Sanitation

First published in September 2019.

Related research entries

Clean water – unsafe sanitation, and poor access to basic handwashing facilities is often linked with unsafe water sources. How does access to clean water vary across the world? What are the health impacts of unsafe water?

Diarrheal diseases – unsafe sanitation is a leading risk for diarrheal diseases. How many die from diarrheal diseases each year, and how can we prevent them?

Causes of death – unsafe sanitation is a leading risk factor for death, especially at low incomes. What do people across the world die from?

Hunger and undernourishment – unsafe sanitation can exacerbation malnutrition, especially in children. How does undernourishment differ across the world?

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.

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.1 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, dysentery, hepatitis A, typhoid and polio.2 It also exacerbates malnutrition, and in particular, childhood 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 – close to 400,000 in 2017.

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.

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. There is a strong negative relationship: death rates decline as countries get richer.

Access to improved sanitation

What share of people 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 are use safe sanitation facilities. We look at coverage of safe sanitation here.

In 2015, 68% of the world population had access to improved sanitation facilities. This means almost one-third of people do not have access.

The map here shows the share of the population with improved sanitation facilities across the world.

We see that there are large inequalities in access to improved sanitation.

Access across Europe, North America, North Africa and some of Latin America is typically greater than 90%. Between 80 and 90% of households in Latin America and the Caribbean have improved sanitation. Access is slightly lower across Central and East Asia, typically between 70 and 80%.

In South Asia, progress has been varied. Sri Lanka has achieved a 95% access rate; Pakistan and Bangladesh both have access of over 60%; whereas India lags behind in this regard with just under 40%. Regionally, access is lowest in Sub-Saharan Africa where most countries have less than 40% access rates. In South Sudan, only 7% of the population had improved sanitation in 2015. 

How many people don’t have access to improved sanitation?

2.4 billion people do not have access to improved sanitation

The share of people with without access to improved sanitation has fallen from 48% in 1990 to 32% in 2015. But how has the number of people without access changed over time?

The visualization here shows the total number of people with and without access to improved sanitation facilities from 1990. This is shown globally as the default, but this data can also be viewed by country and region using the “change country” toggle.

In 2015, 2.4 billion people did not access to improved sanitation.

Since 1990 the number of people without access has remained almost constant: in 1990 this figure was 2.49 billion, and in 2015 it has reduced to 2.39 billion. Total population has of course grown over this period, meaning the number with access has increased from 2.8 billion to nearly 5 billion in 2015.

Number of people without improved sanitation by region

The chart here shows the number of people without access to improved sanitation facilities by region.

Over 90% of those without access in 2015 resided in Asia, the Pacific or Sub-Saharan Africa. The largest region share was from South Asia, accounting for 40% – nearly one billion did not have access. This was followed by Sub-Saharan Africa with nearly 30% (706 million), and East Asia & Pacific with around 22% (520 million).

Number of people without improved sanitation by country

The map here shows the number of people without access to improved sanitation by country. Clicking on any country will show how this number has changed over time.

Access to safe sanitation

What share of people use safely managed sanitation facilities?

The majority of people in the world (60%) do not have access to safely managed sanitation

Having access to improved sanitation facilities increases the likelihood that sanitation is safely managed. But it doesn’t guarantee that the waste is then contained adequately from the surrounding environment, or that is is treated off-site.

Looking at ‘safely’ managed sanitation does guarantee this, although data is not currently available for all countries.

It’s estimated that only 40% of the world population has access to safe sanitation. This means the majority – 60% – don’t have access.

In the map shown we see the share of people across the world that have access to safely managed sanitation.

How many people use safely managed sanitation facilities?

In the map shown we see the total number of people who use safely managed sanitation facilities across the world.

Sanitation facilities coverage

Breakdown of sanitation coverage

In the visualization we see the number of people globally with different levels of sanitation coverage – ranging from ‘at least basic’ to open defecation.

Globally, 5 billion people had access to ‘at least basic’ levels of sanitation. This left around one-third (2.4 billion) without even basic facilities.

This chart can be explored for a range of countries using the ‘change country’ toggle.

Open defecation

What share of people practice open defecation?

15% of the world population still 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.3

In 2015, 15% of the world’s population were still practicing open defecation. This figure has roughly halved since 1990.

The map shows the share of people practicing open defecation across the world. Regionally, prevalence is highest in South Asia where 36% of the population were practicing open defecation. India in particular still has high rates, at nearly 45%.

In Sub-Saharan Africa, this rate was 23%. However, some countries in particular — such as Niger, Chad, South Sudan and Eritrea — still have a prevalence between 60 and 80%.

Access to handwashing facilities

What share of people have access to basic handwashing facilities?

40% of the world population does not have access to basic handwashing facilities

Alongside sanitation, access to basic handwashing facilities is essential for the prevention of infectious diseases and malnutrition. Often access to basic hygiene and access to sanitation are linked.

An estimated 60% of the world population had access to basic handwashing facilities on premises in 2017. This means 40% of the world do not have access.

In the map here we see this distribution across the world, for countries with available data.

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.

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.

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.4

Although, linked to poor nutritional intake (which we cover in our entry on 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. 

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.” 5

Safely managed sanitation facilities: “Safely managed sanitation” is defined 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.”

Data Sources

World Development Indicators – World Bank
  • Data: Access to improved water sources, improved sanitation facilities, open defecation, water consumption by sector and related health indicators
  • Geographical coverage:  Global – by country and world region
  • Time span: 1990 onwards
  • Available at: https://data.worldbank.org/indicator

WHO/UNICEF Joint Monitoring Programme ( JMP ) for Water Supply and Sanitation
  • Data:Water and sanitation sources access
  • Geographical coverage: Global – by country and world region
  • Time span: 2000 onwards
  • Available at: https://washdata.org/