Compendium of WHO and other UN guidance on health and environment
Guidance on WASH and health
- Water, including:
- Drinking water
- Recreational water
- Sanitation
- Personal hygiene
Safe WASH are crucial to human health and well-being. Safe WASH are not only a prerequisite to health, but contribute to livelihoods, school attendance and dignity and help to create resilient communities living in healthy environments.Inadequate or unsafe WASH may cause disease through a range of interrelated transmission pathways, which include among others:
- ingestion of water that is contaminated with faeces or chemicals
- inadequate personal hygiene which may be linked to lack of water
- contact with pathogen-containing water
- proximity to water bodies where disease vectors proliferate.
An estimated 829 000 diarrhoeal disease deaths were estimated to be caused by unsafe WASH in 2016. Other diseases caused by inadequate WASH include among others acute respiratory infections, malnutrition, malaria, soil-transmitted helminth infections, schistosomiasis and trachoma. In addition, environmental enteropathy, a chronic subclinical inflammatory condition of the gut, which is related to faecal contamination of the environment, might be a key mediating pathway for adverse effects on child nutritional and developmental status from inadequate WASH.
Water
Drinking-water
As of 2020, 26% of the worldwide population lack safely managed drinking-water services. Approximately 144 million people still collect drinking-water directly from surface water. Contaminated drinking-water is estimated to cause 485 000 diarrhoeal deaths each year, in addition to malnutrition and many other diseases.
Recreational water
Recreational use of fresh and coastal waters as well as waters in swimming pools and similar environments can deliver important benefits to health and well-being such as physical activity, relaxation, cultural and religious use. Yet, recreational water use can pose risks to health through exposure to microbial and chemical pollution as well as physical risks such as drowning and injury.
Sanitation
Nearly half the world’s population lacked safely managed sanitation services in 2020. Such deficiencies cause 432 000 diarrhoeal disease deaths globally each year (2016), and also lead to soil-transmitted helminth infections, malnutrition and numerous other diseases. Poor sanitation contributes to the spread of antimicrobial resistance and negatively affects broader well-being.
Benefits of improving sanitation extend well beyond reducing the risk of diarrhoea and other diseases and include among others increased dignity and safety, particularly among women and girls, and increased school attendance.
Evidence suggests that simply improving sanitation facilities might not lead to the desired health impacts but needs to be accompanied with the safe disposal of children’s and animal faeces, and the cessation of open defecation.
Personal hygiene
Hygiene is multi-faceted and comprises many behaviours, including hand- and face washing, menstrual hygiene and food hygiene. Hand washing with soap at crucial events such as after visiting the toilet, defecating or before preparing food was estimated to be a poorly practised behaviour globally.
Approximately 2.3 billion people lacked functioning hand-washing facilities with water and soap in 2020. Inadequate hygiene behaviours are an important risk factor for infectious diseases like diarrhoea, soil-transmitted helminth infections, respiratory diseases and contribute to malnutrition and other diseases; they were estimated to have caused 165 000 deaths from diarrhoea alone in 2016.
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