Inadequate sanitation kills people, causes diseases, environmental pollution, and diminishes welfare—this is well-known. But the economic impacts of poor sanitation have not been counted properly.
Inadequate sanitation caused a total of US$53.8 billion equivalent to 6.4 percent of India’s GDP in 2006, according to The Economic Impacts of Inadequate Sanitation in India, a new report from the Water and Sanitation Program (WSP), a global partnership administered by the World Bank. Losses incurred on account of inadequate sanitation were as high as the state incomes of Andhra Pradesh or Tamil Nadu and were more than Gujarat’s state income in 2006-07.
Let's understand these terms before going any further:
Sanitation is broadly defined to include management of human excreta, solid waste, and drainage. The United Nations-World Health Organization Joint Monitoring Programme for Water Supply and Sanitation defines ‘improved’ sanitation as: the means that hygienically separate human excreta from human contact and hence reduces health risks to humans. Inadequate sanitation is thus the lack of improved facilities (toilets, conveyance, and treatment systems), and hygienic practices (for example, hand washing, proper water handling, personal hygiene, and so on) that exposes people to human excreta and thus to disease-causing fecal-oral pathogens through different transmission pathways. The study focused on the safe management of human excreta and associated hygiene behavior.
The methodology adopted by the study included disaggregating the economic impacts of inadequate sanitation into:
a Health-related impacts: Premature deaths, costs of treating diseases; productive time lost due to people falling ill, and time lost by caregivers who look after them.
b Domestic water-related impacts: Household treatment of water; use of bottled water; a portion of costs of obtaining piped water; and time costs of fetching cleaner water from a distance.
c Access time impacts: Cost of additional time spent for accessing shared toilets or open defecation sites; absence of children (mainly girls) from school and women from their workplaces.
d Tourism impacts: Potential loss of tourism revenues and economic impacts of gastrointestinal illnesses among foreign tourists.
a Health-related impacts: Premature deaths, costs of treating diseases; productive time lost due to people falling ill, and time lost by caregivers who look after them.
b Domestic water-related impacts: Household treatment of water; use of bottled water; a portion of costs of obtaining piped water; and time costs of fetching cleaner water from a distance.
c Access time impacts: Cost of additional time spent for accessing shared toilets or open defecation sites; absence of children (mainly girls) from school and women from their workplaces.
d Tourism impacts: Potential loss of tourism revenues and economic impacts of gastrointestinal illnesses among foreign tourists.
The report indicates that premature mortality and other health-related impacts of inadequate sanitation, were the most costly at US$38.5 billion (71.6 percent of total impacts), followed by productive time lost to access sanitation facilities or sites for defecation at US$10.7 billion (20 percent), and drinking water-related impacts at US$4.2 billion ( 7.8 percent).
Children and poor households are the worst affected. More than three-fourths of the premature mortality-related economic losses are due to deaths and diseases in children younger than five. Diarrhea among these children accounts for over 47 percent (US$18 billion, Rs.824 billion) of the total health-related economic impacts. The study also finds that at 75 percent (US$ 37.5) more than the national average and 60 percent (US$ 22.9) more than the urban average, the poorest 20 percent of households living in urban areas bear the highest per capita economic impacts of inadequate sanitation. Rural households in the poorest quintile bear per capita losses 8 percent more than the average loss for households in rural areas.
The per capita loss on account of inadequate sanitation, for various Asian countries, as per the report is
And this calls for immediate intervention in India for bringing about a systemic changes aimed at achieving proper sanitation with universal coverage.The report recommends a new monitoring framework – one that measures not just toilet coverage and use, or coverage of sewerage and number of wastewater treatments, or number of sanitized communities and cities, but also improvements in the overall health, water-related, environmental, and other welfare indicators that result from inadequate sanitation.The report estimates that comprehensive interventions (use of toilets, hygiene promotion, improved access to safe water, and proper waste management) can save India US$32.6 billion (Rs.1.48 trillion) or US$29 (Rs.1321) per capita which was the equivalent of 3.9 percent of GDP in 2006). This signifies a potential gain of Rs. 1,321 (US$29) per capita.
Which brings us to the point - what is it which leads us to have such poor standards of sanitation and personal hygiene and why these continue to be a non-issue and never a priority for us whether in private lives or as a policy instruement?
One prominent reason in my mind is continuing "Population Explosion". I am always haunted by the notings of Paul Ehrlich (which I first read in 2006 fall in Princeton), in his book "The Population Bomb": “I came to understand [the population explosion] emotionally one stinking
hot night in Delhi.… The streets seemed alive with people. People eating, people washing, people sleeping. People visiting, arguing, and screaming. People thrusting their hands through the taxi window, begging. People defecating and urinating. People clinging to buses. People herding animals.People, people, people, people” (Ehrlich 1968: 15). While, in the first instance, some of us may not like the brutal truth as told in such a gory manner by Ehrlich, the factual correctness remains.
hot night in Delhi.… The streets seemed alive with people. People eating, people washing, people sleeping. People visiting, arguing, and screaming. People thrusting their hands through the taxi window, begging. People defecating and urinating. People clinging to buses. People herding animals.People, people, people, people” (Ehrlich 1968: 15). While, in the first instance, some of us may not like the brutal truth as told in such a gory manner by Ehrlich, the factual correctness remains.
While the Malthusian postulates are always debatable and some of us may argue in favour of the Boserupian perspective where Boserup (1965) argued that population pressure both induces and facilitates the adoption of more intensive forms of agriculture and thus population is an asset. The empirical study by Lee and Miller (1990) found positive or no Pareto-relevant economic external effects from Childbearing. Their conclusion is in favor of a laissez-faire population
policy that does not “go beyond assisting well-informed parents to attainthe family size goals they seek”. ( Lee, R. D. and T. Miller. 1990. “Population growth, externalities to childbearing, and fertility policy in developing countries,” Proceedings of the World Bank Annual Conference onDevelopment Economics 1990, pp. 275–304). However, the catch here is "well-informed parents" and to me, it is highly debatable whether the continuing population growth in India (especially in relatively poorer States and those falling at the bottom of HDI & Welfare index) is due to a conscious decision of the "well-informed parents" and it is here I feel that the concept of young population as an asset (Rybczynski and Stolper–Samuelson theorems on economic impact of the population) is doubtful and may not work that way. Inadequate sanitation is one of the manifestations. The list goes on......
policy that does not “go beyond assisting well-informed parents to attainthe family size goals they seek”. ( Lee, R. D. and T. Miller. 1990. “Population growth, externalities to childbearing, and fertility policy in developing countries,” Proceedings of the World Bank Annual Conference onDevelopment Economics 1990, pp. 275–304). However, the catch here is "well-informed parents" and to me, it is highly debatable whether the continuing population growth in India (especially in relatively poorer States and those falling at the bottom of HDI & Welfare index) is due to a conscious decision of the "well-informed parents" and it is here I feel that the concept of young population as an asset (Rybczynski and Stolper–Samuelson theorems on economic impact of the population) is doubtful and may not work that way. Inadequate sanitation is one of the manifestations. The list goes on......
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