MORTALITY DUE TO UNSAFE WATER, UNSAFE SANITATION AND LACK OF HYGIENE

Figure A.15.3.
Mortality rate attributed to exposure to unsafe WASH services (per 100 000 population), 2012a

SDG Target 3.9

By 2030, substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water and soil pollution and contamination
Indicator 3.9.2: Mortality rate attributed to unsafe water, unsafe sanitation and lack of hygiene (exposure to unsafe WASH services)

SITUATION

ACHIEVING THE 2030 TARGET

Worldwide in 2012, an estimated 871 000 deaths

were caused by contamination of drinkingwater, water bodies and soil, inadequate handwashing facilities, and by practices resulting from
inappropriate or inadequate services.1 Unsafe
water, sanitation and hygiene (WASH) services
mainly cause deaths from diarrhoeal diseases, but
also from protein-energy malnutrition, intestinal
nematode infections, and schistosomiasis 2
(Fig. A.15.1).

Reducing the burden of disease from inadequate

WASH services requires: (a) improved coverage of
safe drinking-water supply to prevent consumption
of contaminated water and enable personal
hygiene; (b) adequate sanitation in households and
other setting (such as schools and health facilities)
and safe management of faecal waste to reduce
human excreta in the environment; (c)adequate
hygiene practices such as hand-washing after
defecation, or before food preparation and
consumption; and (d) improved access to
health care and proper case management of
diarrhoea. Ensuring the availability and sustainable
management of water and sanitation for all is
covered by SDG 6 (see the sections on drinkingwater services and sanitation). This goal contains
targets addressing all the elements required to
sustainably reduce the health impacts resulting
from inadequate WASH services.

Figure A.15.1.
Major causes of WASH-service-related mortality, 2012
Protein-energy Intestinal nematode
malnutrition infections
Diarrhoeal
diseases

Almost half (45%) of the deaths in 2012 occurred

in the WHO African Region (Figure A.15.2),
where 13% of the global population lived. This
resulted in a disproportionately high burden
to the Region, with a mortality rate of 43 per
100 000 population attributed to unsafe WASH
services more than triple the 2012 global rate
of 12 per 100 000 population.
Figure A.15.2.
Number of deaths attributed to unsafe WASH services,
by WHO region, 2012
400

Deaths (thousands)

350
300
250
200
150
100

50
0

AFR

AMR

SEAR

EMR

EUR

WPR

Major obstacles to reducing mortality resulting

from inadequate WASH services and related
lack of hygiene include: (a) natural threats
such as water scarcity due to climate change;
(b) inappropriate governance, institutional
arrangements and financing in water supply
and sanitation; (c)rapid expansion of unplanned
settlements; (d) depletion of water resources
through pollution and environmental degradation;
and (e) lack of access to health-care services.

on causes of death. Extensive modelling is thus

required to obtain estimates for this SDG indicator.
Improved evidence of the links between water and
sanitation service levels and hygiene practices
and health, and the systematic assessment of
adequate indicators, would increase the accuracy
of current estimates.

Mortality rate
(per 100 000 population)
<5
514
1539
4069
70

REFERENCES
Unless otherwise noted, all statistics in text, table and figures are
taken from: Preventing disease through healthy environments. A
global assessment of the burden of disease from environmental risks.
Geneva: World Health Organization; 2016 (http://apps.who.int/iris/
bitstream/10665/204585/1/9789241565196_eng.pdf?ua=1, accessed
3 April 2016) and from: Preventing diarrhoea through better water,
sanitation and hygiene. Exposures and impacts in low- and middleincome countries. Geneva: World Health Organization, 2015 (http://
apps.who.int/iris/bitstream/10665/150112/1/9789241564823_eng.
pdf?ua=1&ua=1, accessed 19 April 2016).

WORLD HEALTH STATISTICS: 2016

750 1500

3000 Kilometres

WHO Member States with a population of less than 250 000 in 2012 were not included in the analysis.

Table A.15.1.
Mortality rate attributed to exposure to unsafe WASH services (per 100 000 population), 2012a

Table A.15.1. Mortality rate (per 100 000 population) attributed to exposure to unsafe WASH services, 2012

Although most schistosomiasis deaths may be attributed to unsafe

WASH services, the proportion attributed has not been quantified using
epidemiological methods.

AFR

AMR

EUR

Mauritius

0.9

Bahamas

0.1

Stevens GA, Dias RH, Ezzati M. The effects of 3 environmental risks on

mortality disparities across Mexican communities. Proc Natl Acad Sci U S
A. 2008;105(44):168605 (http://www.pnas.org/content/105/44/16860.
full, accessed 3 April 2016).

Algeria
Cabo Verde

2.4

Barbados

0.2

4.5

Chile

0.2

Botswana

9.2

Trinidad and Tobago

0.2

Gakidou E, Oza S, Vidal Fuertes C, Li AY, Lee DK, Sousa A et al. Improving
child survival through environmental and nutritional interventions.
The importance of targeting interventions toward the poor. JAMA.
2007;298(16):187687 (http://jama.jamanetwork.com/article.
aspx?articleid=209285, accessed 3 April 2016).

Namibia

9.8

Uruguay

0.3

12.1

Canada

0.6

South Africa

EQUITY
Within countries, inequalities in mortality rates
exist between urban and rural areas, between
slums and formal settlements, and between highsocioeconomic status and low-socioeconomic
status population groups.3,4

DATA GAPS
National estimates of mortality from inadequate
WASH services are based on the prevalence of
use of inadequate water and sanitation, along
with hand-washing prevalence, in combination
with relevant health statistics and epidemiological
data. Data on access to water and sanitation are
available from household surveys for most LMIC.
Data on hand-washing prevalence observations
are available for only about 20 countries and
require additional assessments, but show
consistently low hand-washing prevalences. For
many LMIC only limited quality data are available

Rwanda
Ghana

19.4

United States of America

0.6

20.0

Argentina

0.7

Gambia

21.0

Costa Rica

0.7

Swaziland

22.7

Cuba

0.7

Zambia

24.5

Colombia

0.8

Liberia
Senegal

25.0

Suriname

0.8

25.4

Brazil

1.1

Malawi

26.1

Mexico

1.1

Madagascar

26.6

Belize

1.2

Zimbabwe

27.1

1.3

United Republic of Tanzania

Gabon

27.6

Peru
Venezuela (Bolivarian Republic of)

1.3
1.8

Lesotho

28.3

Ecuador
Dominican Republic

1.9

Jamaica

1.9

Paraguay

2.3

El Salvador

2.4

Nicaragua

3.5

28.1

Comoros

28.6

Mauritania

28.9

Ethiopia
Uganda

29.6

Benin

32.2

Kenya

32.5

Eritrea

34.9

Mozambique
Togo

37.9

30.3

37.9

Guinea

40.7

Burkina Faso

40.9

Cameroon

40.9

Cte d'Ivoire
Congo

44.1

Guinea-Bissau

48.9

South Sudan

50.0

Nigeria

50.9

Equatorial Guinea
Mali

72

Data not available

Not applicable

Guyana

4.0

Panama

4.1

Bolivia (Plurinational State of)

7.0

Honduras

7.9

Guatemala

9.2
28.5

Haiti

48.1

SEAR
Maldives 0.6

57.3

DemocraticPeoples
People's
Republic
of ..
Democratic
Republic
of Korea

1.4

Thailand

1.9

Sri Lanka

3.3

Burundi

68.4

Indonesia

3.6

Niger

69.2

Bangladesh

6.0

Bhutan

7.1

61.1

Sierra Leone

90.4

Chad
Central African Republic

92.8

Timor-Leste

10.3

Myanmar

10.4

Democratic Republic of the Congo

107.8

Nepal

12.9

Angola

111.2

India

102.3

27.4

Hungary
Bosnia and Herzegovina
Bulgaria
Croatia
Estonia
Greece
Iceland
Latvia
Lithuania
Malta
Montenegro
Poland
Republic of Moldova
Romania
Slovakia
Slovenia
The former
Yugoslav
of ..
The Former
Yugoslav
RepublicRepublic
of Macedonia
Austria
Italy
Luxembourg
Portugal
Albania
Belarus
Finland
Georgia
Netherlands
Russian Federation
Cyprus
Ireland
Serbia
Spain
Switzerland
Ukraine
United Kingdom
Belgium
Czech Republic
France
Israel
Norway
Denmark
Turkey
Germany
Armenia
Sweden
Kazakhstan
Kyrgyzstan
Azerbaijan
Uzbekistan
Turkmenistan
Tajikistan

EMR
0.0
<0.1
<0.1
<0.1

Kuwait <0.1
Qatar <0.1
United Arab Emirates <0.1

<0.1

Bahrain

0.1

<0.1

Saudi Arabia

0.2

<0.1

Lebanon

0.4

Oman

0.4

<0.1

Libya

0.6

<0.1

Tunisia

0.8

<0.1

Iran (Islamic Republic of)

0.9

Jordan

1.0

<0.1

Egypt

1.6

<0.1

Syrian Arab Republic

1.8

<0.1

Morocco

3.4

Iraq

3.9

<0.1
<0.1

<0.1
<0.1

0.1
0.1
0.1

13.0

Yemen

0.1

Pakistan

20.7

0.2

Djibouti

26.4

0.2

Afghanistan

34.6

Sudan

34.6

0.2
0.2
0.2

Somalia

98.8

0.2
0.3
0.3
0.3
0.3
0.3
0.4

WPR
Australia

<0.1

Brunei Darussalam <0.1

0.4

Japan

0.1

0.5

Singapore

0.1

Republic of Korea

0.2

0.5

China

0.4

0.5

Malaysia

0.4

0.8

New Zealand

0.6

0.5
0.5

0.8
0.9

Viet Nam 2.0

1.1

Fiji

3.0

1.1

Mongolia

3.1

1.2

Philippines

5.1

1.8

Cambodia

5.6

2.1

Solomon Islands

10.4

5.8

Papua New Guinea

12.4

7.5

Lao People's Democratic Republic

13.9

2.4

WHO Member States with a population of less than 250 000 in 2012 were not included in the analysis.
MONITORING HEALTH FOR THE SDGs

73