Improving access to water, sanitation and hygiene could save 1.4 million lives a year, says new WHO report

“With the growing health risks associated with WASH already seen today through conflict, the emergence of antimicrobial resistance, the re-emergence of cholera hotspots and the long-term threat of climate change, the imperative to invest is stronger than ever,” said Dr Maria Neira, Director, WHO department of environment, climate change and health. “We have seen improvements in WASH service levels over the past 10 years, but progress is uneven and insufficient”

Burden of disease attributable to unsafe drinking water, sanitation and hygiene: 2019 update. presents estimates of the burden of disease attributable to unsafe drinking water, sanitation and hygiene for 183 WHO Member States disaggregated by region, age and sex for 2019. Estimates are based on four health outcomes – diarrhoea, acute respiratory infections, malnutrition, and soil-transmitted helminthiasis.

Diarrhea accounts for the largest proportion of the attributable burden, with more than 1 million deaths and 55 million DALYs. The second largest contributor was acute respiratory infections caused by inadequate hand hygiene, which were associated with 356,000 deaths and 17 million DALYs.

Among children under five, unsafe WASH was responsible for 395,000 deaths and 37 million DALYs, representing 7.6% of all deaths and 7.5% of all DALYs in this age group. This includes 273,000 deaths from diarrhea and 112,000 deaths from acute respiratory infections. These diseases are the first two infectious causes of death in children under the age of five in the world.

Significant differences were observed between regions and income groups. More than three-quarters of all WASH-attributable deaths occurred in the WHO Africa and South-East Asia regions, while 89% of attributable deaths were from low- and lower-middle-income countries. However, even high-income countries are at risk, as 18% of their diarrheal diseases are preventable through improved hand hygiene practices.

Although these estimates included four health outcomes for which data were available to quantify the impact, the true burden is likely to be much higher. The health effects of unsafe WASH are wide-ranging and go beyond disease to affect social and mental well-being. In addition, climate change is likely to exacerbate many WASH-related diseases and risks that are not fully captured by current assessments.

To reduce the burden of disease attributable to WASH, WHO calls on governments to take the following actions with the support of UN agencies, multilateral partners, the private sector and civil society organizations:

• Radically speed up action to make safe WASHING a reality for everyone. The mid-term comprehensive review of the International Decade of Action towards the Sustainable Development Goals saw renewed commitments by governments to accelerate progress towards the goal of universal access to safe WASH. By quantifying for the first time the health benefits associated with higher levels of WASH services, the updated estimates provide strong evidence to support efforts to translate these commitments into action.
• Focus efforts on the poorest and most disadvantaged. The burden of disease is largely caused by inadequate access in low- and middle-income countries, and national estimates of access to WASH often hide differences within countries. Access to WASH services tends to be lower among rural populations and lower socioeconomic groups. Even in high-income countries, where access to safely managed drinking water and sanitation services is generally high, certain marginalized communities are underserved and face greater risks.
• Adapt national monitoring systems to improve data on population exposure to safely managed services. Data on higher levels of WASH services remain scarce in many countries. Governments should adapt national and local monitoring systems to take into account the higher levels of services required by the SDG framework, enabling a more accurate reflection of the full disease burden associated with unsafe WASH.