Poor Sanitation Trumps Good Nutrition

Several days ago the New York Times published a very interesting article on the way in which poor sanitation can undermine the health gains among children that should occur with improved nutrition. I had bookmarked it and was reminded of it by Anna Carla Lopez, who posted a link on her Facebook page. As she noted, this is consistent with what she found in her doctoral dissertation research in Accra, Ghana. The NYT story suggests, however, that India is perhaps the worst place on earth when it comes to outdoor defecation.

Two years ago, Unicef, the World Health Organization and the World Bank released a major report on child malnutrition that focused entirely on a lack of food. Sanitation was not mentioned. Now, Unicef officials and those from other major charitable organizations said in interviews that they believe that poor sanitation may cause more than half of the world’s stunting problems. 

“Our realization about the connection between stunting and sanitation is just emerging,” said Sue Coates, chief of water, sanitation and hygiene at Unicef India. “At this point, it is still just an hypothesis, but it is an incredibly exciting and important one because of its potential impact.”

A child raised in India is far more likely to be malnourished than one from the Democratic Republic of Congo, Zimbabwe or Somalia, the planet’s poorest countries. Stunting affects 65 million Indian children under the age of 5, including a third of children from the country’s richest families. 

This disconnect between wealth and malnutrition is so striking that economists have concluded that economic growth does almost nothing to reduce malnutrition. 

Half of India’s population, or at least 620 million people, defecate outdoors. And while this share has declined slightly in the past decade, an analysis of census data shows that rapid population growth has meant that most Indians are being exposed to more human waste than ever before.

This is a very good article. Besides the important policy implications it lays out for children's health, it is almost like a public health primer, and should be required reading for all travelers to India and other less developed nations.






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