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Hygiene, Sanitation, and Water (HSW): Neglected Problems, Lagging Solutions

Maggie Brown, MS, ELS,  Senior Production Editor at PLoS continues her series of posts on water and sanitation.

For a huge proportion of the world’s population, the critical foundation of health—and basic human right [1]—of access to safe drinking water and adequate sanitation are simply nonexistent.

The statistics about HSW almost defy comprehension. For example,

  • Nearly 90% of the world’s cases of diarrhea could be prevented by improved HSW [2].
  • About 15% of deaths in all the children under 5 in the whole world are caused by diarrhea [3].
  • Annually, improving HSW could prevent up to millions of cases of diarrhea, malnutrition, intestinal nematode infection, lymphatic filariasis, trachoma, schistosomiasis, malaria, and drowning [2].
  • The benefits of providing universal access to improved water and sanitation exceed the costs by 10-fold [2].

Progress has been reported at a global scale in the past few decades (from [4]).

  • As of 2008, 87% of the world’s population had access to drinking water from improved sources, an increase of 11% since 1990.
  • The practice of open defecation declined from 25% to 17% between 1990 and 2008.

However, these numbers disguise a more complex situation. As WHO points out, the improvements made in a few countries with large populations tend to skew the averages; parts of Africa and Asia still show rates of access to improved sanitation and drinking water below 50% [4]. And progress in sanitation has lagged behind that for drinking water improvements; at its current rate, the MDG target for water and sanitation will likely be met for drinking-water but not for sanitation. It is important to remember, too, that even if all the components of this target were to be met, many millions of people over the world would still lack access to what most developed countries take for granted and claim as a basic human right.

Poor HSW is responsible for one of the heaviest existing disease burdens worldwide. Safe water supplies and adequate hygiene and sanitation are the foundations of physical, social, and economic health of populations. This foundation needs much more attention and work before the global community can claim that it has done what’s so crucial for disease prevention and optimal human health and well-being.


1. United Nations News Centre (28 July 2010) General Assembly declares access to clean water and sanitation is a human right. Available: Accessed 9 November 2010.

2. Prüss-Üstün A, Bos R, Gore F, Bartram J (2008) Safer water, better health: Costs, benefits and sustainability of interventions to protect and promote health. Geneva: WHO. Available: Accessed 8 November 2010.

3. Cousens S, Johnson HL, Lawn JE, Rudan I, et al. (2010) Global, regional, and national causes of child mortality in 2008: A systematic analysis.  Lancet 375: 1969-1987.

4. WHO/UNICEF (2010) Progress on sanitation and drinking-water 2010 update. Available: Accessed 8 November 2010.

Other water and sanitation features from PLoS Medicine

The PLoS Medicine Editors (2009) Clean Water Should Be Recognized as a Human Right. PLoS Med 6(6): e1000102. doi:10.1371/journal.pmed.1000102


Maggie Brown, MS, ELS, is Senior Production Editor at PLoS.


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