The direct linkages between sanitation and health are evident. The latest study published by World Health Organization (WHO) on October 26, 2016 validates that the value of sanitation cannot be deduced only by the use of improved sanitation facilities but from improving coverage at community level and ensuring better outcomes in the form of health benefits.
Although widely accepted as one of the most important public health advances of the past 100 years, the contribution that improving sanitation coverage can make to child health is still unclear.
Relationship between mortality and sanitation
The study found that the relationship between diarrheal mortality, all-cause mortality, stunting and being underweight is non-linearly and independently associated with improved sanitation and improved water source. Authors, Paul R. Hunter and Annette Pruss-Ustun, applied a generalised additive model over child mortality and sanitation coverage to find the relationship between sanitation coverage and child health. The relation comes out to be a linear at individual level but non-linear at community level.
Child mortality and disease outbreak is independent of sanitation facilities in communities with sanitation coverage of less than 50 per cent because availability of improved sanitation protects the community rather than the individual user. If communities become more reluctant towards open defecation, infant health improves and a gradual decline in ill health is observed. Indeed, it has been shown that sanitation coverage is one of the most important predictors of all-cause mortality in children neonatal mortality.
Increasing sanitation coverage is one of the more important interventions for reducing neonatal and children mortality globally and would dwarf the impact of increased wealth and health expenditure. In the recent diseases burden studies produced by the WHO, the researchers estimated that 280,000 deaths from inadequate access to improved sanitation were recorded in 2012.
The study also found that improving water supplies is also important along with increasing sanitation coverage. Although the association between water coverage and reduced malnutrition is non-linear in the model, there is still a general gradual decline in malnutrition with increasing water coverage. There appears to be a small gradual increase in malnutrition with increases in sanitation at the low end,
Currently, 50 per cent of undernutrition is linked to infections caused by poor sanitation and unhygienic practices. Moreover, stunted growth in about 54 per cent of cases is linked to open defecation.
Conclusion
The study concluded that sanitation coverage is indeed one of the most important factors in reducing child and neonatal mortality which can dramatically change public health priorities in low-income countries. The result of the study shows that increasing sanitation coverage at community level can be a major contributor to reducing childhood stunting and underweight.
Improved sanitation coverage is strongly related to under-five diarrhoea mortality, under-five all-cause mortality and all-cause neo-natal mortality. The incidence of mortality decreases when sanitation coverage increased up to 20 per cent at community level. In a community with more than 50 per cent sanitation coverage, the quality and quantity of water is another major determinant of child health and mortality.
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Steve Ovett, the famous British middle-distance athlete, won the 800-metres gold medal at the Moscow Olympics of 1980. Just a few days later, he was about to win a 5,000-metres race at London’s Crystal Palace. Known for his burst of acceleration on the home stretch, he had supreme confidence in his ability to out-sprint rivals. With the final 100 metres remaining,
[wptelegram-join-channel link=”https://t.me/s/upsctree” text=”Join @upsctree on Telegram”]Ovett waved to the crowd and raised a hand in triumph. But he had celebrated a bit too early. At the finishing line, Ireland’s John Treacy edged past Ovett. For those few moments, Ovett had lost his sense of reality and ignored the possibility of a negative event.
This analogy works well for the India story and our policy failures , including during the ongoing covid pandemic. While we have never been as well prepared or had significant successes in terms of growth stability as Ovett did in his illustrious running career, we tend to celebrate too early. Indeed, we have done so many times before.
It is as if we’re convinced that India is destined for greater heights, come what may, and so we never run through the finish line. Do we and our policymakers suffer from a collective optimism bias, which, as the Nobel Prize winner Daniel Kahneman once wrote, “may well be the most significant of the cognitive biases”? The optimism bias arises from mistaken beliefs which form expectations that are better than the reality. It makes us underestimate chances of a negative outcome and ignore warnings repeatedly.
The Indian economy had a dream run for five years from 2003-04 to 2007-08, with an average annual growth rate of around 9%. Many believed that India was on its way to clocking consistent double-digit growth and comparisons with China were rife. It was conveniently overlooked that this output expansion had come mainly came from a few sectors: automobiles, telecom and business services.
Indians were made to believe that we could sprint without high-quality education, healthcare, infrastructure or banking sectors, which form the backbone of any stable economy. The plan was to build them as we went along, but then in the euphoria of short-term success, it got lost.
India’s exports of goods grew from $20 billion in 1990-91 to over $310 billion in 2019-20. Looking at these absolute figures it would seem as if India has arrived on the world stage. However, India’s share of global trade has moved up only marginally. Even now, the country accounts for less than 2% of the world’s goods exports.
More importantly, hidden behind this performance was the role played by one sector that should have never made it to India’s list of exports—refined petroleum. The share of refined petroleum exports in India’s goods exports increased from 1.4% in 1996-97 to over 18% in 2011-12.
An import-intensive sector with low labour intensity, exports of refined petroleum zoomed because of the then policy regime of a retail price ceiling on petroleum products in the domestic market. While we have done well in the export of services, our share is still less than 4% of world exports.
India seemed to emerge from the 2008 global financial crisis relatively unscathed. But, a temporary demand push had played a role in the revival—the incomes of many households, both rural and urban, had shot up. Fiscal stimulus to the rural economy and implementation of the Sixth Pay Commission scales had led to the salaries of around 20% of organized-sector employees jumping up. We celebrated, but once again, neither did we resolve the crisis brewing elsewhere in India’s banking sector, nor did we improve our capacity for healthcare or quality education.
Employment saw little economy-wide growth in our boom years. Manufacturing jobs, if anything, shrank. But we continued to celebrate. Youth flocked to low-productivity service-sector jobs, such as those in hotels and restaurants, security and other services. The dependence on such jobs on one hand and high-skilled services on the other was bound to make Indian society more unequal.
And then, there is agriculture, an elephant in the room. If and when farm-sector reforms get implemented, celebrations would once again be premature. The vast majority of India’s farmers have small plots of land, and though these farms are at least as productive as larger ones, net absolute incomes from small plots can only be meagre.
A further rise in farm productivity and consequent increase in supply, if not matched by a demand rise, especially with access to export markets, would result in downward pressure on market prices for farm produce and a further decline in the net incomes of small farmers.
We should learn from what John Treacy did right. He didn’t give up, and pushed for the finish line like it was his only chance at winning. Treacy had years of long-distance practice. The same goes for our economy. A long grind is required to build up its base before we can win and celebrate. And Ovett did not blame anyone for his loss. We play the blame game. Everyone else, right from China and the US to ‘greedy corporates’, seems to be responsible for our failures.
We have lowered absolute poverty levels and had technology-based successes like Aadhaar and digital access to public services. But there are no short cuts to good quality and adequate healthcare and education services. We must remain optimistic but stay firmly away from the optimism bias.
In the end, it is not about how we start, but how we finish. The disastrous second wave of covid and our inability to manage it is a ghastly reminder of this fact.