title: The long-term dynamics of mortality benefits from improved water and sanitation in less developed countries.
abstract: The problem of inadequate access to water, sanitation and hygiene (WASH) in less-developed nations has received much attention over the last several decades (most recently in the Millennium Development Goals), largely because diseases associated with such conditions contribute substantially to mortality in poor countries. We present country-level projections for WASH coverage and for WASH-related mortality in developing regions over a long time horizon (1975-2050) and provide dynamic estimates of the economic value of potential reductions in this WASH-related mortality, which go beyond the static results found in previous work. Over the historical period leading up to the present, our analysis shows steady and substantial improvements in WASH coverage and declining mortality rates across many developing regions, namely East Asia and the Pacific, Latin America and the Caribbean, Eastern Europe and the Middle East. The economic value of potential health gains from eliminating mortality attributable to poor water and sanitation has decreased substantially, and in the future will therefore be modest in these regions. Where WASH-related deaths remain high (in parts of South Asia and much of Sub-Saharan Africa), if current trends continue, it will be several decades before economic development and investments in improved water and sanitation will result in the capture of these economic benefits. The fact that health losses will likely remain high in these two regions over the medium term suggests that accelerated efforts are needed to improve access to water and sanitation, though the costs and benefits of such efforts in specific locations should be carefully assessed.
authors.affiliation: Sanford School of Public Policy and Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Jeuland
authors.forename: David E
authors.initials: DE
authors.lastname: Fuente
authors.forename: Semra
authors.initials: S
authors.lastname: Ozdemir
authors.forename: Maura C
authors.initials: MC
authors.lastname: Allaire
authors.forename: Dale
authors.initials: D
authors.lastname: Whittington
mesh_terms: D003906:Developing Countries; D014943:Global Health; D006801:Humans; D008962:Models, Theoretical; D012499:Sanitation / Q000639:trends*; D015996:Survival Rate / Q000639:trends*; D014881:Water Supply