Time to clean up our sanitation act

We are nearly two decades into the 21st century, yet nearly 2.3 billion people – one-third of the global population – still lack basic sanitation. This appalling state of affairs causes unnecessary disease and death. Poor sanitation is linked to transmission of such diseases as cholera, diarrhoea, dysentery, Hepatitis A, typhoid and polio; it also contributes to malnutrition. Poor sanitation not only affects human health, but it can also damage ecosystems and the health of our planet.

In 2010, the United Nations General Assembly recognized access to safe and clean drinking water and sanitation as a human right, and called for international efforts to help countries provide safe, clean, accessible and affordable drinking water and sanitation. Today, this call is enshrined in UN Sustainable Development Goal 6 – ensure availability and sustainable management of water and sanitation for all. Targets for the goal include achieving by 2030 access to adequate and equitable sanitation and hygiene for all and end open defecation (Target 6.2). There is also a call to expand international cooperation and capacity-building support to developing countries in water- and sanitation-related activities and programmes (Target 6.a), and to support and strengthen the participation of local communities in improving water and sanitation management (Target 6.b)

These are ambitious goals, as are most of the SDGs, but they can be achieved and in some cases are starting to be achieved.

Jennifer Cole, public health policy advisor with the Secretariat of the Rockefeller Foundation Economic Council on Planetary Health lays out in the report, Sanitation in the Context of Planetary Health, opportunities and challenges for meeting the SDGs on sanitation. By applying a planetary health approach across the triad of public health, environmental health and economic opportunities, policy-makers and environmentalists can begin to think in terms of not only the disposal of human waste, but also of resource recovery and reuse – and its potential to generate clean energy and the reduction of greenhouses gases – and recovery of nutrients for agriculture, as well as reduced exposure to disease pathogens.

One particular challenge for densely populated human settlements is how to dispose of large quantities of human waste which, if not safely managed, impact on human health, the environment and economic prosperity. The World Health Organization estimates that total global economic losses associated with inadequate water supply and sanitation to be 1.5% of GDP (US$260 billion), with poor sanitation costing some countries, especially in the developing world, as high as 7.2% of annual GDP. This reflects the cost of healthcare treatment, productivity time lost to sickness and seeking treatment, and productivity time lost to accessing sanitation facilities.

Illustrative photo of a latrine (Amy Reed)

Poorly managed sanitation can also create environmental challenges. Ill-functioning latrines and septic tanks can leak into soil and water, and untreated wastewater released directly into the environment can pollute rivers. Untreated waste flowing into our waterways can cause eutrophication – excessive plant growth due to the high concentrations of phosphates and nitrates it contains – which can severely damage freshwater and coastal marine ecosystems. And let us not forget the link between sanitation and greenhouse gas emissions. Pit latrines can produce higher greenhouse gas emissions than open defecation as more of the carbon in fecal matter forms methane rather than CO2 during breakdown, so capturing this methane for clean energy also needs to be considered.


As developing nations industrialize and urbanize, incorporating sanitation and waste management strategies into wider environmental policies can offer an array of benefits. Good waste management practices allow nutrients in waste and wastewater to be reused as agricultural fertilizer, and biogas released from the breakdown of waste can be used as fuel and generate electricity. For example, capturing methane emissions from human waste for biogas compared with losing them to the atmosphere could prevent a 6% annual increase in India’s greenhouse gas emissions. Using this biogas to provide clean energy to households that currently use traditional cooking stoves could potentially avoid more than 4% of the country’s GHGs, worth over US$1 billion on the international carbon market, and reduce black carbon – a cause of human morbidity and premature mortality – by a third.

Challenges to implementing and maintaining improved sanitation vary between locations based on economic status, rural or urban settings, and even cultural barriers. All of these need to be addressed if SDG 6 and its targets are to be achieved by their 2030 deadline. While the developed world is showing immense progress in collecting, treating and reusing waste, much more needs to be done in developing countries. But if we provide affordable and the right equipment and education in hygiene practices, we can reduce the senseless suffering from preventable diseases and loss of life.

By Mark Schulman, Editor, Secretariat of the Rockefeller Foundation Economic Council on Planetary Health