworldindata.org/explorers/water-and-sanitation?tab=chart&Resource=Sanitation&Level+of+Access=Safely+managed&Residence=Total&Relative+to+population=Share+of+population&country=OWID_WRL&hideControls=true" loading="lazy" style="width: 100%; height: 600px; border: 0px none;"></iframe> <!-- /wp:html --></div> <!-- /wp:column --></div> <!-- /wp:columns --> <!-- wp:heading {"level":4} --> <h4>Access to safe sanitation by country</h4> <!-- /wp:heading --> <!-- wp:paragraph --> <p>In the map shown we see the share of people across the world that have access to safely managed sanitation. </p> <!-- /wp:paragraph --> <!-- wp:html --> <iframe src="https://ourworldindata.org/grapher/share-using-safely-managed-sanitation"></iframe> <!-- /wp:html --> <!-- wp:heading {"level":3} --> <h3>How many people do not have access to safe sanitation?</h3> <!-- /wp:heading --> <!-- wp:paragraph --> <p>In the map shown we see the number of people across the world that <em>do not</em> have access to safely managed sanitation.</p> <!-- /wp:paragraph --> <!-- wp:html --> <iframe src="https://ourworldindata.org/grapher/safe-sanitation-without"></iframe> <!-- /wp:html --> <!-- wp:heading --> <h2>Access to improved sanitation</h2> <!-- /wp:heading --> <!-- wp:heading {"level":3} --> <h3>What share of people do not have access to improved sanitation?</h3> <!-- /wp:heading --> <!-- wp:paragraph --> <p>'Improved' sanitation is defined as facilities which ensure hygienic separation of human excreta from human contact. This includes facilities such as flush/pour flush (to piped sewer system, septic tank, pit latrine), ventilated improved pit (VIP) latrine, pit latrine with slab, and a composting toilet. Note that having access to improved sanitation facilities greatly increases the likelihood – but doesn't guarantee – that people use safe sanitation facilities. We look at coverage of <em>safe</em> sanitation <a href="https://ourworldindata.org/sanitation#access-to-safe-sanitation"><strong>here</strong></a>.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>In 2020, 68% of the world population had access to improved sanitation facilities. This means almost one-third of people do not have access.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>In the map shown we see the share of people across the world that <em>do not</em> have access to improved sanitation.</p> <!-- /wp:paragraph --> <!-- wp:html --> <iframe style="width: 100%; height: 600px; border: 0px none;" src="https://ourworldindata.org/grapher/share-without-improved-sanitation" width="300" height="150"></iframe> <!-- /wp:html --> <!-- wp:heading {"level":3} --> <h3>How many people do not have access to improved sanitation?</h3> <!-- /wp:heading --> <!-- wp:paragraph --> <p>In the map shown we see the number of people across the world that <em>do not</em> have access to improved sanitation.</p> <!-- /wp:paragraph --> <!-- wp:html --> <iframe src="https://ourworldindata.org/grapher/number-without-access-to-improved-sanitation"></iframe> <!-- /wp:html --> <!-- wp:heading --> <h2>Open defecation</h2> <!-- /wp:heading --> <!-- wp:heading {"level":3} --> <h3>What share of people practice open defecation?</h3> <!-- /wp:heading --> <!-- wp:paragraph --> <p>Open defecation refers to the defecation in the open, such as in fields, forest, bushes, open bodies of water, on beaches, in other open spaces or disposed of with solid waste. Open defecation has a number of negative health and social impacts, including the spread of infectious diseases, diarrhoea (especially in children), adverse health outcomes in pregnancy, malnutrition, as well as increased vulnerability to violence — particularly for women and girls.{ref}Mara, D. (2017). The elimination of open defecation and its adverse health effects: a moral imperative for governments and development professionals. <em>Journal of Water Sanitation and Hygiene for Development</em>, <em>7</em>(1), 1-12. Available <a href="http://washdev.iwaponline.com/content/7/1/1">online</a>.{/ref}</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>In 2020, 6% of the world's population were still practicing open defecation.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>The map shows the share of people practicing open defecation across the world.</p> <!-- /wp:paragraph --> <!-- wp:html --> <iframe style="width: 100%; height: 600px; border: 0px none;" src="https://ourworldindata.org/grapher/people-practicing-open-defecation-of-population" width="300" height="150"></iframe> <!-- /wp:html --> <!-- wp:heading --> <h2>What determines levels of sanitation access?</h2> <!-- /wp:heading --> <!-- wp:heading {"level":3} --> <h3>Access to sanitation facilities increases with income</h3> <!-- /wp:heading --> <!-- wp:paragraph --> <p>The provision of sanitation facilities tends to increase with income. In the chart we see the share of the population with access to improved sanitation versus gross domestic product (GDP) per capita.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>Overall, we see a strong relationship between the two: access to improved sanitation increases as countries get richer.</p> <!-- /wp:paragraph --> <!-- wp:html --> <iframe style="width: 100%; height: 600px; border: 0px none;" src="https://ourworldindata.org/grapher/improved-sanitation-facilities-vs-gdp-per-capita" width="300" height="150"></iframe> <!-- /wp:html --> <!-- wp:heading {"level":3} --> <h3>Open defecation is mainly a rural issue</h3> <!-- /wp:heading --> <!-- wp:paragraph --> <p>As we see above, rural access to improved sanitation facilities typically lags behind urban areas for most countries. Although having access to improved sanitation facilities does not necessitate open defecation (some households can have very basic or shared sanitation facilities), we also see that open defecation is predominantly a rural issue for most countries.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>In the chart we see the prevalence of open defecation in rural areas versus urban areas. For the majority of countries, open defecation in urban areas is typically below 20 percent of the population. For rural populations, however, the share of the population practicing open defecation can range from less than 20 percent to almost 90 percent. Although open defecation in urban areas is still a pressing in many countries, the problem much more strongly concentrated in rural areas.</p> <!-- /wp:paragraph --> <!-- wp:html --> <iframe style="width: 100%; height: 600px; border: 0px none;" src="https://ourworldindata.org/grapher/open-defecation-in-rural-areas-vs-urban-areas" width="300" height="150"></iframe> <!-- /wp:html --> <!-- wp:heading --> <h2>Other health impacts of poor sanitation</h2> <!-- /wp:heading --> <!-- wp:heading {"level":4} --> <h4>Stunting is higher where access to improved sanitation is low</h4> <!-- /wp:heading --> <!-- wp:paragraph --> <p>Stunting — determined as having a height which falls below the median height-for-age WHO Child Growth Standards — is a sign of <a href="https://ourworldindata.org/hunger-and-undernourishment/#too-little-height-for-age-stunting">chronic malnutrition</a>.{ref}World Health Organization (2014). WHA Global Nutrition Targets 2025: Stunting Policy Brief. Available <a href="http://www.who.int/nutrition/topics/globaltargets_stunting_policybrief.pdf">online</a>.{/ref}</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>Although, linked to poor nutritional intake (which we cover in our entry on <a href="https://ourworldindata.org/hunger-and-undernourishment/">Hunger and Undernourishment</a>), it is linked to a range of compounding factors, including the recurrence of infectious diseases, childhood diarrhea, and poor sanitation & hygeine.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>In the chart we see the prevalence of stunting (measured as the share of children under 5-years-old defined as being more than two standard deviations below the median international height) versus the share of the population with improved sanitation facilities. Overall we see a negative correlation: rates of childhood stunting are typically higher in countries with lower access to improved sanitation facilities. </p> <!-- /wp:paragraph --> <!-- wp:html --> <iframe style="width: 100%; height: 600px; border: 0px none;" src="https://ourworldindata.org/grapher/prevalence-of-stunting-vs-improved-sanitation-facilities" width="300" height="150"></iframe> <!-- /wp:html --> <!-- wp:heading --> <h2>Definitions</h2> <!-- /wp:heading --> <!-- wp:paragraph --> <p><strong>Improved sanitation facilities</strong>: "An improved sanitation facility is defined as one that hygienically separates human excreta from human contact. They include flush/pour flush (to piped sewer system, septic tank, pit latrine), ventilated improved pit (VIP) latrine, pit latrine with slab, and composting toilet.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>Improved sanitation facilities range from simple but protected pit latrines to flush toilets with a sewerage connection. To be effective, facilities must be correctly constructed and properly maintained." {ref}World Bank & WHO/UNICEF Joint Monitoring Programme ( JMP ) for Water Supply and Sanitation. World Development Indicators Metadata. Available <a href="http://databank.worldbank.org/data/reports.aspx?source=2&type=metadata&series=SH.STA.ACSN">online</a>.{/ref}</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p><strong>Safely managed sanitation facilities</strong>: “Safely managed sanitation” <a href="https://www.who.int/water_sanitation_health/monitoring/coverage/explanatorynote-sdg-621-safelymanagedsanitationsServices161027.pdf">is defined</a> as the use of an improved sanitation facility which is not shared with other households and where:<br> • excreta is safely disposed in situ or <br> • excreta is transported and treated off-site.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>The definitions of categories of sanitation facilities coverage include:</p> <!-- /wp:paragraph --> <!-- wp:list --> <ul><li>'<strong>Basic service</strong>': Private improved facility which separates excreta from human contact;</li><li>'<strong>Limited service</strong>': Improved facility shared with other households;</li><li>'<strong>Unimproved service</strong>': Unimproved facility which does not separate excreta from human contact;</li><li>'<strong>No service</strong>': open defecation.</li></ul> <!-- /wp:list --> <!-- wp:paragraph --> <p><strong>Open defecation</strong>: "People practicing open defecation refers to the percentage of the population defecating in the open, such as in fields, forest, bushes, open bodies of water, on beaches, in other open spaces or disposed of with solid waste."</p> <!-- /wp:paragraph --> <!-- wp:image {"id":43854,"sizeSlug":"full","linkDestination":"none"} --> <figure class="wp-block-image size-full"><img src="https://owid.cloud/app/uploads/2021/06/Sanitation-definitions.png" alt="" class="wp-image-43854"/></figure> <!-- /wp:image --> <!-- wp:heading --> <h2>Explore more of our work on Clean Water and Sanitation</h2> <!-- /wp:heading --> <!-- wp-block-tombstone 43845 --> <!-- wp:owid/grid --> <!-- wp:owid/card {"linkUrl":"ourworldindata.org/explorers/water-and-sanitation","mediaId":39373,"mediaUrl":"https://owid.cloud/app/uploads/2021/01/data_explorer-featured.png","mediaAlt":"COVID-19 data explorer"} --> <!-- wp:paragraph --> <p>Explore all the metrics – clean drinking water, sanitation and handwashing access – in one place.</p> <!-- /wp:paragraph --> <!-- /wp:owid/card --> <!-- wp:owid/card {"linkUrl":"https://owid.cloud/water-access","mediaId":43900,"mediaUrl":"https://owid.cloud/app/uploads/2021/06/Clean-Water-thumbnail.png","mediaAlt":""} --> <!-- wp:paragraph --> <p>See how access to safe drinking water varies across the world.</p> <!-- /wp:paragraph --> <!-- /wp:owid/card --> <!-- wp:owid/card {"linkUrl":"https://owid.cloud/sanitation","mediaId":43902,"mediaUrl":"https://owid.cloud/app/uploads/2021/06/Sanitation-thumbnail.png","mediaAlt":""} --> <!-- wp:paragraph --> <p>How does access to sanitation vary across the world? See global progress on sanitation.</p> <!-- /wp:paragraph --> <!-- /wp:owid/card --> <!-- wp:owid/card {"linkUrl":"ourworldindata.org/hygiene","mediaId":43901,"mediaUrl":"https://owid.cloud/app/uploads/2021/06/Hygiene-thumbnail.png","mediaAlt":""} --> <!-- wp:paragraph --> <p>How many people lack access to basic handwashing facilities? Explore the global data on hygiene. </p> <!-- /wp:paragraph --> <!-- /wp:owid/card --> <!-- /wp:owid/grid --> <!-- wp:paragraph --> <p></p> <!-- /wp:paragraph -->	{ "id": "wp-24932", "slug": "sanitation", "content": { "toc": [], "body": [ { "type": "text", "value": [ { "text": "First published in September 2019. 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This chart is shown for the global total, but can be explored for any country or region using the \"change country\" toggle.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "Lack of access to poor sanitation is a leading risk factor for infectious diseases, including cholera, ", "spanType": "span-simple-text" }, { "url": "https://owid.cloud/diarrheal-diseases", "children": [ { "text": "diarrhoea", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": ", dysentery, hepatitis A, typhoid and ", "spanType": "span-simple-text" }, { "url": "https://owid.cloud/polio", "children": [ { "text": "polio", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": ".{ref}WHO (2019) \u2013 Fact sheet \u2013 Drinking water. Updated June 2019. Online ", "spanType": "span-simple-text" }, { "url": "https://www.who.int/news-room/fact-sheets/detail/sanitation", "children": [ { "text": "here", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": ".{/ref} It also exacerbates malnutrition, and in particular, ", "spanType": "span-simple-text" }, { "url": "https://ourworldindata.org/hunger-and-undernourishment#too-little-height-for-age-stunting", "children": [ { "text": "childhood stunting", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": ". In the chart we see that it ranks as a very important risk factor for death globally. ", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "According to the ", "spanType": "span-simple-text" }, { "children": [ { "text": "Global Burden of Disease", "spanType": "span-simple-text" } ], "spanType": "span-italic" }, { "text": " study 775,000 people died prematurely in 2017 as a result of poor sanitation. To put this into context: this was almost double the ", "spanType": "span-simple-text" }, { "url": "https://ourworldindata.org/grapher/annual-number-of-deaths-by-cause", "children": [ { "text": "number of homicides", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": " \u2013 close to 400,000 in 2017.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "url": "https://ourworldindata.org/grapher/number-of-deaths-by-risk-factor", "type": "chart", "parseErrors": [] }, { "type": "horizontal-rule", "parseErrors": [] }, { "text": [ { "text": "The global distribution of deaths from sanitation", "spanType": "span-simple-text" } ], "type": "heading", "level": 1, "parseErrors": [] }, { "type": "horizontal-rule", "parseErrors": [] }, { "text": [ { "text": "In low-income countries poor sanitation accounts for 5% of deaths", "spanType": "span-simple-text" } ], "type": "heading", "level": 3, "parseErrors": [] }, { "type": "text", "value": [ { "text": "An estimated 775,000 people died prematurely as a result of poor sanitation in 2017. This was 1.4% of global deaths.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "In low-income countries, it accounts for 5% of deaths.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "In the map here we see the share of annual deaths attributed to unsafe sanitation across the world. In 2017 this ranged from a high of close to 11% in Chad \u2013 more than 1-in-10 deaths \u2013 to less than 0.01% across most of Europe.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "When we compare the share of deaths attributed to unsafe sanitation either over time or between countries, we are not only comparing the extent of sanitation, but its severity ", "spanType": "span-simple-text" }, { "children": [ { "text": "in the context", "spanType": "span-simple-text" } ], "spanType": "span-italic" }, { "text": " of other risk factors for death. Sanitation's share does not only depend on how many die prematurely from it, but what else people are dying from and how this is changing.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "url": "https://ourworldindata.org/grapher/share-deaths-unsafe-sanitation", "type": "chart", "parseErrors": [] }, { "text": [ { "text": "Death rates are much higher in low-income countries", "spanType": "span-simple-text" } ], "type": "heading", "level": 3, "parseErrors": [] }, { "type": "text", "value": [ { "text": "Death rates from unsafe sanitation give us an accurate comparison of differences in its mortality impacts between countries and over time. In contrast to the share of deaths that we studied before, death rates are not influenced by how other causes or risk factors for death are changing.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "In this map we see death rates from unsafe sanitation across the world. Death rates measure the number of deaths per 100,000 people in a given country or region.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "What becomes clear is the large differences in death rates between countries: rates are high in lower-income countries, particularly across Sub-Saharan Africa and Asia. Rates here are often greater than 50 deaths per 100,000 \u2013 in the Central African Republic and Chad this was over 120 per 100,000.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "Compare this with death rates across high-income countries: across Europe rates are below 0.1 deaths per 100,000. That\u2019s a greater than 1000-fold difference.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "The issue of unsafe water is therefore one which is largely limited to low and lower-middle income countries.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "We see this relationship clearly when we plot death rates versus income, as shown\u00a0", "spanType": "span-simple-text" }, { "url": "https://ourworldindata.org/grapher/death-rates-from-unsafe-sanitation-vs-gdp-per-capita", "children": [ { "children": [ { "text": "here", "spanType": "span-simple-text" } ], "spanType": "span-bold" } ], "spanType": "span-link" }, { "text": ". There is a strong negative relationship: death rates decline as countries get richer.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "url": "https://ourworldindata.org/grapher/death-rates-sanitation", "type": "chart", "parseErrors": [] }, { "type": "horizontal-rule", "parseErrors": [] }, { "text": [ { "text": "Access to safe sanitation", "spanType": "span-simple-text" } ], "type": "heading", "level": 1, "parseErrors": [] }, { "type": "horizontal-rule", "parseErrors": [] }, { "text": [ { "text": "What share of people use safely managed sanitation facilities?", "spanType": "span-simple-text" } ], "type": "heading", "level": 2, "parseErrors": [] }, { "text": [ { "text": "Nearly half of the world do not have access to safe sanitation", "spanType": "span-simple-text" } ], "type": "heading", "level": 3, "parseErrors": [] }, { "type": "text", "value": [ { "url": "https://sdg-tracker.org/water-and-sanitation#6.2", "children": [ { "text": "SDG Target 6.2", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": " is to: \u201cachieve access to adequate and equitable sanitation and hygiene for all and end open defecation\u201d by 2030.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "children": [ { "text": "Where are we today? ", "spanType": "span-simple-text" } ], "spanType": "span-bold" }, { "text": "In 2020, just over half (54%) of the world population had access to ", "spanType": "span-simple-text" }, { "url": "http://ourworldindata.org/sanitation#definitions", "children": [ { "text": "safely managed sanitation", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": ". It is shocking that nearly one-in-two don\u2019t. Around 6% do not have ", "spanType": "span-simple-text" }, { "children": [ { "text": "any", "spanType": "span-simple-text" } ], "spanType": "span-italic" }, { "text": " sanitation facilities at all, and instead have to practice open defecation.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "In the chart we see the breakdown of sanitation access globally, and across regions and income groups. We see that in countries at the lowest incomes, less than one-fifth of the population have safe sanitation. Much like safe drinking water, most live in Sub-Saharan Africa.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "children": [ { "text": "Are we making progress? ", "spanType": "span-simple-text" } ], "spanType": "span-bold" }, { "text": "The world has made progress in the last five years. But again, this has been far too slow albeit slightly faster than our progress on drinking water. In 2015 only 47% of the global population had safe sanitation. That means we\u2019ve seen an increase of seven percentage points over five years.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "The gap between where we are now and universal access is still huge. Our progress is far too slow to achieve this by 2030. If progress continues at these rates, we would only reach 68% by 2030. Almost one-third of the world would miss out. If we\u2019re to meet our target we need almost exactly the same acceleration as our progress on drinking water: rates would need to more than triple (increase 3.3-fold) for the coming decade.{ref}To reach universal access within 10 years (the current gap is 46%) we need to see a 23 percentage point increase every five years. That\u2019s 3.3 times higher than the 7 percentage point increase we\u2019ve seen in the last five years.{/ref}", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "url": "https://ourworldindata.org/grapher/share-of-the-population-with-access-to-sanitation-facilities", "type": "chart", "parseErrors": [] }, { "url": "https://ourworldindata.org/explorers/water-and-sanitation?tab=chart&Resource=Sanitation&Level+of+Access=Safely+managed&Residence=Total&Relative+to+population=Share+of+population&country=OWID_WRL&hideControls=true", "type": "chart", "parseErrors": [] }, { "text": [ { "text": "Access to safe sanitation by country", "spanType": "span-simple-text" } ], "type": "heading", "level": 3, "parseErrors": [] }, { "type": "text", "value": [ { "text": "In the map shown we see the share of people across the world that have access to safely managed sanitation. ", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "url": "https://ourworldindata.org/grapher/share-using-safely-managed-sanitation", "type": "chart", "parseErrors": [] }, { "text": [ { "text": "How many people do not have access to safe sanitation?", "spanType": "span-simple-text" } ], "type": "heading", "level": 2, "parseErrors": [] }, { "type": "text", "value": [ { "text": "In the map shown we see the number of people across the world that ", "spanType": "span-simple-text" }, { "children": [ { "text": "do not", "spanType": "span-simple-text" } ], "spanType": "span-italic" }, { "text": " have access to safely managed sanitation.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "url": "https://ourworldindata.org/grapher/safe-sanitation-without", "type": "chart", "parseErrors": [] }, { "type": "horizontal-rule", "parseErrors": [] }, { "text": [ { "text": "Access to improved sanitation", "spanType": "span-simple-text" } ], "type": "heading", "level": 1, "parseErrors": [] }, { "type": "horizontal-rule", "parseErrors": [] }, { "text": [ { "text": "What share of people do not have access to improved sanitation?", "spanType": "span-simple-text" } ], "type": "heading", "level": 2, "parseErrors": [] }, { "type": "text", "value": [ { "text": "'Improved' sanitation is defined as facilities which ensure hygienic separation of human excreta from human contact. This includes facilities such as flush/pour flush (to piped sewer system, septic tank, pit latrine), ventilated improved pit (VIP) latrine, pit latrine with slab, and a composting toilet. Note that having access to improved sanitation facilities greatly increases the likelihood \u2013 but doesn't guarantee \u2013 that people use safe sanitation facilities. We look at coverage of ", "spanType": "span-simple-text" }, { "children": [ { "text": "safe", "spanType": "span-simple-text" } ], "spanType": "span-italic" }, { "text": " sanitation ", "spanType": "span-simple-text" }, { "url": "https://ourworldindata.org/sanitation#access-to-safe-sanitation", "children": [ { "children": [ { "text": "here", "spanType": "span-simple-text" } ], "spanType": "span-bold" } ], "spanType": "span-link" }, { "text": ".", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "In 2020, 68% of the world population had access to improved sanitation facilities. This means almost one-third of people do not have access.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "In the map shown we see the share of people across the world that ", "spanType": "span-simple-text" }, { "children": [ { "text": "do not", "spanType": "span-simple-text" } ], "spanType": "span-italic" }, { "text": " have access to improved sanitation.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "url": "https://ourworldindata.org/grapher/share-without-improved-sanitation", "type": "chart", "parseErrors": [] }, { "text": [ { "text": "How many people do not have access to improved sanitation?", "spanType": "span-simple-text" } ], "type": "heading", "level": 2, "parseErrors": [] }, { "type": "text", "value": [ { "text": "In the map shown we see the number of people across the world that ", "spanType": "span-simple-text" }, { "children": [ { "text": "do not", "spanType": "span-simple-text" } ], "spanType": "span-italic" }, { "text": " have access to improved sanitation.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "url": "https://ourworldindata.org/grapher/number-without-access-to-improved-sanitation", "type": "chart", "parseErrors": [] }, { "type": "horizontal-rule", "parseErrors": [] }, { "text": [ { "text": "Open defecation", "spanType": "span-simple-text" } ], "type": "heading", "level": 1, "parseErrors": [] }, { "type": "horizontal-rule", "parseErrors": [] }, { "text": [ { "text": "What share of people practice open defecation?", "spanType": "span-simple-text" } ], "type": "heading", "level": 2, "parseErrors": [] }, { "type": "text", "value": [ { "text": "Open defecation refers to the defecation in the open, such as in fields, forest, bushes, open bodies of water, on beaches, in other open spaces or disposed of with solid waste. Open defecation has a number of negative health and social impacts, including the spread of infectious diseases, diarrhoea (especially in children), adverse health outcomes in pregnancy, malnutrition, as well as increased vulnerability to violence \u2014 particularly for women and girls.{ref}Mara, D. (2017). The elimination of open defecation and its adverse health effects: a moral imperative for governments and development professionals.\u00a0", "spanType": "span-simple-text" }, { "children": [ { "text": "Journal of Water Sanitation and Hygiene for Development", "spanType": "span-simple-text" } ], "spanType": "span-italic" }, { "text": ",\u00a0", "spanType": "span-simple-text" }, { "children": [ { "text": "7", "spanType": "span-simple-text" } ], "spanType": "span-italic" }, { "text": "(1), 1-12. Available ", "spanType": "span-simple-text" }, { "url": "http://washdev.iwaponline.com/content/7/1/1", "children": [ { "text": "online", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": ".{/ref}", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "In 2020, 6% of the world's population were still practicing open defecation.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "The map shows the share of people practicing open defecation across the world.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "url": "https://ourworldindata.org/grapher/people-practicing-open-defecation-of-population", "type": "chart", "parseErrors": [] }, { "type": "horizontal-rule", "parseErrors": [] }, { "text": [ { "text": "What determines levels of sanitation access?", "spanType": "span-simple-text" } ], "type": "heading", "level": 1, "parseErrors": [] }, { "type": "horizontal-rule", "parseErrors": [] }, { "text": [ { "text": "Access to sanitation facilities increases with income", "spanType": "span-simple-text" } ], "type": "heading", "level": 2, "parseErrors": [] }, { "type": "text", "value": [ { "text": "The provision of sanitation facilities tends to increase with income. In the chart we see the share of the population with access to improved sanitation versus gross domestic product (GDP) per capita.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "Overall, we see a strong relationship between the two: access to improved sanitation increases as countries get richer.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "url": "https://ourworldindata.org/grapher/improved-sanitation-facilities-vs-gdp-per-capita", "type": "chart", "parseErrors": [] }, { "text": [ { "text": "Open defecation is mainly a rural issue", "spanType": "span-simple-text" } ], "type": "heading", "level": 2, "parseErrors": [] }, { "type": "text", "value": [ { "text": "As we see above, rural access to improved sanitation facilities typically lags behind urban areas for most countries. Although having access to improved sanitation facilities does not necessitate open defecation (some households can have very basic or shared sanitation facilities), we also see that open defecation is predominantly a rural issue for most countries.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "In the chart we see the prevalence of open defecation in rural areas versus urban areas. For the majority of countries, open defecation in urban areas is typically below 20 percent of the population. For rural populations, however, the share of the population practicing open defecation can range from less than 20 percent to almost 90 percent. Although open defecation in urban areas is still a pressing in many countries, the problem much more strongly concentrated in rural areas.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "url": "https://ourworldindata.org/grapher/open-defecation-in-rural-areas-vs-urban-areas", "type": "chart", "parseErrors": [] }, { "type": "horizontal-rule", "parseErrors": [] }, { "text": [ { "text": "Other health impacts of poor sanitation", "spanType": "span-simple-text" } ], "type": "heading", "level": 1, "parseErrors": [] }, { "type": "horizontal-rule", "parseErrors": [] }, { "text": [ { "text": "Stunting is higher where access to improved sanitation is low", "spanType": "span-simple-text" } ], "type": "heading", "level": 3, "parseErrors": [] }, { "type": "text", "value": [ { "text": "Stunting \u2014 determined as having a height which falls below the median height-for-age WHO Child Growth Standards\u00a0\u2014 is a sign of ", "spanType": "span-simple-text" }, { "url": "https://ourworldindata.org/hunger-and-undernourishment/#too-little-height-for-age-stunting", "children": [ { "text": "chronic malnutrition", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": ".{ref}World Health Organization (2014). WHA Global Nutrition Targets 2025: Stunting Policy Brief. Available\u00a0", "spanType": "span-simple-text" }, { "url": "http://www.who.int/nutrition/topics/globaltargets_stunting_policybrief.pdf", "children": [ { "text": "online", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": ".{/ref}", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "Although, linked to poor nutritional intake (which we cover in our entry on ", "spanType": "span-simple-text" }, { "url": "https://ourworldindata.org/hunger-and-undernourishment/", "children": [ { "text": "Hunger and Undernourishment", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": "), it is linked to a range of compounding factors, including the recurrence of infectious diseases, childhood diarrhea, and poor sanitation & hygeine.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "In the chart we see the prevalence of stunting (measured as the share of children under 5-years-old defined as being more than two standard deviations below\u00a0the median international height) versus the share of the population with improved sanitation facilities. Overall we see a negative correlation: rates of childhood stunting are typically higher in countries with lower access to improved sanitation facilities.\u00a0", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "url": "https://ourworldindata.org/grapher/prevalence-of-stunting-vs-improved-sanitation-facilities", "type": "chart", "parseErrors": [] }, { "type": "horizontal-rule", "parseErrors": [] }, { "text": [ { "text": "Definitions", "spanType": "span-simple-text" } ], "type": "heading", "level": 1, "parseErrors": [] }, { "type": "horizontal-rule", "parseErrors": [] }, { "type": "text", "value": [ { "children": [ { "text": "Improved sanitation facilities", "spanType": "span-simple-text" } ], "spanType": "span-bold" }, { "text": ": \"An improved sanitation facility is defined as one that hygienically separates human excreta from human contact.\u00a0They include flush/pour flush (to piped sewer system, septic tank, pit latrine), ventilated improved pit (VIP) latrine, pit latrine with slab, and composting toilet.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "Improved sanitation facilities range from simple but protected pit latrines to flush toilets with a sewerage connection. To be effective, facilities must be correctly constructed and properly maintained.\"\u00a0{ref}World Bank &\u00a0WHO/UNICEF Joint Monitoring Programme ( JMP ) for Water Supply and Sanitation. World Development Indicators Metadata. 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See global progress on sanitation.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "How many people lack access to basic handwashing facilities? Explore the global data on hygiene. ", "spanType": "span-simple-text" } ], "parseErrors": [] } ], "type": "linear-topic-page", "title": "Sanitation", "authors": [ "Hannah Ritchie", "Max Roser" ], "excerpt": "Access to safe sanitation is essential for reducing deaths from infectious disease, preventing malnutrition and providing dignity. \nWhat is the global situation today and how can we make progress?", "dateline": "September 25, 2019", "subtitle": "Access to safe sanitation is essential for reducing deaths from infectious disease, preventing malnutrition and providing dignity. \nWhat is the global situation today and how can we make progress?", "sticky-nav": [], "sidebar-toc": true, "featured-image": "Sanitation-thumbnail.png" }, "createdAt": "2019-09-25T17:00:31.000Z", "published": false, "updatedAt": "2022-04-12T13:28:45.000Z", "revisionId": null, "publishedAt": "2019-09-25T16:00:31.000Z", "relatedCharts": [], "publicationContext": "listed" }	{ "errors": [ { "name": "unexpected wp component tag", "details": "Found unhandled wp:comment tag list" }, { "name": "unexpected wp component tag", "details": "Found unhandled wp:comment tag image" }, { "name": "unexpected wp component tag", "details": "Found unhandled wp:comment tag owid/card" }, { "name": "unexpected wp component tag", "details": "Found unhandled wp:comment tag owid/card" }, { "name": "unexpected wp component tag", "details": "Found unhandled wp:comment tag owid/card" }, { "name": "unexpected wp component tag", "details": "Found unhandled wp:comment tag owid/card" }, { "name": "unexpected wp component tag", "details": "Found unhandled wp:comment tag owid/grid" } ], "numBlocks": 102, "numErrors": 7, "wpTagCounts": { "html": 15, "list": 2, "image": 1, "column": 2, "columns": 1, "heading": 22, "owid/card": 4, "owid/grid": 1, "paragraph": 47, "owid/summary": 1 }, "htmlTagCounts": { "p": 47, "h2": 9, "h3": 7, "h4": 6, "ul": 2, "div": 4, "figure": 1, "iframe": 13 } }	2019-09-25 16:00:31	2024-02-16 14:22:40	1vb0BMBIbn8XvTgQcsiVEkGU8O61hMzbafLfQH8D1G-c	[ "Hannah Ritchie" ]	Access to safe sanitation is essential for reducing deaths from infectious disease, preventing malnutrition and providing dignity. What is the global situation today and how can we make progress?	2019-09-25 17:00:31	2022-04-12 13:28:45	https://ourworldindata.org/wp-content/uploads/2021/06/Sanitation-thumbnail.png	{ "subnavId": "water", "subnavCurrentId": "sanitation" }	First published in September 2019. Latest update in June 2021. --- # Unsafe sanitation is a leading risk factor for death --- ### Unsafe sanitation is responsible for 775,000 deaths each year Unsafe sanitation is one of the world's largest health and environmental problems – particularly for the [poorest in the world](https://owid.cloud/extreme-poverty). The _Global Burden of Disease_ is a major global study on the causes and risk factors for death and disease published in the medical journal _The Lancet_.{ref}The latest study can be found at the website of the Lancet here: [TheLancet.com/GBD](https://www.thelancet.com/gbd) The 2017 study was published as GBD 2017 Risk Factor Collaborators – "Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017" and is online [here](http://www.healthdata.org/research-article/global-regional-and-national-comparative-risk-assessment-84-behavioral-0).{/ref} These estimates of the annual number of deaths attributed to a wide range of risk factors are shown here. This chart is shown for the global total, but can be explored for any country or region using the "change country" toggle. Lack of access to poor sanitation is a leading risk factor for infectious diseases, including cholera, [diarrhoea](https://owid.cloud/diarrheal-diseases), dysentery, hepatitis A, typhoid and [polio](https://owid.cloud/polio).{ref}WHO (2019) – Fact sheet – Drinking water. Updated June 2019. Online [here](https://www.who.int/news-room/fact-sheets/detail/sanitation).{/ref} It also exacerbates malnutrition, and in particular, [childhood stunting](https://ourworldindata.org/hunger-and-undernourishment#too-little-height-for-age-stunting). In the chart we see that it ranks as a very important risk factor for death globally. According to the _Global Burden of Disease_ study 775,000 people died prematurely in 2017 as a result of poor sanitation. To put this into context: this was almost double the [number of homicides](https://ourworldindata.org/grapher/annual-number-of-deaths-by-cause) – close to 400,000 in 2017. <Chart url="https://ourworldindata.org/grapher/number-of-deaths-by-risk-factor"/> --- # The global distribution of deaths from sanitation --- ### In low-income countries poor sanitation accounts for 5% of deaths An estimated 775,000 people died prematurely as a result of poor sanitation in 2017. This was 1.4% of global deaths. In low-income countries, it accounts for 5% of deaths. In the map here we see the share of annual deaths attributed to unsafe sanitation across the world. In 2017 this ranged from a high of close to 11% in Chad – more than 1-in-10 deaths – to less than 0.01% across most of Europe. When we compare the share of deaths attributed to unsafe sanitation either over time or between countries, we are not only comparing the extent of sanitation, but its severity _in the context_ of other risk factors for death. Sanitation's share does not only depend on how many die prematurely from it, but what else people are dying from and how this is changing. <Chart url="https://ourworldindata.org/grapher/share-deaths-unsafe-sanitation"/> ### Death rates are much higher in low-income countries Death rates from unsafe sanitation give us an accurate comparison of differences in its mortality impacts between countries and over time. In contrast to the share of deaths that we studied before, death rates are not influenced by how other causes or risk factors for death are changing. In this map we see death rates from unsafe sanitation across the world. Death rates measure the number of deaths per 100,000 people in a given country or region. What becomes clear is the large differences in death rates between countries: rates are high in lower-income countries, particularly across Sub-Saharan Africa and Asia. Rates here are often greater than 50 deaths per 100,000 – in the Central African Republic and Chad this was over 120 per 100,000. Compare this with death rates across high-income countries: across Europe rates are below 0.1 deaths per 100,000. That’s a greater than 1000-fold difference. The issue of unsafe water is therefore one which is largely limited to low and lower-middle income countries. We see this relationship clearly when we plot death rates versus income, as shown [here](https://ourworldindata.org/grapher/death-rates-from-unsafe-sanitation-vs-gdp-per-capita). There is a strong negative relationship: death rates decline as countries get richer. <Chart url="https://ourworldindata.org/grapher/death-rates-sanitation"/> --- # Access to safe sanitation --- ## What share of people use safely managed sanitation facilities? ### Nearly half of the world do not have access to safe sanitation [SDG Target 6.2](https://sdg-tracker.org/water-and-sanitation#6.2) is to: “achieve access to adequate and equitable sanitation and hygiene for all and end open defecation” by 2030. Where are we today? In 2020, just over half (54%) of the world population had access to [safely managed sanitation](http://ourworldindata.org/sanitation#definitions). It is shocking that nearly one-in-two don’t. Around 6% do not have _any_ sanitation facilities at all, and instead have to practice open defecation. In the chart we see the breakdown of sanitation access globally, and across regions and income groups. We see that in countries at the lowest incomes, less than one-fifth of the population have safe sanitation. Much like safe drinking water, most live in Sub-Saharan Africa. Are we making progress? The world has made progress in the last five years. But again, this has been far too slow albeit slightly faster than our progress on drinking water. In 2015 only 47% of the global population had safe sanitation. That means we’ve seen an increase of seven percentage points over five years. The gap between where we are now and universal access is still huge. Our progress is far too slow to achieve this by 2030. If progress continues at these rates, we would only reach 68% by 2030. Almost one-third of the world would miss out. If we’re to meet our target we need almost exactly the same acceleration as our progress on drinking water: rates would need to more than triple (increase 3.3-fold) for the coming decade.{ref}To reach universal access within 10 years (the current gap is 46%) we need to see a 23 percentage point increase every five years. That’s 3.3 times higher than the 7 percentage point increase we’ve seen in the last five years.{/ref} <Chart url="https://ourworldindata.org/grapher/share-of-the-population-with-access-to-sanitation-facilities"/> <Chart url="https://ourworldindata.org/explorers/water-and-sanitation?tab=chart&Resource=Sanitation&Level+of+Access=Safely+managed&Residence=Total&Relative+to+population=Share+of+population&country=OWID_WRL&hideControls=true"/> ### Access to safe sanitation by country In the map shown we see the share of people across the world that have access to safely managed sanitation. <Chart url="https://ourworldindata.org/grapher/share-using-safely-managed-sanitation"/> ## How many people do not have access to safe sanitation? In the map shown we see the number of people across the world that _do not_ have access to safely managed sanitation. <Chart url="https://ourworldindata.org/grapher/safe-sanitation-without"/> --- # Access to improved sanitation --- ## What share of people do not have access to improved sanitation? 'Improved' sanitation is defined as facilities which ensure hygienic separation of human excreta from human contact. This includes facilities such as flush/pour flush (to piped sewer system, septic tank, pit latrine), ventilated improved pit (VIP) latrine, pit latrine with slab, and a composting toilet. Note that having access to improved sanitation facilities greatly increases the likelihood – but doesn't guarantee – that people use safe sanitation facilities. We look at coverage of _safe_ sanitation [here](https://ourworldindata.org/sanitation#access-to-safe-sanitation). In 2020, 68% of the world population had access to improved sanitation facilities. This means almost one-third of people do not have access. In the map shown we see the share of people across the world that _do not_ have access to improved sanitation. <Chart url="https://ourworldindata.org/grapher/share-without-improved-sanitation"/> ## How many people do not have access to improved sanitation? In the map shown we see the number of people across the world that _do not_ have access to improved sanitation. <Chart url="https://ourworldindata.org/grapher/number-without-access-to-improved-sanitation"/> --- # Open defecation --- ## What share of people practice open defecation? Open defecation refers to the defecation in the open, such as in fields, forest, bushes, open bodies of water, on beaches, in other open spaces or disposed of with solid waste. Open defecation has a number of negative health and social impacts, including the spread of infectious diseases, diarrhoea (especially in children), adverse health outcomes in pregnancy, malnutrition, as well as increased vulnerability to violence — particularly for women and girls.{ref}Mara, D. (2017). The elimination of open defecation and its adverse health effects: a moral imperative for governments and development professionals. _Journal of Water Sanitation and Hygiene for Development_, _7_(1), 1-12. Available [online](http://washdev.iwaponline.com/content/7/1/1).{/ref} In 2020, 6% of the world's population were still practicing open defecation. The map shows the share of people practicing open defecation across the world. <Chart url="https://ourworldindata.org/grapher/people-practicing-open-defecation-of-population"/> --- # What determines levels of sanitation access? --- ## Access to sanitation facilities increases with income The provision of sanitation facilities tends to increase with income. In the chart we see the share of the population with access to improved sanitation versus gross domestic product (GDP) per capita. Overall, we see a strong relationship between the two: access to improved sanitation increases as countries get richer. <Chart url="https://ourworldindata.org/grapher/improved-sanitation-facilities-vs-gdp-per-capita"/> ## Open defecation is mainly a rural issue As we see above, rural access to improved sanitation facilities typically lags behind urban areas for most countries. Although having access to improved sanitation facilities does not necessitate open defecation (some households can have very basic or shared sanitation facilities), we also see that open defecation is predominantly a rural issue for most countries. In the chart we see the prevalence of open defecation in rural areas versus urban areas. For the majority of countries, open defecation in urban areas is typically below 20 percent of the population. For rural populations, however, the share of the population practicing open defecation can range from less than 20 percent to almost 90 percent. Although open defecation in urban areas is still a pressing in many countries, the problem much more strongly concentrated in rural areas. <Chart url="https://ourworldindata.org/grapher/open-defecation-in-rural-areas-vs-urban-areas"/> --- # Other health impacts of poor sanitation --- ### Stunting is higher where access to improved sanitation is low Stunting — determined as having a height which falls below the median height-for-age WHO Child Growth Standards — is a sign of [chronic malnutrition](https://ourworldindata.org/hunger-and-undernourishment/#too-little-height-for-age-stunting).{ref}World Health Organization (2014). WHA Global Nutrition Targets 2025: Stunting Policy Brief. Available [online](http://www.who.int/nutrition/topics/globaltargets_stunting_policybrief.pdf).{/ref} Although, linked to poor nutritional intake (which we cover in our entry on [Hunger and Undernourishment](https://ourworldindata.org/hunger-and-undernourishment/)), it is linked to a range of compounding factors, including the recurrence of infectious diseases, childhood diarrhea, and poor sanitation & hygeine. In the chart we see the prevalence of stunting (measured as the share of children under 5-years-old defined as being more than two standard deviations below the median international height) versus the share of the population with improved sanitation facilities. Overall we see a negative correlation: rates of childhood stunting are typically higher in countries with lower access to improved sanitation facilities. <Chart url="https://ourworldindata.org/grapher/prevalence-of-stunting-vs-improved-sanitation-facilities"/> --- # Definitions --- Improved sanitation facilities: "An improved sanitation facility is defined as one that hygienically separates human excreta from human contact. They include flush/pour flush (to piped sewer system, septic tank, pit latrine), ventilated improved pit (VIP) latrine, pit latrine with slab, and composting toilet. Improved sanitation facilities range from simple but protected pit latrines to flush toilets with a sewerage connection. To be effective, facilities must be correctly constructed and properly maintained." {ref}World Bank & WHO/UNICEF Joint Monitoring Programme ( JMP ) for Water Supply and Sanitation. World Development Indicators Metadata. Available [online](http://databank.worldbank.org/data/reports.aspx?source=2&type=metadata&series=SH.STA.ACSN).{/ref} Safely managed sanitation facilities: “Safely managed sanitation” [is defined](https://www.who.int/water_sanitation_health/monitoring/coverage/explanatorynote-sdg-621-safelymanagedsanitationsServices161027.pdf) as the use of an improved sanitation facility which is not shared with other households and where: • excreta is safely disposed in situ or • excreta is transported and treated off-site. The definitions of categories of sanitation facilities coverage include: * 'Basic service': Private improved facility which separates excreta from human contact; * 'Limited service': Improved facility shared with other households; * 'Unimproved service': Unimproved facility which does not separate excreta from human contact; * 'No service': open defecation. Open defecation: "People practicing open defecation refers to the percentage of the population defecating in the open, such as in fields, forest, bushes, open bodies of water, on beaches, in other open spaces or disposed of with solid waste." <Image filename="Sanitation-definitions.png" alt=""/> --- # Explore more of our work on Clean Water and Sanitation --- Explore all the metrics – clean drinking water, sanitation and handwashing access – in one place. See how access to safe drinking water varies across the world. How does access to sanitation vary across the world? See global progress on sanitation. How many people lack access to basic handwashing facilities? Explore the global data on hygiene.	{ "id": 24932, "date": "2019-09-25T17:00:31", "guid": { "rendered": "https://owid.cloud/?page_id=24932" }, "link": "https://owid.cloud/sanitation", "meta": { "owid_publication_context_meta_field": [], "owid_key_performance_indicators_meta_field": { "raw": "3.7 billion people do not have access to safely managed sanitation.\n\nThat's 46% of the world population.", "rendered": "<p><strong>3.7 billion</strong> people do not have access to safely managed sanitation.</p>\n<p>That's <strong>46%</strong> of the world population.</p>\n" } }, "slug": "sanitation", "tags": [], "type": "page", "title": { "rendered": "Sanitation" }, "_links": { "self": [ { "href": "https://owid.cloud/wp-json/wp/v2/pages/24932" } ], "about": [ { "href": "https://owid.cloud/wp-json/wp/v2/types/page" } ], "author": [ { "href": "https://owid.cloud/wp-json/wp/v2/users/17", "embeddable": true } ], "curies": [ { "href": "https://api.w.org/{rel}", "name": "wp", "templated": true } ], "replies": [ { "href": "https://owid.cloud/wp-json/wp/v2/comments?post=24932", "embeddable": true } ], "wp:term": [ { "href": "https://owid.cloud/wp-json/wp/v2/categories?post=24932", "taxonomy": "category", "embeddable": true }, { "href": "https://owid.cloud/wp-json/wp/v2/tags?post=24932", "taxonomy": "post_tag", "embeddable": true } ], "collection": [ { "href": "https://owid.cloud/wp-json/wp/v2/pages" } ], "wp:attachment": [ { "href": "https://owid.cloud/wp-json/wp/v2/media?parent=24932" } ], "version-history": [ { "href": "https://owid.cloud/wp-json/wp/v2/pages/24932/revisions", "count": 25 } ], "wp:featuredmedia": [ { "href": "https://owid.cloud/wp-json/wp/v2/media/43902", "embeddable": true } ], "predecessor-version": [ { "id": 50689, "href": "https://owid.cloud/wp-json/wp/v2/pages/24932/revisions/50689" } ] }, "author": 17, "parent": 0, "status": "publish", "content": { "rendered": "\n<!-- formatting-options subnavId:water subnavCurrentId:sanitation -->\n\n\n\n<div class=\"blog-info\">First published in September 2019. Latest update in June 2021.</div>\n\n\n\t<div class=\"wp-block-owid-summary\">\n\t\t<h2>Summary</h2>\n\t\t\n\n<ul><li><a href=\"https://ourworldindata.org/sanitation#unsafe-sanitation-is-a-leading-risk-factor-for-death\">Unsafe sanitation is responsible for 775,000 deaths each year.</a></li><li><a href=\"https://ourworldindata.org/sanitation#the-global-distribution-of-deaths-from-sanitation\">5% of deaths in low-income countries result from unsafe sanitation</a></li><li><a href=\"https://ourworldindata.org/sanitation#access-to-safe-sanitation\">46% of the world do not have access to safely managed sanitation.</a></li><li><a href=\"https://ourworldindata.org/sanitation#open-defecation\">6% of the world still practice open defecation.</a></li><li><a href=\"https://ourworldindata.org/sanitation#other-health-impacts-of-poor-sanitation\">Unsafe sanitation has a significant impact on childhood stunting.</a></li></ul>\n\n\n\n<p></p>\n\n\n\t</div>\n\n\n<h2>Unsafe sanitation is a leading risk factor for death</h2>\n\n\n\n<h4>Unsafe sanitation is responsible for 775,000 deaths each year</h4>\n\n\n\n<p>Unsafe sanitation is one of the world’s largest health and environmental problems \u2013 particularly for the <a href=\"https://owid.cloud/extreme-poverty\">poorest in the world</a>.</p>\n\n\n\n<p>The <em>Global Burden of Disease</em> is a major global study on the causes and risk factors for death and disease published in the medical journal <em>The Lancet</em>.{ref}The latest study can be found at the website of the Lancet here: <a href=\"https://www.thelancet.com/gbd\">TheLancet.com/GBD</a></p>\n\n\n\n<p>The 2017 study was published as GBD 2017 Risk Factor Collaborators \u2013 “Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017” and is online <a href=\"http://www.healthdata.org/research-article/global-regional-and-national-comparative-risk-assessment-84-behavioral-0\">here</a>.{/ref} These estimates of the annual number of deaths attributed to a wide range of risk factors are shown here. This chart is shown for the global total, but can be explored for any country or region using the “change country” toggle.</p>\n\n\n\n<p>Lack of access to poor sanitation is a leading risk factor for infectious diseases, including cholera, <a href=\"https://owid.cloud/diarrheal-diseases\">diarrhoea</a>, dysentery, hepatitis A, typhoid and <a href=\"https://owid.cloud/polio\">polio</a>.{ref}WHO (2019) \u2013 Fact sheet \u2013 Drinking water. Updated June 2019. Online <a href=\"https://www.who.int/news-room/fact-sheets/detail/sanitation\">here</a>.{/ref} It also exacerbates malnutrition, and in particular, <a href=\"https://ourworldindata.org/hunger-and-undernourishment#too-little-height-for-age-stunting\">childhood stunting</a>. In the chart we see that it ranks as a very important risk factor for death globally. </p>\n\n\n\n<p>According to the <em>Global Burden of Disease</em> study 775,000 people died prematurely in 2017 as a result of poor sanitation. To put this into context: this was almost double the <a href=\"https://ourworldindata.org/grapher/annual-number-of-deaths-by-cause\">number of homicides</a> \u2013 close to 400,000 in 2017.</p>\n\n\n\n<iframe src=\"https://ourworldindata.org/grapher/number-of-deaths-by-risk-factor\" style=\"width: 100%; height: 600px; border: 0px none;\"></iframe>\n\n\n\n<h2>The global distribution of deaths from sanitation</h2>\n\n\n\n<h4>In low-income countries poor sanitation accounts for 5% of deaths</h4>\n\n\n\n<p>An estimated 775,000 people died prematurely as a result of poor sanitation in 2017. This was 1.4% of global deaths.</p>\n\n\n\n<p>In low-income countries, it accounts for 5% of deaths.</p>\n\n\n\n<p>In the map here we see the share of annual deaths attributed to unsafe sanitation across the world. In 2017 this ranged from a high of close to 11% in Chad \u2013 more than 1-in-10 deaths \u2013 to less than 0.01% across most of Europe.</p>\n\n\n\n<p>When we compare the share of deaths attributed to unsafe sanitation either over time or between countries, we are not only comparing the extent of sanitation, but its severity <em>in the context</em> of other risk factors for death. Sanitation’s share does not only depend on how many die prematurely from it, but what else people are dying from and how this is changing.</p>\n\n\n\n<iframe src=\"https://ourworldindata.org/grapher/share-deaths-unsafe-sanitation\" style=\"width: 100%; height: 600px; border: 0px none;\"></iframe>\n\n\n\n<h4>Death rates are much higher in low-income countries</h4>\n\n\n\n<p>Death rates from unsafe sanitation give us an accurate comparison of differences in its mortality impacts between countries and over time. In contrast to the share of deaths that we studied before, death rates are not influenced by how other causes or risk factors for death are changing.</p>\n\n\n\n<p>In this map we see death rates from unsafe sanitation across the world. Death rates measure the number of deaths per 100,000 people in a given country or region.</p>\n\n\n\n<p>What becomes clear is the large differences in death rates between countries: rates are high in lower-income countries, particularly across Sub-Saharan Africa and Asia. Rates here are often greater than 50 deaths per 100,000 \u2013 in the Central African Republic and Chad this was over 120 per 100,000.</p>\n\n\n\n<p>Compare this with death rates across high-income countries: across Europe rates are below 0.1 deaths per 100,000. That\u2019s a greater than 1000-fold difference.</p>\n\n\n\n<p>The issue of unsafe water is therefore one which is largely limited to low and lower-middle income countries.</p>\n\n\n\n<p>We see this relationship clearly when we plot death rates versus income, as shown <a href=\"https://ourworldindata.org/grapher/death-rates-from-unsafe-sanitation-vs-gdp-per-capita\"><strong>here</strong></a>. There is a strong negative relationship: death rates decline as countries get richer.</p>\n\n\n\n<iframe src=\"https://ourworldindata.org/grapher/death-rates-sanitation\" style=\"width: 100%; height: 600px; border: 0px none;\"></iframe>\n\n\n\n<h2>Access to safe sanitation</h2>\n\n\n\n<h3>What share of people use safely managed sanitation facilities?</h3>\n\n\n\n<h4>Nearly half of the world do not have access to safe sanitation</h4>\n\n\n\n<p><a href=\"https://sdg-tracker.org/water-and-sanitation#6.2\">SDG Target 6.2</a> is to: \u201cachieve access to adequate and equitable sanitation and hygiene for all and end open defecation\u201d by 2030.</p>\n\n\n\n<p><strong>Where are we today? </strong>In 2020, just over half (54%) of the world population had access to <a href=\"http://ourworldindata.org/sanitation#definitions\">safely managed sanitation</a>. It is shocking that nearly one-in-two don\u2019t. Around 6% do not have <em>any</em> sanitation facilities at all, and instead have to practice open defecation.</p>\n\n\n\n<p>In the chart we see the breakdown of sanitation access globally, and across regions and income groups. We see that in countries at the lowest incomes, less than one-fifth of the population have safe sanitation. Much like safe drinking water, most live in Sub-Saharan Africa.</p>\n\n\n\n<p><strong>Are we making progress? </strong>The world has made progress in the last five years. But again, this has been far too slow albeit slightly faster than our progress on drinking water. In 2015 only 47% of the global population had safe sanitation. That means we\u2019ve seen an increase of seven percentage points over five years.</p>\n\n\n\n<p>The gap between where we are now and universal access is still huge. Our progress is far too slow to achieve this by 2030. If progress continues at these rates, we would only reach 68% by 2030. Almost one-third of the world would miss out. If we\u2019re to meet our target we need almost exactly the same acceleration as our progress on drinking water: rates would need to more than triple (increase 3.3-fold) for the coming decade.{ref}To reach universal access within 10 years (the current gap is 46%) we need to see a 23 percentage point increase every five years. That\u2019s 3.3 times higher than the 7 percentage point increase we\u2019ve seen in the last five years.{/ref}</p>\n\n\n\n<div class=\"wp-block-columns is-style-side-by-side\">\n<div class=\"wp-block-column\">\n<iframe src=\"https://ourworldindata.org/grapher/share-of-the-population-with-access-to-sanitation-facilities\" loading=\"lazy\" style=\"width: 100%; height: 600px; border: 0px none;\"></iframe>\n</div>\n\n\n\n<div class=\"wp-block-column\">\n<iframe src=\"https://ourworldindata.org/explorers/water-and-sanitation?tab=chart&Resource=Sanitation&Level+of+Access=Safely+managed&Residence=Total&Relative+to+population=Share+of+population&country=OWID_WRL&hideControls=true\" loading=\"lazy\" style=\"width: 100%; height: 600px; border: 0px none;\"></iframe>\n</div>\n</div>\n\n\n\n<h4>Access to safe sanitation by country</h4>\n\n\n\n<p>In the map shown we see the share of people across the world that have access to safely managed sanitation. </p>\n\n\n\n<iframe src=\"https://ourworldindata.org/grapher/share-using-safely-managed-sanitation\"></iframe>\n\n\n\n<h3>How many people do not have access to safe sanitation?</h3>\n\n\n\n<p>In the map shown we see the number of people across the world that <em>do not</em> have access to safely managed sanitation.</p>\n\n\n\n<iframe src=\"https://ourworldindata.org/grapher/safe-sanitation-without\"></iframe>\n\n\n\n<h2>Access to improved sanitation</h2>\n\n\n\n<h3>What share of people do not have access to improved sanitation?</h3>\n\n\n\n<p>‘Improved’ sanitation is defined as facilities which ensure hygienic separation of human excreta from human contact. This includes facilities such as flush/pour flush (to piped sewer system, septic tank, pit latrine), ventilated improved pit (VIP) latrine, pit latrine with slab, and a composting toilet. Note that having access to improved sanitation facilities greatly increases the likelihood \u2013 but doesn’t guarantee \u2013 that people use safe sanitation facilities. We look at coverage of <em>safe</em> sanitation <a href=\"https://ourworldindata.org/sanitation#access-to-safe-sanitation\"><strong>here</strong></a>.</p>\n\n\n\n<p>In 2020, 68% of the world population had access to improved sanitation facilities. This means almost one-third of people do not have access.</p>\n\n\n\n<p>In the map shown we see the share of people across the world that <em>do not</em> have access to improved sanitation.</p>\n\n\n\n<iframe loading=\"lazy\" style=\"width: 100%; height: 600px; border: 0px none;\" src=\"https://ourworldindata.org/grapher/share-without-improved-sanitation\" width=\"300\" height=\"150\"></iframe>\n\n\n\n<h3>How many people do not have access to improved sanitation?</h3>\n\n\n\n<p>In the map shown we see the number of people across the world that <em>do not</em> have access to improved sanitation.</p>\n\n\n\n<iframe src=\"https://ourworldindata.org/grapher/number-without-access-to-improved-sanitation\"></iframe>\n\n\n\n<h2>Open defecation</h2>\n\n\n\n<h3>What share of people practice open defecation?</h3>\n\n\n\n<p>Open defecation refers to the defecation in the open, such as in fields, forest, bushes, open bodies of water, on beaches, in other open spaces or disposed of with solid waste. Open defecation has a number of negative health and social impacts, including the spread of infectious diseases, diarrhoea (especially in children), adverse health outcomes in pregnancy, malnutrition, as well as increased vulnerability to violence \u2014 particularly for women and girls.{ref}Mara, D. (2017). The elimination of open defecation and its adverse health effects: a moral imperative for governments and development professionals. <em>Journal of Water Sanitation and Hygiene for Development</em>, <em>7</em>(1), 1-12. Available <a href=\"http://washdev.iwaponline.com/content/7/1/1\">online</a>.{/ref}</p>\n\n\n\n<p>In 2020, 6% of the world’s population were still practicing open defecation.</p>\n\n\n\n<p>The map shows the share of people practicing open defecation across the world.</p>\n\n\n\n<iframe loading=\"lazy\" style=\"width: 100%; height: 600px; border: 0px none;\" src=\"https://ourworldindata.org/grapher/people-practicing-open-defecation-of-population\" width=\"300\" height=\"150\"></iframe>\n\n\n\n<h2>What determines levels of sanitation access?</h2>\n\n\n\n<h3>Access to sanitation facilities increases with income</h3>\n\n\n\n<p>The provision of sanitation facilities tends to increase with income. In the chart we see the share of the population with access to improved sanitation versus gross domestic product (GDP) per capita.</p>\n\n\n\n<p>Overall, we see a strong relationship between the two: access to improved sanitation increases as countries get richer.</p>\n\n\n\n<iframe loading=\"lazy\" style=\"width: 100%; height: 600px; border: 0px none;\" src=\"https://ourworldindata.org/grapher/improved-sanitation-facilities-vs-gdp-per-capita\" width=\"300\" height=\"150\"></iframe>\n\n\n\n<h3>Open defecation is mainly a rural issue</h3>\n\n\n\n<p>As we see above, rural access to improved sanitation facilities typically lags behind urban areas for most countries. Although having access to improved sanitation facilities does not necessitate open defecation (some households can have very basic or shared sanitation facilities), we also see that open defecation is predominantly a rural issue for most countries.</p>\n\n\n\n<p>In the chart we see the prevalence of open defecation in rural areas versus urban areas. For the majority of countries, open defecation in urban areas is typically below 20 percent of the population. For rural populations, however, the share of the population practicing open defecation can range from less than 20 percent to almost 90 percent. Although open defecation in urban areas is still a pressing in many countries, the problem much more strongly concentrated in rural areas.</p>\n\n\n\n<iframe loading=\"lazy\" style=\"width: 100%; height: 600px; border: 0px none;\" src=\"https://ourworldindata.org/grapher/open-defecation-in-rural-areas-vs-urban-areas\" width=\"300\" height=\"150\"></iframe>\n\n\n\n<h2>Other health impacts of poor sanitation</h2>\n\n\n\n<h4>Stunting is higher where access to improved sanitation is low</h4>\n\n\n\n<p>Stunting \u2014 determined as having a height which falls below the median height-for-age WHO Child Growth Standards \u2014 is a sign of <a href=\"https://ourworldindata.org/hunger-and-undernourishment/#too-little-height-for-age-stunting\">chronic malnutrition</a>.{ref}World Health Organization (2014). WHA Global Nutrition Targets 2025: Stunting Policy Brief. Available <a href=\"http://www.who.int/nutrition/topics/globaltargets_stunting_policybrief.pdf\">online</a>.{/ref}</p>\n\n\n\n<p>Although, linked to poor nutritional intake (which we cover in our entry on <a href=\"https://ourworldindata.org/hunger-and-undernourishment/\">Hunger and Undernourishment</a>), it is linked to a range of compounding factors, including the recurrence of infectious diseases, childhood diarrhea, and poor sanitation & hygeine.</p>\n\n\n\n<p>In the chart we see the prevalence of stunting (measured as the share of children under 5-years-old defined as being more than two standard deviations below the median international height) versus the share of the population with improved sanitation facilities. Overall we see a negative correlation: rates of childhood stunting are typically higher in countries with lower access to improved sanitation facilities. </p>\n\n\n\n<iframe loading=\"lazy\" style=\"width: 100%; height: 600px; border: 0px none;\" src=\"https://ourworldindata.org/grapher/prevalence-of-stunting-vs-improved-sanitation-facilities\" width=\"300\" height=\"150\"></iframe>\n\n\n\n<h2>Definitions</h2>\n\n\n\n<p><strong>Improved sanitation facilities</strong>: “An improved sanitation facility is defined as one that hygienically separates human excreta from human contact. They include flush/pour flush (to piped sewer system, septic tank, pit latrine), ventilated improved pit (VIP) latrine, pit latrine with slab, and composting toilet.</p>\n\n\n\n<p>Improved sanitation facilities range from simple but protected pit latrines to flush toilets with a sewerage connection. To be effective, facilities must be correctly constructed and properly maintained.” {ref}World Bank & WHO/UNICEF Joint Monitoring Programme ( JMP ) for Water Supply and Sanitation. World Development Indicators Metadata. Available <a href=\"http://databank.worldbank.org/data/reports.aspx?source=2&type=metadata&series=SH.STA.ACSN\">online</a>.{/ref}</p>\n\n\n\n<p><strong>Safely managed sanitation facilities</strong>: \u201cSafely managed sanitation\u201d <a href=\"https://www.who.int/water_sanitation_health/monitoring/coverage/explanatorynote-sdg-621-safelymanagedsanitationsServices161027.pdf\">is defined</a> as the use of an improved sanitation facility which is not shared with other households and where:<br> \u2022 excreta is safely disposed in situ or <br> \u2022 excreta is transported and treated off-site.</p>\n\n\n\n<p>The definitions of categories of sanitation facilities coverage include:</p>\n\n\n\n<ul><li>‘<strong>Basic service</strong>‘: Private improved facility which separates excreta from human contact;</li><li>‘<strong>Limited service</strong>‘: Improved facility shared with other households;</li><li>‘<strong>Unimproved service</strong>‘: Unimproved facility which does not separate excreta from human contact;</li><li>‘<strong>No service</strong>‘: open defecation.</li></ul>\n\n\n\n<p><strong>Open defecation</strong>: “People practicing open defecation refers to the percentage of the population defecating in the open, such as in fields, forest, bushes, open bodies of water, on beaches, in other open spaces or disposed of with solid waste.”</p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" width=\"1677\" height=\"545\" src=\"https://owid.cloud/app/uploads/2021/06/Sanitation-definitions.png\" alt=\"\" class=\"wp-image-43854\" srcset=\"https://owid.cloud/app/uploads/2021/06/Sanitation-definitions.png 1677w, https://owid.cloud/app/uploads/2021/06/Sanitation-definitions-400x130.png 400w, https://owid.cloud/app/uploads/2021/06/Sanitation-definitions-800x260.png 800w, https://owid.cloud/app/uploads/2021/06/Sanitation-definitions-150x49.png 150w, https://owid.cloud/app/uploads/2021/06/Sanitation-definitions-768x250.png 768w, https://owid.cloud/app/uploads/2021/06/Sanitation-definitions-1536x499.png 1536w\" sizes=\"(max-width: 1677px) 100vw, 1677px\" /></figure>\n\n\n\n<h2>Explore more of our work on Clean Water and Sanitation</h2>\n\n\n\t<div class=\"wp-block-owid-grid \">\n\t\t\n <div class=\"wp-block-owid-card with-image\" data-no-lightbox>\n <a href=\"http://ourworldindata.org/explorers/water-and-sanitation\">\n <figure><img width=\"768\" height=\"404\" src=\"https://owid.cloud/app/uploads/2021/01/data_explorer-featured-768x404.png\" class=\"attachment-medium_large size-medium_large\" alt=\"COVID-19 data explorer\" loading=\"lazy\" srcset=\"https://owid.cloud/app/uploads/2021/01/data_explorer-featured-768x404.png 768w, https://owid.cloud/app/uploads/2021/01/data_explorer-featured-400x210.png 400w, https://owid.cloud/app/uploads/2021/01/data_explorer-featured-800x421.png 800w, https://owid.cloud/app/uploads/2021/01/data_explorer-featured-150x79.png 150w, https://owid.cloud/app/uploads/2021/01/data_explorer-featured.png 1200w\" sizes=\"(max-width: 768px) 100vw, 768px\" /></figure>\n <div class=\"text-wrapper\">\n \n <div class=\"description\">\n \n\n<p>Explore all the metrics \u2013 clean drinking water, sanitation and handwashing access \u2013 in one place.</p>\n\n\n </div>\n </div>\n </a>\n </div>\n\n <div class=\"wp-block-owid-card with-image\" data-no-lightbox>\n <a href=\"https://owid.cloud/water-access\">\n <figure><img width=\"768\" height=\"404\" src=\"https://owid.cloud/app/uploads/2021/06/Clean-Water-thumbnail-768x404.png\" class=\"attachment-medium_large size-medium_large\" alt=\"\" loading=\"lazy\" srcset=\"https://owid.cloud/app/uploads/2021/06/Clean-Water-thumbnail-768x404.png 768w, https://owid.cloud/app/uploads/2021/06/Clean-Water-thumbnail-400x210.png 400w, https://owid.cloud/app/uploads/2021/06/Clean-Water-thumbnail-800x421.png 800w, https://owid.cloud/app/uploads/2021/06/Clean-Water-thumbnail-150x79.png 150w, https://owid.cloud/app/uploads/2021/06/Clean-Water-thumbnail-1536x808.png 1536w, https://owid.cloud/app/uploads/2021/06/Clean-Water-thumbnail-2048x1077.png 2048w\" sizes=\"(max-width: 768px) 100vw, 768px\" /></figure>\n <div class=\"text-wrapper\">\n \n <div class=\"description\">\n \n\n<p>See how access to safe drinking water varies across the world.</p>\n\n\n </div>\n </div>\n </a>\n </div>\n\n <div class=\"wp-block-owid-card with-image\" data-no-lightbox>\n <a href=\"https://owid.cloud/sanitation\">\n <figure><img width=\"768\" height=\"404\" src=\"https://owid.cloud/app/uploads/2021/06/Sanitation-thumbnail-768x404.png\" class=\"attachment-medium_large size-medium_large\" alt=\"\" loading=\"lazy\" srcset=\"https://owid.cloud/app/uploads/2021/06/Sanitation-thumbnail-768x404.png 768w, https://owid.cloud/app/uploads/2021/06/Sanitation-thumbnail-400x210.png 400w, https://owid.cloud/app/uploads/2021/06/Sanitation-thumbnail-800x421.png 800w, https://owid.cloud/app/uploads/2021/06/Sanitation-thumbnail-150x79.png 150w, https://owid.cloud/app/uploads/2021/06/Sanitation-thumbnail-1536x808.png 1536w, https://owid.cloud/app/uploads/2021/06/Sanitation-thumbnail-2048x1077.png 2048w\" sizes=\"(max-width: 768px) 100vw, 768px\" /></figure>\n <div class=\"text-wrapper\">\n \n <div class=\"description\">\n \n\n<p>How does access to sanitation vary across the world? See global progress on sanitation.</p>\n\n\n </div>\n </div>\n </a>\n </div>\n\n <div class=\"wp-block-owid-card with-image\" data-no-lightbox>\n <a href=\"http://ourworldindata.org/hygiene\">\n <figure><img width=\"768\" height=\"404\" src=\"https://owid.cloud/app/uploads/2021/06/Hygiene-thumbnail-768x404.png\" class=\"attachment-medium_large size-medium_large\" alt=\"\" loading=\"lazy\" srcset=\"https://owid.cloud/app/uploads/2021/06/Hygiene-thumbnail-768x404.png 768w, https://owid.cloud/app/uploads/2021/06/Hygiene-thumbnail-400x210.png 400w, https://owid.cloud/app/uploads/2021/06/Hygiene-thumbnail-800x421.png 800w, https://owid.cloud/app/uploads/2021/06/Hygiene-thumbnail-150x79.png 150w, https://owid.cloud/app/uploads/2021/06/Hygiene-thumbnail-1536x808.png 1536w, https://owid.cloud/app/uploads/2021/06/Hygiene-thumbnail-2048x1077.png 2048w\" sizes=\"(max-width: 768px) 100vw, 768px\" /></figure>\n <div class=\"text-wrapper\">\n \n <div class=\"description\">\n \n\n<p>How many people lack access to basic handwashing facilities? Explore the global data on hygiene. </p>\n\n\n </div>\n </div>\n </a>\n </div>\n\n\t</div>\n\n\n<p></p>\n", "protected": false }, "excerpt": { "rendered": "Access to safe sanitation is essential for reducing deaths from infectious disease, preventing malnutrition and providing dignity. \nWhat is the global situation today and how can we make progress?", "protected": false }, "date_gmt": "2019-09-25T16:00:31", "modified": "2022-04-12T14:28:45", "template": "", "categories": [ 49, 187, 52, 192 ], "menu_order": 344, "ping_status": "closed", "authors_name": [ "Hannah Ritchie" ], "modified_gmt": "2022-04-12T13:28:45", "comment_status": "closed", "featured_media": 43902, "featured_media_paths": { "thumbnail": "/app/uploads/2021/06/Sanitation-thumbnail-150x79.png", "medium_large": "/app/uploads/2021/06/Sanitation-thumbnail-768x404.png" } }

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Sanitation

sanitation

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<div class="blog-info">First published in September 2019. Latest update in June 2021.</div>    <ul><li><a href="https://ourworldindata.org/sanitation#unsafe-sanitation-is-a-leading-risk-factor-for-death">Unsafe sanitation is responsible for 775,000 deaths each year.</a></li><li><a href="https://ourworldindata.org/sanitation#the-global-distribution-of-deaths-from-sanitation">5% of deaths in low-income countries result from unsafe sanitation</a></li><li><a href="https://ourworldindata.org/sanitation#access-to-safe-sanitation">46% of the world do not have access to safely managed sanitation.</a></li><li><a href="https://ourworldindata.org/sanitation#open-defecation">6% of the world still practice open defecation.</a></li><li><a href="https://ourworldindata.org/sanitation#other-health-impacts-of-poor-sanitation">Unsafe sanitation has a significant impact on childhood stunting.</a></li></ul>   <p></p>    <h2>Unsafe sanitation is a leading risk factor for death</h2>   <h4>Unsafe sanitation is responsible for 775,000 deaths each year</h4>   <p>Unsafe sanitation is one of the world's largest health and environmental problems – particularly for the <a href="https://owid.cloud/extreme-poverty">poorest in the world</a>.</p>   <p>The <em>Global Burden of Disease</em> is a major global study on the causes and risk factors for death and disease published in the medical journal <em>The Lancet</em>.{ref}The latest study can be found at the website of the Lancet here: <a href="https://www.thelancet.com/gbd">TheLancet.com/GBD</a></p>   <p>The 2017 study was published as GBD 2017 Risk Factor Collaborators – "Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017" and is online <a href="http://www.healthdata.org/research-article/global-regional-and-national-comparative-risk-assessment-84-behavioral-0">here</a>.{/ref} These estimates of the annual number of deaths attributed to a wide range of risk factors are shown here. This chart is shown for the global total, but can be explored for any country or region using the "change country" toggle.</p>   <p>Lack of access to poor sanitation is a leading risk factor for infectious diseases, including cholera, <a href="https://owid.cloud/diarrheal-diseases">diarrhoea</a>, dysentery, hepatitis A, typhoid and <a href="https://owid.cloud/polio">polio</a>.{ref}WHO (2019) – Fact sheet – Drinking water. Updated June 2019. Online <a href="https://www.who.int/news-room/fact-sheets/detail/sanitation">here</a>.{/ref} It also exacerbates malnutrition, and in particular, <a href="https://ourworldindata.org/hunger-and-undernourishment#too-little-height-for-age-stunting">childhood stunting</a>. In the chart we see that it ranks as a very important risk factor for death globally. </p>   <p>According to the <em>Global Burden of Disease</em> study 775,000 people died prematurely in 2017 as a result of poor sanitation. To put this into context: this was almost double the <a href="https://ourworldindata.org/grapher/annual-number-of-deaths-by-cause">number of homicides</a> – close to 400,000 in 2017.</p>   <iframe src="https://ourworldindata.org/grapher/number-of-deaths-by-risk-factor" style="width: 100%; height: 600px; border: 0px none;"></iframe>   <h2>The global distribution of deaths from sanitation</h2>   <h4>In low-income countries poor sanitation accounts for 5% of deaths</h4>   <p>An estimated 775,000 people died prematurely as a result of poor sanitation in 2017. This was 1.4% of global deaths.</p>   <p>In low-income countries, it accounts for 5% of deaths.</p>   <p>In the map here we see the share of annual deaths attributed to unsafe sanitation across the world. In 2017 this ranged from a high of close to 11% in Chad – more than 1-in-10 deaths – to less than 0.01% across most of Europe.</p>   <p>When we compare the share of deaths attributed to unsafe sanitation either over time or between countries, we are not only comparing the extent of sanitation, but its severity <em>in the context</em> of other risk factors for death. Sanitation's share does not only depend on how many die prematurely from it, but what else people are dying from and how this is changing.</p>   <iframe src="https://ourworldindata.org/grapher/share-deaths-unsafe-sanitation" style="width: 100%; height: 600px; border: 0px none;"></iframe>   <h4>Death rates are much higher in low-income countries</h4>   <p>Death rates from unsafe sanitation give us an accurate comparison of differences in its mortality impacts between countries and over time. In contrast to the share of deaths that we studied before, death rates are not influenced by how other causes or risk factors for death are changing.</p>   <p>In this map we see death rates from unsafe sanitation across the world. Death rates measure the number of deaths per 100,000 people in a given country or region.</p>   <p>What becomes clear is the large differences in death rates between countries: rates are high in lower-income countries, particularly across Sub-Saharan Africa and Asia. Rates here are often greater than 50 deaths per 100,000 – in the Central African Republic and Chad this was over 120 per 100,000.</p>   <p>Compare this with death rates across high-income countries: across Europe rates are below 0.1 deaths per 100,000. That’s a greater than 1000-fold difference.</p>   <p>The issue of unsafe water is therefore one which is largely limited to low and lower-middle income countries.</p>   <p>We see this relationship clearly when we plot death rates versus income, as shown <a href="https://ourworldindata.org/grapher/death-rates-from-unsafe-sanitation-vs-gdp-per-capita"><strong>here</strong></a>. There is a strong negative relationship: death rates decline as countries get richer.</p>   <iframe src="https://ourworldindata.org/grapher/death-rates-sanitation" style="width: 100%; height: 600px; border: 0px none;"></iframe>   <h2>Access to safe sanitation</h2>   <h3>What share of people use safely managed sanitation facilities?</h3>   <h4>Nearly half of the world do not have access to safe sanitation</h4>   <p><a href="https://sdg-tracker.org/water-and-sanitation#6.2">SDG Target 6.2</a> is to: “achieve access to adequate and equitable sanitation and hygiene for all and end open defecation” by 2030.</p>   <p><strong>Where are we today? </strong>In 2020, just over half (54%) of the world population had access to <a href="http://ourworldindata.org/sanitation#definitions">safely managed sanitation</a>. It is shocking that nearly one-in-two don’t. Around 6% do not have <em>any</em> sanitation facilities at all, and instead have to practice open defecation.</p>   <p>In the chart we see the breakdown of sanitation access globally, and across regions and income groups. We see that in countries at the lowest incomes, less than one-fifth of the population have safe sanitation. Much like safe drinking water, most live in Sub-Saharan Africa.</p>   <p><strong>Are we making progress? </strong>The world has made progress in the last five years. But again, this has been far too slow albeit slightly faster than our progress on drinking water. In 2015 only 47% of the global population had safe sanitation. That means we’ve seen an increase of seven percentage points over five years.</p>   <p>The gap between where we are now and universal access is still huge. Our progress is far too slow to achieve this by 2030. If progress continues at these rates, we would only reach 68% by 2030. Almost one-third of the world would miss out. If we’re to meet our target we need almost exactly the same acceleration as our progress on drinking water: rates would need to more than triple (increase 3.3-fold) for the coming decade.{ref}To reach universal access within 10 years (the current gap is 46%) we need to see a 23 percentage point increase every five years. That’s 3.3 times higher than the 7 percentage point increase we’ve seen in the last five years.{/ref}</p>   <div class="wp-block-columns is-style-side-by-side"> <div class="wp-block-column"> <iframe src="https://ourworldindata.org/grapher/share-of-the-population-with-access-to-sanitation-facilities" loading="lazy" style="width: 100%; height: 600px; border: 0px none;"></iframe> </div>   <div class="wp-block-column"> <iframe src="https://ourworldindata.org/explorers/water-and-sanitation?tab=chart&Resource=Sanitation&Level+of+Access=Safely+managed&Residence=Total&Relative+to+population=Share+of+population&country=OWID_WRL&hideControls=true" loading="lazy" style="width: 100%; height: 600px; border: 0px none;"></iframe> </div> </div>   <h4>Access to safe sanitation by country</h4>   <p>In the map shown we see the share of people across the world that have access to safely managed sanitation. </p>   <iframe src="https://ourworldindata.org/grapher/share-using-safely-managed-sanitation"></iframe>   <h3>How many people do not have access to safe sanitation?</h3>   <p>In the map shown we see the number of people across the world that <em>do not</em> have access to safely managed sanitation.</p>   <iframe src="https://ourworldindata.org/grapher/safe-sanitation-without"></iframe>   <h2>Access to improved sanitation</h2>   <h3>What share of people do not have access to improved sanitation?</h3>   <p>'Improved' sanitation is defined as facilities which ensure hygienic separation of human excreta from human contact. This includes facilities such as flush/pour flush (to piped sewer system, septic tank, pit latrine), ventilated improved pit (VIP) latrine, pit latrine with slab, and a composting toilet. Note that having access to improved sanitation facilities greatly increases the likelihood – but doesn't guarantee – that people use safe sanitation facilities. We look at coverage of <em>safe</em> sanitation <a href="https://ourworldindata.org/sanitation#access-to-safe-sanitation"><strong>here</strong></a>.</p>   <p>In 2020, 68% of the world population had access to improved sanitation facilities. This means almost one-third of people do not have access.</p>   <p>In the map shown we see the share of people across the world that <em>do not</em> have access to improved sanitation.</p>   <iframe style="width: 100%; height: 600px; border: 0px none;" src="https://ourworldindata.org/grapher/share-without-improved-sanitation" width="300" height="150"></iframe>   <h3>How many people do not have access to improved sanitation?</h3>   <p>In the map shown we see the number of people across the world that <em>do not</em> have access to improved sanitation.</p>   <iframe src="https://ourworldindata.org/grapher/number-without-access-to-improved-sanitation"></iframe>   <h2>Open defecation</h2>   <h3>What share of people practice open defecation?</h3>   <p>Open defecation refers to the defecation in the open, such as in fields, forest, bushes, open bodies of water, on beaches, in other open spaces or disposed of with solid waste. Open defecation has a number of negative health and social impacts, including the spread of infectious diseases, diarrhoea (especially in children), adverse health outcomes in pregnancy, malnutrition, as well as increased vulnerability to violence — particularly for women and girls.{ref}Mara, D. (2017). The elimination of open defecation and its adverse health effects: a moral imperative for governments and development professionals. <em>Journal of Water Sanitation and Hygiene for Development</em>, <em>7</em>(1), 1-12. Available <a href="http://washdev.iwaponline.com/content/7/1/1">online</a>.{/ref}</p>   <p>In 2020, 6% of the world's population were still practicing open defecation.</p>   <p>The map shows the share of people practicing open defecation across the world.</p>   <iframe style="width: 100%; height: 600px; border: 0px none;" src="https://ourworldindata.org/grapher/people-practicing-open-defecation-of-population" width="300" height="150"></iframe>   <h2>What determines levels of sanitation access?</h2>   <h3>Access to sanitation facilities increases with income</h3>   <p>The provision of sanitation facilities tends to increase with income. In the chart we see the share of the population with access to improved sanitation versus gross domestic product (GDP) per capita.</p>   <p>Overall, we see a strong relationship between the two: access to improved sanitation increases as countries get richer.</p>   <iframe style="width: 100%; height: 600px; border: 0px none;" src="https://ourworldindata.org/grapher/improved-sanitation-facilities-vs-gdp-per-capita" width="300" height="150"></iframe>   <h3>Open defecation is mainly a rural issue</h3>   <p>As we see above, rural access to improved sanitation facilities typically lags behind urban areas for most countries. Although having access to improved sanitation facilities does not necessitate open defecation (some households can have very basic or shared sanitation facilities), we also see that open defecation is predominantly a rural issue for most countries.</p>   <p>In the chart we see the prevalence of open defecation in rural areas versus urban areas. For the majority of countries, open defecation in urban areas is typically below 20 percent of the population. For rural populations, however, the share of the population practicing open defecation can range from less than 20 percent to almost 90 percent. Although open defecation in urban areas is still a pressing in many countries, the problem much more strongly concentrated in rural areas.</p>   <iframe style="width: 100%; height: 600px; border: 0px none;" src="https://ourworldindata.org/grapher/open-defecation-in-rural-areas-vs-urban-areas" width="300" height="150"></iframe>   <h2>Other health impacts of poor sanitation</h2>   <h4>Stunting is higher where access to improved sanitation is low</h4>   <p>Stunting — determined as having a height which falls below the median height-for-age WHO Child Growth Standards — is a sign of <a href="https://ourworldindata.org/hunger-and-undernourishment/#too-little-height-for-age-stunting">chronic malnutrition</a>.{ref}World Health Organization (2014). WHA Global Nutrition Targets 2025: Stunting Policy Brief. Available <a href="http://www.who.int/nutrition/topics/globaltargets_stunting_policybrief.pdf">online</a>.{/ref}</p>   <p>Although, linked to poor nutritional intake (which we cover in our entry on <a href="https://ourworldindata.org/hunger-and-undernourishment/">Hunger and Undernourishment</a>), it is linked to a range of compounding factors, including the recurrence of infectious diseases, childhood diarrhea, and poor sanitation & hygeine.</p>   <p>In the chart we see the prevalence of stunting (measured as the share of children under 5-years-old defined as being more than two standard deviations below the median international height) versus the share of the population with improved sanitation facilities. Overall we see a negative correlation: rates of childhood stunting are typically higher in countries with lower access to improved sanitation facilities. </p>   <iframe style="width: 100%; height: 600px; border: 0px none;" src="https://ourworldindata.org/grapher/prevalence-of-stunting-vs-improved-sanitation-facilities" width="300" height="150"></iframe>   <h2>Definitions</h2>   <p><strong>Improved sanitation facilities</strong>: "An improved sanitation facility is defined as one that hygienically separates human excreta from human contact. They include flush/pour flush (to piped sewer system, septic tank, pit latrine), ventilated improved pit (VIP) latrine, pit latrine with slab, and composting toilet.</p>   <p>Improved sanitation facilities range from simple but protected pit latrines to flush toilets with a sewerage connection. To be effective, facilities must be correctly constructed and properly maintained." {ref}World Bank & WHO/UNICEF Joint Monitoring Programme ( JMP ) for Water Supply and Sanitation. World Development Indicators Metadata. Available <a href="http://databank.worldbank.org/data/reports.aspx?source=2&type=metadata&series=SH.STA.ACSN">online</a>.{/ref}</p>   <p><strong>Safely managed sanitation facilities</strong>: “Safely managed sanitation” <a href="https://www.who.int/water_sanitation_health/monitoring/coverage/explanatorynote-sdg-621-safelymanagedsanitationsServices161027.pdf">is defined</a> as the use of an improved sanitation facility which is not shared with other households and where:<br> • excreta is safely disposed in situ or <br> • excreta is transported and treated off-site.</p>   <p>The definitions of categories of sanitation facilities coverage include:</p>   <ul><li>'<strong>Basic service</strong>': Private improved facility which separates excreta from human contact;</li><li>'<strong>Limited service</strong>': Improved facility shared with other households;</li><li>'<strong>Unimproved service</strong>': Unimproved facility which does not separate excreta from human contact;</li><li>'<strong>No service</strong>': open defecation.</li></ul>   <p><strong>Open defecation</strong>: "People practicing open defecation refers to the percentage of the population defecating in the open, such as in fields, forest, bushes, open bodies of water, on beaches, in other open spaces or disposed of with solid waste."</p>   <figure class="wp-block-image size-full"><img src="https://owid.cloud/app/uploads/2021/06/Sanitation-definitions.png" alt="" class="wp-image-43854"/></figure>   <h2>Explore more of our work on Clean Water and Sanitation</h2>      <p>Explore all the metrics – clean drinking water, sanitation and handwashing access – in one place.</p>     <p>See how access to safe drinking water varies across the world.</p>     <p>How does access to sanitation vary across the world? See global progress on sanitation.</p>     <p>How many people lack access to basic handwashing facilities? Explore the global data on hygiene. </p>     <p></p>

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                        "text": "First published in September 2019. Latest update in June 2021.",
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                        "text": "Unsafe sanitation is responsible for 775,000 deaths each year."
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                        "text": "5% of deaths in low-income countries result from unsafe sanitation"
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                        "text": ".{ref}The latest study can be found at the website of the Lancet here: ",
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                        "text": "The 2017 study was published as GBD 2017 Risk Factor Collaborators \u2013 \"Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017\" and is online ",
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                        "text": ".{/ref} These estimates of the annual number of deaths attributed to a wide range of risk factors are shown here. This chart is shown for the global total, but can be explored for any country or region using the \"change country\" toggle.",
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                        "text": ".{ref}WHO (2019) \u2013 Fact sheet \u2013 Drinking water. Updated June 2019. Online ",
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                        "text": ".{/ref} It also exacerbates malnutrition, and in particular, ",
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                        "text": ". In the chart we see that it ranks as a very important risk factor for death globally. ",
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                        "text": " study 775,000 people died prematurely in 2017 as a result of poor sanitation. To put this into context: this was almost double the ",
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                        "text": "In the map here we see the share of annual deaths attributed to unsafe sanitation across the world. In 2017 this ranged from a high of close to 11% in Chad \u2013 more than 1-in-10 deaths \u2013 to less than 0.01% across most of Europe.",
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                        "text": " of other risk factors for death. Sanitation's share does not only depend on how many die prematurely from it, but what else people are dying from and how this is changing.",
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                        "text": "Death rates from unsafe sanitation give us an accurate comparison of differences in its mortality impacts between countries and over time. In contrast to the share of deaths that we studied before, death rates are not influenced by how other causes or risk factors for death are changing.",
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                        "text": "In this map we see death rates from unsafe sanitation across the world. Death rates measure the number of deaths per 100,000 people in a given country or region.",
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                        "text": "What becomes clear is the large differences in death rates between countries: rates are high in lower-income countries, particularly across Sub-Saharan Africa and Asia. Rates here are often greater than 50 deaths per 100,000 \u2013 in the Central African Republic and Chad this was over 120 per 100,000.",
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                        "text": "Compare this with death rates across high-income countries: across Europe rates are below 0.1 deaths per 100,000. That\u2019s a greater than 1000-fold difference.",
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                        "text": "The issue of unsafe water is therefore one which is largely limited to low and lower-middle income countries.",
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                        "text": "We see this relationship clearly when we plot death rates versus income, as shown\u00a0",
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                        "text": "What share of people use safely managed sanitation facilities?",
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                        "text": "Nearly half of the world do not have access to safe sanitation",
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                        "text": " is to: \u201cachieve access to adequate and equitable sanitation and hygiene for all and end open defecation\u201d by 2030.",
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                                "text": "Where are we today? ",
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                        "text": "In 2020, just over half (54%) of the world population had access to ",
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                        "text": " sanitation facilities at all, and instead have to practice open defecation.",
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                        "text": "In the chart we see the breakdown of sanitation access globally, and across regions and income groups. We see that in countries at the lowest incomes, less than one-fifth of the population have safe sanitation. Much like safe drinking water, most live in Sub-Saharan Africa.",
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                                "text": "Are we making progress? ",
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                        "text": "The world has made progress in the last five years. But again, this has been far too slow albeit slightly faster than our progress on drinking water. In 2015 only 47% of the global population had safe sanitation. That means we\u2019ve seen an increase of seven percentage points over five years.",
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                        "text": "The gap between where we are now and universal access is still huge. Our progress is far too slow to achieve this by 2030. If progress continues at these rates, we would only reach 68% by 2030. Almost one-third of the world would miss out. If we\u2019re to meet our target we need almost exactly the same acceleration as our progress on drinking water: rates would need to more than triple (increase 3.3-fold) for the coming decade.{ref}To reach universal access within 10 years (the current gap is 46%) we need to see a 23 percentage point increase every five years. That\u2019s 3.3 times higher than the 7 percentage point increase we\u2019ve seen in the last five years.{/ref}",
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                        "text": "Access to safe sanitation by country",
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                        "text": "In the map shown we see the share of people across the world that have access to safely managed sanitation. ",
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                        "text": "What share of people do not have access to improved sanitation?",
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                        "text": "'Improved' sanitation is defined as facilities which ensure hygienic separation of human excreta from human contact. This includes facilities such as flush/pour flush (to piped sewer system, septic tank, pit latrine), ventilated improved pit (VIP) latrine, pit latrine with slab, and a composting toilet. Note that having access to improved sanitation facilities greatly increases the likelihood \u2013 but doesn't guarantee \u2013 that people use safe sanitation facilities. We look at coverage of ",
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                        "text": "In 2020, 68% of the world population had access to improved sanitation facilities. This means almost one-third of people do not have access.",
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                        "text": " have access to improved sanitation.",
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                        "text": "What share of people practice open defecation?",
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                        "text": "Open defecation refers to the defecation in the open, such as in fields, forest, bushes, open bodies of water, on beaches, in other open spaces or disposed of with solid waste. Open defecation has a number of negative health and social impacts, including the spread of infectious diseases, diarrhoea (especially in children), adverse health outcomes in pregnancy, malnutrition, as well as increased vulnerability to violence \u2014 particularly for women and girls.{ref}Mara, D. (2017). The elimination of open defecation and its adverse health effects: a moral imperative for governments and development professionals.\u00a0",
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                        "text": "In 2020, 6% of the world's population were still practicing open defecation.",
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                        "text": "The map shows the share of people practicing open defecation across the world.",
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                        "text": "What determines levels of sanitation access?",
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                        "text": "Access to sanitation facilities increases with income",
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                        "text": "The provision of sanitation facilities tends to increase with income. In the chart we see the share of the population with access to improved sanitation versus gross domestic product (GDP) per capita.",
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                        "text": "Overall, we see a strong relationship between the two: access to improved sanitation increases as countries get richer.",
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                        "text": "Open defecation is mainly a rural issue",
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                        "text": "As we see above, rural access to improved sanitation facilities typically lags behind urban areas for most countries. Although having access to improved sanitation facilities does not necessitate open defecation (some households can have very basic or shared sanitation facilities), we also see that open defecation is predominantly a rural issue for most countries.",
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                        "text": "In the chart we see the prevalence of open defecation in rural areas versus urban areas. For the majority of countries, open defecation in urban areas is typically below 20 percent of the population. For rural populations, however, the share of the population practicing open defecation can range from less than 20 percent to almost 90 percent. Although open defecation in urban areas is still a pressing in many countries, the problem much more strongly concentrated in rural areas.",
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                        "text": "Other health impacts of poor sanitation",
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                        "text": "Stunting is higher where access to improved sanitation is low",
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                        "text": "Stunting \u2014 determined as having a height which falls below the median height-for-age WHO Child Growth Standards\u00a0\u2014 is a sign of ",
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                        "text": ".{ref}World Health Organization (2014). WHA Global Nutrition Targets 2025: Stunting Policy Brief. Available\u00a0",
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                        "text": "Although, linked to poor nutritional intake (which we cover in our entry on ",
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                        "text": "), it is linked to a range of compounding factors, including the recurrence of infectious diseases, childhood diarrhea, and poor sanitation & hygeine.",
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                        "text": "In the chart we see the prevalence of stunting (measured as the share of children under 5-years-old defined as being more than two standard deviations below\u00a0the median international height) versus the share of the population with improved sanitation facilities. Overall we see a negative correlation: rates of childhood stunting are typically higher in countries with lower access to improved sanitation facilities.\u00a0",
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                        "text": ": \"An improved sanitation facility is defined as one that hygienically separates human excreta from human contact.\u00a0They include flush/pour flush (to piped sewer system, septic tank, pit latrine), ventilated improved pit (VIP) latrine, pit latrine with slab, and composting toilet.",
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                        "text": "Improved sanitation facilities range from simple but protected pit latrines to flush toilets with a sewerage connection. To be effective, facilities must be correctly constructed and properly maintained.\"\u00a0{ref}World Bank &\u00a0WHO/UNICEF Joint Monitoring Programme ( JMP ) for Water Supply and Sanitation. World Development Indicators Metadata. Available ",
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                        "text": ": \u201cSafely managed sanitation\u201d ",
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                        "text": " as the use of  an improved sanitation facility which is not shared  with other households and where:",
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                                "text": "': open defecation.",
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                        "text": ": \"People practicing open defecation refers to the percentage of the population defecating in the open, such as in fields, forest, bushes, open bodies of water, on beaches, in other open spaces or disposed of with solid waste.\"",
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                        "text": "Explore more of our work on Clean Water and Sanitation",
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                        "text": "Explore all the metrics \u2013 clean drinking water, sanitation and handwashing access \u2013 in one place.",
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                        "text": "See how access to safe drinking water varies across the world.",
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                        "text": "How does access to sanitation vary across the world? See global progress on sanitation.",
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                        "text": "How many people lack access to basic handwashing facilities? Explore the global data on hygiene. ",
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2019-09-25 16:00:31

2024-02-16 14:22:40

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[
    "Hannah Ritchie"
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Access to safe sanitation is essential for reducing deaths from infectious disease, preventing malnutrition and providing dignity. What is the global situation today and how can we make progress?

2019-09-25 17:00:31

2022-04-12 13:28:45

https://ourworldindata.org/wp-content/uploads/2021/06/Sanitation-thumbnail.png

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First published in September 2019. Latest update in June 2021. --- # Unsafe sanitation is a leading risk factor for death --- ### Unsafe sanitation is responsible for 775,000 deaths each year Unsafe sanitation is one of the world's largest health and environmental problems – particularly for the [poorest in the world](https://owid.cloud/extreme-poverty). The _Global Burden of Disease_ is a major global study on the causes and risk factors for death and disease published in the medical journal _The Lancet_.{ref}The latest study can be found at the website of the Lancet here: [TheLancet.com/GBD](https://www.thelancet.com/gbd) The 2017 study was published as GBD 2017 Risk Factor Collaborators – "Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017" and is online [here](http://www.healthdata.org/research-article/global-regional-and-national-comparative-risk-assessment-84-behavioral-0).{/ref} These estimates of the annual number of deaths attributed to a wide range of risk factors are shown here. This chart is shown for the global total, but can be explored for any country or region using the "change country" toggle. Lack of access to poor sanitation is a leading risk factor for infectious diseases, including cholera, [diarrhoea](https://owid.cloud/diarrheal-diseases), dysentery, hepatitis A, typhoid and [polio](https://owid.cloud/polio).{ref}WHO (2019) – Fact sheet – Drinking water. Updated June 2019. Online [here](https://www.who.int/news-room/fact-sheets/detail/sanitation).{/ref} It also exacerbates malnutrition, and in particular, [childhood stunting](https://ourworldindata.org/hunger-and-undernourishment#too-little-height-for-age-stunting). In the chart we see that it ranks as a very important risk factor for death globally. According to the _Global Burden of Disease_ study 775,000 people died prematurely in 2017 as a result of poor sanitation. To put this into context: this was almost double the [number of homicides](https://ourworldindata.org/grapher/annual-number-of-deaths-by-cause) – close to 400,000 in 2017. <Chart url="https://ourworldindata.org/grapher/number-of-deaths-by-risk-factor"/> --- # The global distribution of deaths from sanitation --- ### In low-income countries poor sanitation accounts for 5% of deaths An estimated 775,000 people died prematurely as a result of poor sanitation in 2017. This was 1.4% of global deaths. In low-income countries, it accounts for 5% of deaths. In the map here we see the share of annual deaths attributed to unsafe sanitation across the world. In 2017 this ranged from a high of close to 11% in Chad – more than 1-in-10 deaths – to less than 0.01% across most of Europe. When we compare the share of deaths attributed to unsafe sanitation either over time or between countries, we are not only comparing the extent of sanitation, but its severity _in the context_ of other risk factors for death. Sanitation's share does not only depend on how many die prematurely from it, but what else people are dying from and how this is changing. <Chart url="https://ourworldindata.org/grapher/share-deaths-unsafe-sanitation"/> ### Death rates are much higher in low-income countries Death rates from unsafe sanitation give us an accurate comparison of differences in its mortality impacts between countries and over time. In contrast to the share of deaths that we studied before, death rates are not influenced by how other causes or risk factors for death are changing. In this map we see death rates from unsafe sanitation across the world. Death rates measure the number of deaths per 100,000 people in a given country or region. What becomes clear is the large differences in death rates between countries: rates are high in lower-income countries, particularly across Sub-Saharan Africa and Asia. Rates here are often greater than 50 deaths per 100,000 – in the Central African Republic and Chad this was over 120 per 100,000. Compare this with death rates across high-income countries: across Europe rates are below 0.1 deaths per 100,000. That’s a greater than 1000-fold difference. The issue of unsafe water is therefore one which is largely limited to low and lower-middle income countries. We see this relationship clearly when we plot death rates versus income, as shown [**here**](https://ourworldindata.org/grapher/death-rates-from-unsafe-sanitation-vs-gdp-per-capita). There is a strong negative relationship: death rates decline as countries get richer. <Chart url="https://ourworldindata.org/grapher/death-rates-sanitation"/> --- # Access to safe sanitation --- ## What share of people use safely managed sanitation facilities? ### Nearly half of the world do not have access to safe sanitation [SDG Target 6.2](https://sdg-tracker.org/water-and-sanitation#6.2) is to: “achieve access to adequate and equitable sanitation and hygiene for all and end open defecation” by 2030. **Where are we today? **In 2020, just over half (54%) of the world population had access to [safely managed sanitation](http://ourworldindata.org/sanitation#definitions). It is shocking that nearly one-in-two don’t. Around 6% do not have _any_ sanitation facilities at all, and instead have to practice open defecation. In the chart we see the breakdown of sanitation access globally, and across regions and income groups. We see that in countries at the lowest incomes, less than one-fifth of the population have safe sanitation. Much like safe drinking water, most live in Sub-Saharan Africa. **Are we making progress? **The world has made progress in the last five years. But again, this has been far too slow albeit slightly faster than our progress on drinking water. In 2015 only 47% of the global population had safe sanitation. That means we’ve seen an increase of seven percentage points over five years. The gap between where we are now and universal access is still huge. Our progress is far too slow to achieve this by 2030. If progress continues at these rates, we would only reach 68% by 2030. Almost one-third of the world would miss out. If we’re to meet our target we need almost exactly the same acceleration as our progress on drinking water: rates would need to more than triple (increase 3.3-fold) for the coming decade.{ref}To reach universal access within 10 years (the current gap is 46%) we need to see a 23 percentage point increase every five years. That’s 3.3 times higher than the 7 percentage point increase we’ve seen in the last five years.{/ref} <Chart url="https://ourworldindata.org/grapher/share-of-the-population-with-access-to-sanitation-facilities"/> <Chart url="https://ourworldindata.org/explorers/water-and-sanitation?tab=chart&Resource=Sanitation&Level+of+Access=Safely+managed&Residence=Total&Relative+to+population=Share+of+population&country=OWID_WRL&hideControls=true"/> ### Access to safe sanitation by country In the map shown we see the share of people across the world that have access to safely managed sanitation. <Chart url="https://ourworldindata.org/grapher/share-using-safely-managed-sanitation"/> ## How many people do not have access to safe sanitation? In the map shown we see the number of people across the world that _do not_ have access to safely managed sanitation. <Chart url="https://ourworldindata.org/grapher/safe-sanitation-without"/> --- # Access to improved sanitation --- ## What share of people do not have access to improved sanitation? 'Improved' sanitation is defined as facilities which ensure hygienic separation of human excreta from human contact. This includes facilities such as flush/pour flush (to piped sewer system, septic tank, pit latrine), ventilated improved pit (VIP) latrine, pit latrine with slab, and a composting toilet. Note that having access to improved sanitation facilities greatly increases the likelihood – but doesn't guarantee – that people use safe sanitation facilities. We look at coverage of _safe_ sanitation [**here**](https://ourworldindata.org/sanitation#access-to-safe-sanitation). In 2020, 68% of the world population had access to improved sanitation facilities. This means almost one-third of people do not have access. In the map shown we see the share of people across the world that _do not_ have access to improved sanitation. <Chart url="https://ourworldindata.org/grapher/share-without-improved-sanitation"/> ## How many people do not have access to improved sanitation? In the map shown we see the number of people across the world that _do not_ have access to improved sanitation. <Chart url="https://ourworldindata.org/grapher/number-without-access-to-improved-sanitation"/> --- # Open defecation --- ## What share of people practice open defecation? Open defecation refers to the defecation in the open, such as in fields, forest, bushes, open bodies of water, on beaches, in other open spaces or disposed of with solid waste. Open defecation has a number of negative health and social impacts, including the spread of infectious diseases, diarrhoea (especially in children), adverse health outcomes in pregnancy, malnutrition, as well as increased vulnerability to violence — particularly for women and girls.{ref}Mara, D. (2017). The elimination of open defecation and its adverse health effects: a moral imperative for governments and development professionals. _Journal of Water Sanitation and Hygiene for Development_, _7_(1), 1-12. Available [online](http://washdev.iwaponline.com/content/7/1/1).{/ref} In 2020, 6% of the world's population were still practicing open defecation. The map shows the share of people practicing open defecation across the world. <Chart url="https://ourworldindata.org/grapher/people-practicing-open-defecation-of-population"/> --- # What determines levels of sanitation access? --- ## Access to sanitation facilities increases with income The provision of sanitation facilities tends to increase with income. In the chart we see the share of the population with access to improved sanitation versus gross domestic product (GDP) per capita. Overall, we see a strong relationship between the two: access to improved sanitation increases as countries get richer. <Chart url="https://ourworldindata.org/grapher/improved-sanitation-facilities-vs-gdp-per-capita"/> ## Open defecation is mainly a rural issue As we see above, rural access to improved sanitation facilities typically lags behind urban areas for most countries. Although having access to improved sanitation facilities does not necessitate open defecation (some households can have very basic or shared sanitation facilities), we also see that open defecation is predominantly a rural issue for most countries. In the chart we see the prevalence of open defecation in rural areas versus urban areas. For the majority of countries, open defecation in urban areas is typically below 20 percent of the population. For rural populations, however, the share of the population practicing open defecation can range from less than 20 percent to almost 90 percent. Although open defecation in urban areas is still a pressing in many countries, the problem much more strongly concentrated in rural areas. <Chart url="https://ourworldindata.org/grapher/open-defecation-in-rural-areas-vs-urban-areas"/> --- # Other health impacts of poor sanitation --- ### Stunting is higher where access to improved sanitation is low Stunting — determined as having a height which falls below the median height-for-age WHO Child Growth Standards — is a sign of [chronic malnutrition](https://ourworldindata.org/hunger-and-undernourishment/#too-little-height-for-age-stunting).{ref}World Health Organization (2014). WHA Global Nutrition Targets 2025: Stunting Policy Brief. Available [online](http://www.who.int/nutrition/topics/globaltargets_stunting_policybrief.pdf).{/ref} Although, linked to poor nutritional intake (which we cover in our entry on [Hunger and Undernourishment](https://ourworldindata.org/hunger-and-undernourishment/)), it is linked to a range of compounding factors, including the recurrence of infectious diseases, childhood diarrhea, and poor sanitation & hygeine. In the chart we see the prevalence of stunting (measured as the share of children under 5-years-old defined as being more than two standard deviations below the median international height) versus the share of the population with improved sanitation facilities. Overall we see a negative correlation: rates of childhood stunting are typically higher in countries with lower access to improved sanitation facilities. <Chart url="https://ourworldindata.org/grapher/prevalence-of-stunting-vs-improved-sanitation-facilities"/> --- # Definitions --- **Improved sanitation facilities**: "An improved sanitation facility is defined as one that hygienically separates human excreta from human contact. They include flush/pour flush (to piped sewer system, septic tank, pit latrine), ventilated improved pit (VIP) latrine, pit latrine with slab, and composting toilet. Improved sanitation facilities range from simple but protected pit latrines to flush toilets with a sewerage connection. To be effective, facilities must be correctly constructed and properly maintained." {ref}World Bank & WHO/UNICEF Joint Monitoring Programme ( JMP ) for Water Supply and Sanitation. World Development Indicators Metadata. Available [online](http://databank.worldbank.org/data/reports.aspx?source=2&type=metadata&series=SH.STA.ACSN).{/ref} **Safely managed sanitation facilities**: “Safely managed sanitation” [is defined](https://www.who.int/water_sanitation_health/monitoring/coverage/explanatorynote-sdg-621-safelymanagedsanitationsServices161027.pdf) as the use of an improved sanitation facility which is not shared with other households and where: • excreta is safely disposed in situ or • excreta is transported and treated off-site. The definitions of categories of sanitation facilities coverage include: * '**Basic service**': Private improved facility which separates excreta from human contact; * '**Limited service**': Improved facility shared with other households; * '**Unimproved service**': Unimproved facility which does not separate excreta from human contact; * '**No service**': open defecation. **Open defecation**: "People practicing open defecation refers to the percentage of the population defecating in the open, such as in fields, forest, bushes, open bodies of water, on beaches, in other open spaces or disposed of with solid waste." <Image filename="Sanitation-definitions.png" alt=""/> --- # Explore more of our work on Clean Water and Sanitation --- Explore all the metrics – clean drinking water, sanitation and handwashing access – in one place. See how access to safe drinking water varies across the world. How does access to sanitation vary across the world? See global progress on sanitation. How many people lack access to basic handwashing facilities? Explore the global data on hygiene.

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        "rendered": "\n<!-- formatting-options subnavId:water subnavCurrentId:sanitation -->\n\n\n\n<div class=\"blog-info\">First published in September 2019. Latest update in June 2021.</div>\n\n\n\t<div class=\"wp-block-owid-summary\">\n\t\t<h2>Summary</h2>\n\t\t\n\n<ul><li><a href=\"https://ourworldindata.org/sanitation#unsafe-sanitation-is-a-leading-risk-factor-for-death\">Unsafe sanitation is responsible for 775,000 deaths each year.</a></li><li><a href=\"https://ourworldindata.org/sanitation#the-global-distribution-of-deaths-from-sanitation\">5% of deaths in low-income countries result from unsafe sanitation</a></li><li><a href=\"https://ourworldindata.org/sanitation#access-to-safe-sanitation\">46% of the world do not have access to safely managed sanitation.</a></li><li><a href=\"https://ourworldindata.org/sanitation#open-defecation\">6% of the world still practice open defecation.</a></li><li><a href=\"https://ourworldindata.org/sanitation#other-health-impacts-of-poor-sanitation\">Unsafe sanitation has a significant impact on childhood stunting.</a></li></ul>\n\n\n\n<p></p>\n\n\n\t</div>\n\n\n<h2>Unsafe sanitation is a leading risk factor for death</h2>\n\n\n\n<h4>Unsafe sanitation is responsible for 775,000 deaths each year</h4>\n\n\n\n<p>Unsafe sanitation is one of the world&#8217;s largest health and environmental problems \u2013 particularly for the <a href=\"https://owid.cloud/extreme-poverty\">poorest in the world</a>.</p>\n\n\n\n<p>The <em>Global Burden of Disease</em> is a major global study on the causes and risk factors for death and disease published in the medical journal <em>The Lancet</em>.{ref}The latest study can be found at the website of the Lancet here: <a href=\"https://www.thelancet.com/gbd\">TheLancet.com/GBD</a></p>\n\n\n\n<p>The 2017 study was published as GBD 2017 Risk Factor Collaborators \u2013 &#8220;Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017&#8221; and is online <a href=\"http://www.healthdata.org/research-article/global-regional-and-national-comparative-risk-assessment-84-behavioral-0\">here</a>.{/ref} These estimates of the annual number of deaths attributed to a wide range of risk factors are shown here. This chart is shown for the global total, but can be explored for any country or region using the &#8220;change country&#8221; toggle.</p>\n\n\n\n<p>Lack of access to poor sanitation is a leading risk factor for infectious diseases, including cholera, <a href=\"https://owid.cloud/diarrheal-diseases\">diarrhoea</a>, dysentery, hepatitis A, typhoid and <a href=\"https://owid.cloud/polio\">polio</a>.{ref}WHO (2019) \u2013 Fact sheet \u2013 Drinking water. Updated June 2019. Online <a href=\"https://www.who.int/news-room/fact-sheets/detail/sanitation\">here</a>.{/ref} It also exacerbates malnutrition, and in particular, <a href=\"https://ourworldindata.org/hunger-and-undernourishment#too-little-height-for-age-stunting\">childhood stunting</a>. In the chart we see that it ranks as a very important risk factor for death globally. </p>\n\n\n\n<p>According to the <em>Global Burden of Disease</em> study 775,000 people died prematurely in 2017 as a result of poor sanitation. To put this into context: this was almost double the <a href=\"https://ourworldindata.org/grapher/annual-number-of-deaths-by-cause\">number of homicides</a> \u2013 close to 400,000 in 2017.</p>\n\n\n\n<iframe src=\"https://ourworldindata.org/grapher/number-of-deaths-by-risk-factor\" style=\"width: 100%; height: 600px; border: 0px none;\"></iframe>\n\n\n\n<h2>The global distribution of deaths from sanitation</h2>\n\n\n\n<h4>In low-income countries poor sanitation accounts for 5% of deaths</h4>\n\n\n\n<p>An estimated 775,000 people died prematurely as a result of poor sanitation in 2017. This was 1.4% of global deaths.</p>\n\n\n\n<p>In low-income countries, it accounts for 5% of deaths.</p>\n\n\n\n<p>In the map here we see the share of annual deaths attributed to unsafe sanitation across the world. In 2017 this ranged from a high of close to 11% in Chad \u2013 more than 1-in-10 deaths \u2013 to less than 0.01% across most of Europe.</p>\n\n\n\n<p>When we compare the share of deaths attributed to unsafe sanitation either over time or between countries, we are not only comparing the extent of sanitation, but its severity <em>in the context</em> of other risk factors for death. Sanitation&#8217;s share does not only depend on how many die prematurely from it, but what else people are dying from and how this is changing.</p>\n\n\n\n<iframe src=\"https://ourworldindata.org/grapher/share-deaths-unsafe-sanitation\" style=\"width: 100%; height: 600px; border: 0px none;\"></iframe>\n\n\n\n<h4>Death rates are much higher in low-income countries</h4>\n\n\n\n<p>Death rates from unsafe sanitation give us an accurate comparison of differences in its mortality impacts between countries and over time. In contrast to the share of deaths that we studied before, death rates are not influenced by how other causes or risk factors for death are changing.</p>\n\n\n\n<p>In this map we see death rates from unsafe sanitation across the world. Death rates measure the number of deaths per 100,000 people in a given country or region.</p>\n\n\n\n<p>What becomes clear is the large differences in death rates between countries: rates are high in lower-income countries, particularly across Sub-Saharan Africa and Asia. Rates here are often greater than 50 deaths per 100,000 \u2013 in the Central African Republic and Chad this was over 120 per 100,000.</p>\n\n\n\n<p>Compare this with death rates across high-income countries: across Europe rates are below 0.1 deaths per 100,000. That\u2019s a greater than 1000-fold difference.</p>\n\n\n\n<p>The issue of unsafe water is therefore one which is largely limited to low and lower-middle income countries.</p>\n\n\n\n<p>We see this relationship clearly when we plot death rates versus income, as shown&nbsp;<a href=\"https://ourworldindata.org/grapher/death-rates-from-unsafe-sanitation-vs-gdp-per-capita\"><strong>here</strong></a>. There is a strong negative relationship: death rates decline as countries get richer.</p>\n\n\n\n<iframe src=\"https://ourworldindata.org/grapher/death-rates-sanitation\" style=\"width: 100%; height: 600px; border: 0px none;\"></iframe>\n\n\n\n<h2>Access to safe sanitation</h2>\n\n\n\n<h3>What share of people use safely managed sanitation facilities?</h3>\n\n\n\n<h4>Nearly half of the world do not have access to safe sanitation</h4>\n\n\n\n<p><a href=\"https://sdg-tracker.org/water-and-sanitation#6.2\">SDG Target 6.2</a> is to: \u201cachieve access to adequate and equitable sanitation and hygiene for all and end open defecation\u201d by 2030.</p>\n\n\n\n<p><strong>Where are we today? </strong>In 2020, just over half (54%) of the world population had access to <a href=\"http://ourworldindata.org/sanitation#definitions\">safely managed sanitation</a>. It is shocking that nearly one-in-two don\u2019t. Around 6% do not have <em>any</em> sanitation facilities at all, and instead have to practice open defecation.</p>\n\n\n\n<p>In the chart we see the breakdown of sanitation access globally, and across regions and income groups. We see that in countries at the lowest incomes, less than one-fifth of the population have safe sanitation. Much like safe drinking water, most live in Sub-Saharan Africa.</p>\n\n\n\n<p><strong>Are we making progress? </strong>The world has made progress in the last five years. But again, this has been far too slow albeit slightly faster than our progress on drinking water. In 2015 only 47% of the global population had safe sanitation. That means we\u2019ve seen an increase of seven percentage points over five years.</p>\n\n\n\n<p>The gap between where we are now and universal access is still huge. Our progress is far too slow to achieve this by 2030. If progress continues at these rates, we would only reach 68% by 2030. Almost one-third of the world would miss out. If we\u2019re to meet our target we need almost exactly the same acceleration as our progress on drinking water: rates would need to more than triple (increase 3.3-fold) for the coming decade.{ref}To reach universal access within 10 years (the current gap is 46%) we need to see a 23 percentage point increase every five years. That\u2019s 3.3 times higher than the 7 percentage point increase we\u2019ve seen in the last five years.{/ref}</p>\n\n\n\n<div class=\"wp-block-columns is-style-side-by-side\">\n<div class=\"wp-block-column\">\n<iframe src=\"https://ourworldindata.org/grapher/share-of-the-population-with-access-to-sanitation-facilities\" loading=\"lazy\" style=\"width: 100%; height: 600px; border: 0px none;\"></iframe>\n</div>\n\n\n\n<div class=\"wp-block-column\">\n<iframe src=\"https://ourworldindata.org/explorers/water-and-sanitation?tab=chart&amp;Resource=Sanitation&amp;Level+of+Access=Safely+managed&amp;Residence=Total&amp;Relative+to+population=Share+of+population&amp;country=OWID_WRL&amp;hideControls=true\" loading=\"lazy\" style=\"width: 100%; height: 600px; border: 0px none;\"></iframe>\n</div>\n</div>\n\n\n\n<h4>Access to safe sanitation by country</h4>\n\n\n\n<p>In the map shown we see the share of people across the world that have access to safely managed sanitation. </p>\n\n\n\n<iframe src=\"https://ourworldindata.org/grapher/share-using-safely-managed-sanitation\"></iframe>\n\n\n\n<h3>How many people do not have access to safe sanitation?</h3>\n\n\n\n<p>In the map shown we see the number of people across the world that <em>do not</em> have access to safely managed sanitation.</p>\n\n\n\n<iframe src=\"https://ourworldindata.org/grapher/safe-sanitation-without\"></iframe>\n\n\n\n<h2>Access to improved sanitation</h2>\n\n\n\n<h3>What share of people do not have access to improved sanitation?</h3>\n\n\n\n<p>&#8216;Improved&#8217; sanitation is defined as facilities which ensure hygienic separation of human excreta from human contact. This includes facilities such as flush/pour flush (to piped sewer system, septic tank, pit latrine), ventilated improved pit (VIP) latrine, pit latrine with slab, and a composting toilet. Note that having access to improved sanitation facilities greatly increases the likelihood \u2013 but doesn&#8217;t guarantee \u2013 that people use safe sanitation facilities. We look at coverage of <em>safe</em> sanitation <a href=\"https://ourworldindata.org/sanitation#access-to-safe-sanitation\"><strong>here</strong></a>.</p>\n\n\n\n<p>In 2020, 68% of the world population had access to improved sanitation facilities. This means almost one-third of people do not have access.</p>\n\n\n\n<p>In the map shown we see the share of people across the world that <em>do not</em> have access to improved sanitation.</p>\n\n\n\n<iframe loading=\"lazy\" style=\"width: 100%; height: 600px; border: 0px none;\" src=\"https://ourworldindata.org/grapher/share-without-improved-sanitation\" width=\"300\" height=\"150\"></iframe>\n\n\n\n<h3>How many people do not have access to improved sanitation?</h3>\n\n\n\n<p>In the map shown we see the number of people across the world that <em>do not</em> have access to improved sanitation.</p>\n\n\n\n<iframe src=\"https://ourworldindata.org/grapher/number-without-access-to-improved-sanitation\"></iframe>\n\n\n\n<h2>Open defecation</h2>\n\n\n\n<h3>What share of people practice open defecation?</h3>\n\n\n\n<p>Open defecation refers to the defecation in the open, such as in fields, forest, bushes, open bodies of water, on beaches, in other open spaces or disposed of with solid waste. Open defecation has a number of negative health and social impacts, including the spread of infectious diseases, diarrhoea (especially in children), adverse health outcomes in pregnancy, malnutrition, as well as increased vulnerability to violence \u2014 particularly for women and girls.{ref}Mara, D. (2017). The elimination of open defecation and its adverse health effects: a moral imperative for governments and development professionals.&nbsp;<em>Journal of Water Sanitation and Hygiene for Development</em>,&nbsp;<em>7</em>(1), 1-12. Available <a href=\"http://washdev.iwaponline.com/content/7/1/1\">online</a>.{/ref}</p>\n\n\n\n<p>In 2020, 6% of the world&#8217;s population were still practicing open defecation.</p>\n\n\n\n<p>The map shows the share of people practicing open defecation across the world.</p>\n\n\n\n<iframe loading=\"lazy\" style=\"width: 100%; height: 600px; border: 0px none;\" src=\"https://ourworldindata.org/grapher/people-practicing-open-defecation-of-population\" width=\"300\" height=\"150\"></iframe>\n\n\n\n<h2>What determines levels of sanitation access?</h2>\n\n\n\n<h3>Access to sanitation facilities increases with income</h3>\n\n\n\n<p>The provision of sanitation facilities tends to increase with income. In the chart we see the share of the population with access to improved sanitation versus gross domestic product (GDP) per capita.</p>\n\n\n\n<p>Overall, we see a strong relationship between the two: access to improved sanitation increases as countries get richer.</p>\n\n\n\n<iframe loading=\"lazy\" style=\"width: 100%; height: 600px; border: 0px none;\" src=\"https://ourworldindata.org/grapher/improved-sanitation-facilities-vs-gdp-per-capita\" width=\"300\" height=\"150\"></iframe>\n\n\n\n<h3>Open defecation is mainly a rural issue</h3>\n\n\n\n<p>As we see above, rural access to improved sanitation facilities typically lags behind urban areas for most countries. Although having access to improved sanitation facilities does not necessitate open defecation (some households can have very basic or shared sanitation facilities), we also see that open defecation is predominantly a rural issue for most countries.</p>\n\n\n\n<p>In the chart we see the prevalence of open defecation in rural areas versus urban areas. For the majority of countries, open defecation in urban areas is typically below 20 percent of the population. For rural populations, however, the share of the population practicing open defecation can range from less than 20 percent to almost 90 percent. Although open defecation in urban areas is still a pressing in many countries, the problem much more strongly concentrated in rural areas.</p>\n\n\n\n<iframe loading=\"lazy\" style=\"width: 100%; height: 600px; border: 0px none;\" src=\"https://ourworldindata.org/grapher/open-defecation-in-rural-areas-vs-urban-areas\" width=\"300\" height=\"150\"></iframe>\n\n\n\n<h2>Other health impacts of poor sanitation</h2>\n\n\n\n<h4>Stunting is higher where access to improved sanitation is low</h4>\n\n\n\n<p>Stunting \u2014 determined as having a height which falls below the median height-for-age WHO Child Growth Standards&nbsp;\u2014 is a sign of <a href=\"https://ourworldindata.org/hunger-and-undernourishment/#too-little-height-for-age-stunting\">chronic malnutrition</a>.{ref}World Health Organization (2014). WHA Global Nutrition Targets 2025: Stunting Policy Brief. Available&nbsp;<a href=\"http://www.who.int/nutrition/topics/globaltargets_stunting_policybrief.pdf\">online</a>.{/ref}</p>\n\n\n\n<p>Although, linked to poor nutritional intake (which we cover in our entry on <a href=\"https://ourworldindata.org/hunger-and-undernourishment/\">Hunger and Undernourishment</a>), it is linked to a range of compounding factors, including the recurrence of infectious diseases, childhood diarrhea, and poor sanitation &amp; hygeine.</p>\n\n\n\n<p>In the chart we see the prevalence of stunting (measured as the share of children under 5-years-old defined as being more than two standard deviations below&nbsp;the median international height) versus the share of the population with improved sanitation facilities. Overall we see a negative correlation: rates of childhood stunting are typically higher in countries with lower access to improved sanitation facilities.&nbsp;</p>\n\n\n\n<iframe loading=\"lazy\" style=\"width: 100%; height: 600px; border: 0px none;\" src=\"https://ourworldindata.org/grapher/prevalence-of-stunting-vs-improved-sanitation-facilities\" width=\"300\" height=\"150\"></iframe>\n\n\n\n<h2>Definitions</h2>\n\n\n\n<p><strong>Improved sanitation facilities</strong>: &#8220;An improved sanitation facility is defined as one that hygienically separates human excreta from human contact.&nbsp;They include flush/pour flush (to piped sewer system, septic tank, pit latrine), ventilated improved pit (VIP) latrine, pit latrine with slab, and composting toilet.</p>\n\n\n\n<p>Improved sanitation facilities range from simple but protected pit latrines to flush toilets with a sewerage connection. To be effective, facilities must be correctly constructed and properly maintained.&#8221;&nbsp;{ref}World Bank &amp;&nbsp;WHO/UNICEF Joint Monitoring Programme ( JMP ) for Water Supply and Sanitation. World Development Indicators Metadata. Available <a href=\"http://databank.worldbank.org/data/reports.aspx?source=2&amp;type=metadata&amp;series=SH.STA.ACSN\">online</a>.{/ref}</p>\n\n\n\n<p><strong>Safely managed sanitation facilities</strong>: \u201cSafely managed sanitation\u201d <a href=\"https://www.who.int/water_sanitation_health/monitoring/coverage/explanatorynote-sdg-621-safelymanagedsanitationsServices161027.pdf\">is defined</a> as the use of  an improved sanitation facility which is not shared  with other households and where:<br> \u2022 excreta is  safely  disposed in situ or  <br> \u2022 excreta is  transported and treated off-site.</p>\n\n\n\n<p>The definitions of categories of sanitation facilities coverage include:</p>\n\n\n\n<ul><li>&#8216;<strong>Basic service</strong>&#8216;: Private improved facility which separates excreta from human contact;</li><li>&#8216;<strong>Limited service</strong>&#8216;: Improved facility shared with other households;</li><li>&#8216;<strong>Unimproved service</strong>&#8216;: Unimproved facility which does not separate    excreta from human contact;</li><li>&#8216;<strong>No service</strong>&#8216;: open defecation.</li></ul>\n\n\n\n<p><strong>Open defecation</strong>: &#8220;People practicing open defecation refers to the percentage of the population defecating in the open, such as in fields, forest, bushes, open bodies of water, on beaches, in other open spaces or disposed of with solid waste.&#8221;</p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" width=\"1677\" height=\"545\" src=\"https://owid.cloud/app/uploads/2021/06/Sanitation-definitions.png\" alt=\"\" class=\"wp-image-43854\" srcset=\"https://owid.cloud/app/uploads/2021/06/Sanitation-definitions.png 1677w, https://owid.cloud/app/uploads/2021/06/Sanitation-definitions-400x130.png 400w, https://owid.cloud/app/uploads/2021/06/Sanitation-definitions-800x260.png 800w, https://owid.cloud/app/uploads/2021/06/Sanitation-definitions-150x49.png 150w, https://owid.cloud/app/uploads/2021/06/Sanitation-definitions-768x250.png 768w, https://owid.cloud/app/uploads/2021/06/Sanitation-definitions-1536x499.png 1536w\" sizes=\"(max-width: 1677px) 100vw, 1677px\" /></figure>\n\n\n\n<h2>Explore more of our work on Clean Water and Sanitation</h2>\n\n\n\t<div class=\"wp-block-owid-grid \">\n\t\t\n      <div class=\"wp-block-owid-card  with-image\" data-no-lightbox>\n        <a href=\"http://ourworldindata.org/explorers/water-and-sanitation\">\n            <figure><img width=\"768\" height=\"404\" src=\"https://owid.cloud/app/uploads/2021/01/data_explorer-featured-768x404.png\" class=\"attachment-medium_large size-medium_large\" alt=\"COVID-19 data explorer\" loading=\"lazy\" srcset=\"https://owid.cloud/app/uploads/2021/01/data_explorer-featured-768x404.png 768w, https://owid.cloud/app/uploads/2021/01/data_explorer-featured-400x210.png 400w, https://owid.cloud/app/uploads/2021/01/data_explorer-featured-800x421.png 800w, https://owid.cloud/app/uploads/2021/01/data_explorer-featured-150x79.png 150w, https://owid.cloud/app/uploads/2021/01/data_explorer-featured.png 1200w\" sizes=\"(max-width: 768px) 100vw, 768px\" /></figure>\n            <div class=\"text-wrapper\">\n              \n              <div class=\"description\">\n                \n\n<p>Explore all the metrics \u2013 clean drinking water, sanitation and handwashing access \u2013 in one place.</p>\n\n\n              </div>\n            </div>\n        </a>\n      </div>\n\n      <div class=\"wp-block-owid-card  with-image\" data-no-lightbox>\n        <a href=\"https://owid.cloud/water-access\">\n            <figure><img width=\"768\" height=\"404\" src=\"https://owid.cloud/app/uploads/2021/06/Clean-Water-thumbnail-768x404.png\" class=\"attachment-medium_large size-medium_large\" alt=\"\" loading=\"lazy\" srcset=\"https://owid.cloud/app/uploads/2021/06/Clean-Water-thumbnail-768x404.png 768w, https://owid.cloud/app/uploads/2021/06/Clean-Water-thumbnail-400x210.png 400w, https://owid.cloud/app/uploads/2021/06/Clean-Water-thumbnail-800x421.png 800w, https://owid.cloud/app/uploads/2021/06/Clean-Water-thumbnail-150x79.png 150w, https://owid.cloud/app/uploads/2021/06/Clean-Water-thumbnail-1536x808.png 1536w, https://owid.cloud/app/uploads/2021/06/Clean-Water-thumbnail-2048x1077.png 2048w\" sizes=\"(max-width: 768px) 100vw, 768px\" /></figure>\n            <div class=\"text-wrapper\">\n              \n              <div class=\"description\">\n                \n\n<p>See how access to safe drinking water varies across the world.</p>\n\n\n              </div>\n            </div>\n        </a>\n      </div>\n\n      <div class=\"wp-block-owid-card  with-image\" data-no-lightbox>\n        <a href=\"https://owid.cloud/sanitation\">\n            <figure><img width=\"768\" height=\"404\" src=\"https://owid.cloud/app/uploads/2021/06/Sanitation-thumbnail-768x404.png\" class=\"attachment-medium_large size-medium_large\" alt=\"\" loading=\"lazy\" srcset=\"https://owid.cloud/app/uploads/2021/06/Sanitation-thumbnail-768x404.png 768w, https://owid.cloud/app/uploads/2021/06/Sanitation-thumbnail-400x210.png 400w, https://owid.cloud/app/uploads/2021/06/Sanitation-thumbnail-800x421.png 800w, https://owid.cloud/app/uploads/2021/06/Sanitation-thumbnail-150x79.png 150w, https://owid.cloud/app/uploads/2021/06/Sanitation-thumbnail-1536x808.png 1536w, https://owid.cloud/app/uploads/2021/06/Sanitation-thumbnail-2048x1077.png 2048w\" sizes=\"(max-width: 768px) 100vw, 768px\" /></figure>\n            <div class=\"text-wrapper\">\n              \n              <div class=\"description\">\n                \n\n<p>How does access to sanitation vary across the world? See global progress on sanitation.</p>\n\n\n              </div>\n            </div>\n        </a>\n      </div>\n\n      <div class=\"wp-block-owid-card  with-image\" data-no-lightbox>\n        <a href=\"http://ourworldindata.org/hygiene\">\n            <figure><img width=\"768\" height=\"404\" src=\"https://owid.cloud/app/uploads/2021/06/Hygiene-thumbnail-768x404.png\" class=\"attachment-medium_large size-medium_large\" alt=\"\" loading=\"lazy\" srcset=\"https://owid.cloud/app/uploads/2021/06/Hygiene-thumbnail-768x404.png 768w, https://owid.cloud/app/uploads/2021/06/Hygiene-thumbnail-400x210.png 400w, https://owid.cloud/app/uploads/2021/06/Hygiene-thumbnail-800x421.png 800w, https://owid.cloud/app/uploads/2021/06/Hygiene-thumbnail-150x79.png 150w, https://owid.cloud/app/uploads/2021/06/Hygiene-thumbnail-1536x808.png 1536w, https://owid.cloud/app/uploads/2021/06/Hygiene-thumbnail-2048x1077.png 2048w\" sizes=\"(max-width: 768px) 100vw, 768px\" /></figure>\n            <div class=\"text-wrapper\">\n              \n              <div class=\"description\">\n                \n\n<p>How many people lack access to basic handwashing facilities? Explore the global data on hygiene. </p>\n\n\n              </div>\n            </div>\n        </a>\n      </div>\n\n\t</div>\n\n\n<p></p>\n",
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    "excerpt": {
        "rendered": "Access to safe sanitation is essential for reducing deaths from infectious disease, preventing malnutrition and providing dignity. \nWhat is the global situation today and how can we make progress?",
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    },
    "date_gmt": "2019-09-25T16:00:31",
    "modified": "2022-04-12T14:28:45",
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    "menu_order": 344,
    "ping_status": "closed",
    "authors_name": [
        "Hannah Ritchie"
    ],
    "modified_gmt": "2022-04-12T13:28:45",
    "comment_status": "closed",
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