Sanitation encompasses the measures, methods, and activities that prevent the transmission of diseases and ensure public health. Specifically, sanitation refers to the principles and practices relating to the safe collection, removal, and disposal of human waste, refuse, and wastewater.

Waterway in Port-au-Prince, Haiti full of garbage. Haiti has little sanitation which is a factor in the spreading of the cholera epidemic.

Waterway in Port-au-Prince, Haiti full of garbage. Haiti has little sanitation which is a factor in the spreading of the cholera epidemic.
(Julie Dermansky/Science Source)


The problems that result from inadequate sanitation can be illustrated by the following events in history:

Modern sanitation challenges

In 1992, the South Pacific Regional Environment Programme (SPREP) and a land-based pollutants inventory stated that the “disposal of solid and liquid wastes (particularly of human excrement and household garbage in urban areas), which have long plagued the Pacific, emerge now as perhaps the foremost regional environmental problem of the decade.”

For example, high levels of fecal coliform bacteria have been found in surface and coastal waters of the South Pacific. This is because local developing regions pollute the water with household garbage and human waste. Pollutants from sewage make water availability more of a problem and introduce disease in residents.

In addition, septic systems used in some rural areas are said to be of poor design and construction and pour-flush toilets and latrines, which frequently overflow in heavy rains, are more common. Over-the-water latrines are found in many coastal areas, as well. Many areas deal with contamination of their ground water, making well water that might be available unsafe for drinking or washing food. Some low-lying areas served by available systems experience periodic back-flows of sewage, causing waste to run into forest or mangrove areas when pumps fail and electrical power outages occur. In many countries, people live in crowded and substandard conditions. In addition, refugees from areas of war or human rights violations relocate to camps and other crowded conditions with substandard water and sanitation.

Wastewater problems also result from agriculture. According to the EPA, pig waste is considered to be a more significant problem than human sewage in many areas.

Because sanitation has become a social responsibility, national, state, and local governments have adopted regulations that, when followed, should provide adequate sanitation for the governed society. However, some of the very technologies and practices that were instituted to provide better health and sanitation were later found to be contaminating ground and surface waters. For example, placing chlorine in drinking water and wastewater to provide disinfection was found to produce carcinogenic compounds called trihalomethanes and dioxin. Collecting sanitary waste and transporting it along with industrial waste to inadequate treatment plants costing billions of dollars has failed to provide adequate protection for public health and environmental security.


Globally, about 2.3 billion people have no access to sanitation facilities such as toilets. More than 890 million people must defecate outdoors, such as into bodies of water or street gutters. Another 600 million people have limited access to sanitation, such as sharing of facilities with neighbors. At least 1.8 billion people must rely on a source of drinking water that is contaminated with feces. Most people without access to adequate sanitation facilities live in sub-Saharan Africa and South Asia. Further, most African countries had basic hand-washing facilities for less than 50% of their populations. However, by 2015, 154 countries had basic sanitation services for more than 75% of their populations.


The main purpose of adequate sanitation for all of the world's peoples is to reduce the amount of disease that is caused by inadequate sanitation facilities. By saving lives, improving health conditions, and raising living standards around the world, especially in developing countries, people have a better chance at surviving and contributing to society. Specifically, improved sanitation facilities are shown to increase a country's gross domestic product (GDP). Consequently, good sanitation is an important health, humanitarian, and economic factor for all countries.

Common diseases and disorders

Common diseases that are caused by sanitation and water-related problems include the following:

EDWIN CHADWICK (1800–1890)

Edwin Chadwick was a progressive thinking man. He studied law in London, and in 1832, he was asked by the prime minister to participate in the Royal Commission of Enquiry on the English Poor Laws. The Commission worked with Parliament, and the Poor Law Amendment Act was passed. Chadwick was credited with writing almost one-third of the published report.

London experienced influenza and typhoid epidemics in 1837 and 1838, and Chadwick determined that the city's unsafe sanitation practices directly affected health conditions. His findings were outlined in a 1842 report entitled The Sanitary Conditions of the Labouring Population.

This report explained that the government needed to take a greater role in public health reform and sanitary conditions. Chadwick proposed changes for the environment, including indoor bathrooms in each house, and a sewage disposal system that transferred sewage to farmlands for fertilizer. However, these changes were refuted. People that benefitted from the poor health conditions (landlords, water companies) effectively blocked these ideas.

Even though his efforts were thwarted, Chadwick believed in his cause. He continued to fight for environmental legislation changes.

Stable ecosystems model

Increasingly, the solution seems to be found in methods and practices that borrow from the stable ecosystems model of waste management. That is, there are no wastes, only resources that process waste sustainably. New waterless composting toilets that destroy human fecal organisms while producing fertilizer are the technology of choice in the developing world and have also found a growing niche in the developed world. Wash water, or gray water, is being used for irrigation, rather than being disposed of in ground and surface waters. The combination of these two ecologically engineered technologies provides economical sanitation, eliminates pollution, and creates valuable fertilizers for plants, while reducing the use of potable water for irrigation and toilets.

Simple hand washing is the most important measure in preventing disease transmission. Hand washing breaks the primary connection between surfaces contaminated with fecal organisms and the introduction of these pathogens into the human body. The use of basic soap and water, not exotic disinfectants, when practiced before eating and after defecating may save more lives than all of the modern methodologies and technologies combined.

Public health role and response

Following the MDGs, the United Nations led efforts toward Sustainable Development Goals (SDGs). The SDGs are part of the 2030 Agenda for Sustainable Development, a plan adopted by world leaders to end poverty and inequality around the world, improve health, and address climate change. The SDGs are not laws but serve as a framework for governments to use in setting their own goals and plans. A total of 17 goals address these global issues. Goal 6 focuses on ensuring access to water and sanitation for all by 2030. Water scarcity affects health and ability to provide sanitation services. Drought has added to the problem in many areas of the world. Addressing sanitation problems requires cooperation of governments and public health, and the money to afford needed infrastructure. The Johannesburg Plan of Implementation focused on goals for sanitation and merged with the SDG efforts in 2014.


According to the World Health Organization (WHO), improved access to safe drinking water, sanitation, and hygiene could prevent the deaths annually of more than 360,000 children under five years of age. Poor sanitation is the cause of most of the deaths. With more than 4.5 billion people around the world lacking access to a toilet at home, there is much work remaining to be done.

Specific SDG targets include achieving universal and equal access to water, sanitation, and hygiene by 2030. The goal also includes ending open defecation. A target is to implement integrated water resources management at all levels by 2030, even across national boundaries if necessary. The SDG recognizes it will take international cooperation to support improvement in drinking water and sanitation in developing countries.


The prevention of diseases that can be transmitted through human waste is achieved through isolating waste using adequate sanitation and hygiene practices. Such diseases include waterborne diseases (which contaminate drinking water), fecal-borne diseases (which occur when humans come into physical contact with feces), and hookworm (whose eggs can be acquired from contacting infected soil).

Any of numerous by-products of various industrial processes, which are regarded as extremely toxic. These dioxins or dioxin-like compounds include polychlorinated dibenzo-p-dioxins (PCDDs), polychlorinated dibenzofurans (PCDFs), and polychlorinated biphenyls (PCBs).
A compound that is separated into ions within a solution.
Red tide—
A brownish-red coloration in seawater that is caused by increased plant-based plankton.
Safely managed sanitation service—
A safe method for disposing of waste in place or off-site.

According to the report Progress on Sanitation and Drinking-water, 2010 Update, by the Joint Monitoring Programme for Water Supply and Sanitation, which is conducted by the WHO and the United Nations Children's Fund (UNICEF), improved sanitation facilities are those that “hygienically separates human excreta from human contact.” The following are ways to provide improved sanitation facilities to peoples of the world without adequate sanitation and thus help to prevent unsanitary conditions:

See also Cholera ; Dioxins ; Guinea worm disease ; Malaria ; Parasites ; Save Drinking Water Act (1974) ; Schistosomiasis .



Davis, Mackenzie Leo. Introduction to Environmental Engineering, 5th ed. Dubuque, IA: McGraw-Hill, 2014.

Eaton, Andrew D., and M. A. H. Franson. Standard Methods for the Examination of Water and Wastewater, 23rd ed. Washington, DC: Water Environment Federation, 2017.

Teitey, Emmanuel. Global Sanitation and Urban Areas in the Current Era. Riga, Latvia: Lambert Academic, 2018.


The Independent Staff. “World's Poor to Wait 200 Years for Sanitation.” . (accessed April 3, 2018).

Sanitation Updates. “Cholera Epidemic Kills 60 in Ghana.” (accessed April 3, 2018).

UNICEF. “Progress on Drinking Water, Sanitation and Hygiene.” (accessed April 3, 2018).

United Nations. “Sustainable Development Goals, Goal 6: Ensure Access to Water and Sanitation for All.” (accessed April 3, 2018).

United Nations Children's Fund. “Water, Sanitation and Hygiene.” (accessed April 3, 2018).

World Health Organization. “Cholera.” (accessed April 3, 2018).

World Health Organization. “Water, Sanitation, Hygiene.” (accessed April 3, 2018).


Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA, 30333, (800) 232-4636,, .

Environmental Protection Agency, 1200 Pennsylvania Ave. NW, Washington, DC, 20460, .

UN-Water, 7 bis, Avenue de la Paix, 1202, Geneva, Switzerland, 41 (22) 730-8636,, .

Carol Steinfeld
Revised by Teresa G. Odle, BA, ELS

  This information is not a tool for self-diagnosis or a substitute for professional care.