Sanitation in the Context of Planetary Health: Opportunities and Challenges

This paper is an output of the Secretariat of the Rockefeller Economic Council on Planetary Health. It is intended to inform the council and to review the relationship between sanitation, one of the key public health challenges, and planetary health.

Sustainable access to clean and adequate water, air and diets sit at the heart of the planetary health agenda. The United Nations Sustainable Development Goals, SDG 6 in particular, focus attention on the role of water and sanitation. Global losses associated with inadequate water supply and sanitation are estimated to be 1.5% of GDP. Poor sanitation is costing countries such as India more than 6% of GDP, while less than half the global population use a safely managed sanitation service. This paper shows investment in sanitation to be the second-best health investment globally, behind only hygiene promotion. Economic benefits are in the range of US$5-16 benefit for every US$1 spent.

Barriers to improving sanitation vary across contexts both in terms of rural and urban development and national wealth. We suggest that the application of a planetary health approach can provide new ways of valuing and addressing the challenges of sanitation, and in doing so can generate additional benefits for the environment and economic development.

In particular, by focussing on resource recovery from fecal sludge and wastewater – and its potential to generate clean energy – prudent investment in sanitation and waste management can help countries to reduce their greenhouse gas emissions, reduce the use of artificial fertilizers in agriculture, ease pressures on freshwater availability, and create jobs in the waste collection sector and in waste treatment plants.