Sanitation a ects health.

Discuss the morbidity and mortality associated with

poor sanitation. Using the action areas of the Ottawa Charter as a framework,
discuss policy and/or programmes that have been implemented either
nationally or internationally to in uence sanitation.
According to the WHO, the social determinants of health are non-medical related factors which describe the
conditions that shape people’s daily lives in which they are born in, raised and age. (WHO, 2021)

For the purpose of this assignment, sanitation will be mainly discussed as a factor of social determinants.

Sanitation is the provision of clean drinking water and safe management of human excretion e.g. faeces,
urine or menstrual blood. It’s a critical intervention that’s needed to improve living conditions and social and
economic progress. In healthcare facilities, sanitation is an important component of quality of care, control
strategy and prevention of infectious diseases.

Morbidity is a state of being symptomatic due to a disease, it’s estimated through prevalence or incidence
of the population with a symptom. Mortality is the number of deaths as a result of morbidity, it’s represented
as a rate per 1000 individuals. (Bien and Kim, 2019)

Morbidly and mortality rates are worse for those negatively impacted by poor sanitation.
Every year, 1.7 billion people don’t have basic sanitation services e.g. private toilets resulting in around
775,000 deaths annually with its highest mortality rates in Sub-Saharan Africa and South-east Asia as
stated in a published article (Bernadeta Dadonaite, Ritchie and Roser, 2019). Trachoma is the world’s
leading cause of preventable disease resulting from poor sanitation in low income countries, 41 million
people su er from it. 576-746 million people infected by hookworm disease worldwide from contaminated
soil are also associated with poor sanitation (CDC 2019). In 2017, almost 1.6 million people died from
diarrhoeal diseases (a third of all cases were children).

The Ottawa Charter set up by WHO for health promotion was a commitment to allow people to achieve
their “highest health potential” and equity. It acknowledges 5 key action areas where policies or
programmes should be set up around them (World Health Organisation 1986)

1. Build health public policy.

Governments set up health programmes to o er improved sanitation facilities in the community or schools
e.g. the Focusing Resources on E ective School Health (FRESH) was launched in 2000 to promote and
campaign for increased access to high quality sanitation in schools around the world.

Around 21 million South Africans don’t have access to adequate sanitation facilities. White Paper on Water
Supply and Sanitation was developed in 1994 by six South African government departments to highlight the
importance of implementing a national sanitation policy which was later established in 2001 that highlighted
the responsibility to ensure all South Africans have access to adequate sanitation services. This was used
as the starting point for a national e ort in developing strategies to improve and enhance community
sanitation services in rural and urban areas. (DWS 1996, pp.1-2)

2. Creating supportive environments:

A supportive social and physical and environment makes healthier choices more easily accessible.
Organisations e.g. NGOs support better environments by investing in various infrastructures and acting and
responding in an appropriate manner to the needs of the community and improving the living conditions of
the population by increasing equity and healthcare facilities which will strengthen their health and reduce
transmission of diseases.
In 2020, Rural Water Supply and Sanitation Agency (RUWASA) in Tanzania moved to focus on improving the
delivery of sustainable sanitation services in rural areas and strengthen the institutions to deliver the
sanitisation services. Since the program was implemented in place in 2019, 4.67 million people have gained
access to improved sanitation. The programme have improved access to safe sanitation facilities in 637
primary schools and 873 health facilities. Flush toilets, ventilated latrines without leaks, walls and door
shutter were constructed to provide privacy and dignity for the individuals. (World Bank, 2022b)
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3. Strengthen community action

Community action planning is a form of democratic lifestyle that enables people to work together, reinforce
a bond and address their sanitation crisis to improve sustainability in the environment.

Sierra Leone’s community approach to total sanitation (CATS), a term used by UNICEF, led to the
development of Community-Led Total Sanitation (CLTS) programme and their role is to actively engage in
the community, assess, strategise and determine a solution for their sanitation problem e.g. open
defecation and contamination by constructing low cost latrines or toilets using their available resources and
undertaking a local sanitation plan. The CLTS was shown to be successful. “Out of the 754 communities
triggered across the country, 169 of these declared open defecation free, approximately 24,000 people
living in ODF environments as of June 2009. CLTS is now accepted by majority of stakeholders as a viable
sanitation strategy.” (Community Approaches to Total Sanitation, 2009, pp. 11-15). Trainings and workshops
lead to 14 teams in uencing CLTS in 28 di erent villages in rural and urban communities.

4. Developing personal skills:

NGOs and health promotion practitioners can support the population through providing information,
educating people (increasing their skills and knowledge) and enhance their levels of control over their own
health and wellbeing.

Life skill-based school sanitation programmes (LSBHE) e.g. School sanitation and hygiene education
programmes (SSHE) supported by UNICEF was set up in Vietnam to combine a balance of all learning
experiences of knowledge (understanding of factual information and teaching knowledge), positive attitudes
(biased thoughts and beliefs) and interpersonal skills which enables them to take responsibility for their own
health, learn about better sanitation and defecation practices, improve social wellbeing and preventing
transmission of sanitation-related diseases in the communities. Vietnamese schools facilitated the
improvement of sanitation education and promoted children’s rights to express themselves and participate
in workshops at school to review the conditions of sanitation, and discuss possible solutions to resolve their
problem and enhance a change in their society. (Postma, Getkate, and van Wijk, 2004, p. 35)

5. Reorienting health services:

Reorienting health services is essentially about the public health sector changing its views beyond clinical
or curative treatment service oriented perspective of care to focusing on promoting a balance between a
healthier lifestyle, supporting those in need and prevention of diseases in the community and striving for a
healthier social wellbeing.

A good example is WaterAid in India, it seeks to improve access to good sanitation practice for the
community. WaterAid works with the rural and urban areas through partnership with the government and
organisations e.g. WHO and has helped and supported millions of people with the essentials e.g. “decent
toilet facilities, clean water and good hygiene” (Hashmi, no date) which in turn, enables the community to
break free from poverty and improve their daily lives. “In the last year, 374,000 people received decent
toilets and 466,000 people received clean, adequate drinking water”. (Powell, no date)

Ultimately, sanitation is an important factor to consider in the social determinants of health, it’s a key
intervention for reducing preventable morbidity and mortality (premature deaths) and increases life
expectancy. In contrast, diseases that are related to poor sanitation still kills millions of people every year
across developing countries. Immense e orts have been made to prevent poor sanitation and improve
hygiene practices through partnership of di erent organisations and its local government. However, more
strategies and policies should be undertaken in order to enhance further the positive outcomes of
community sanitation across the developing countries.
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Reference list:
Bernadeta Dadonaite, Ritchie, H. and Roser, M. (2019). Diarrheal diseases. [online] Our World in Data.
Available at: https://ourworldindata.org/diarrheal-diseases. [Accessed: December 26, 2022].

Bien, J. and Kim, P.Y. (2019). Epidemiology Morbidity And Mortality. [online] Nih.gov. Available at: https://
www.ncbi.nlm.nih.gov/books/NBK547668/. [Accessed: December 26, 2022].

CDC (2019). Global WASH fast facts. [online] Centers for Disease Control and Prevention. Available at:
https://www.cdc.gov/healthywater/global/wash_statistics.html [Accessed: December 26, 2022].

Community approaches to total sanitation - community-led total sanitation (2009). Field Note.
pp. 11-15. Available at: https://archive.ids.ac.uk/clts/sites/communityledtotalsanitation.org/ les/media/
Field_Note_-_Community_Approaches_to_Total_Sanitation.pdf (Accessed: December 26, 2022).

Hashmi, A. (No date) Water NGO in India for Drinking Water Sanitation and Hygiene| WaterAid India. [online]
Available at: https://www.wateraid.org/in/why-wateraid [Accessed 26 Dec. 2022].

National sanitation policy - DWS (1996). National Sanitation Task Team. pp.1-2. Available at: https://
www.dws.gov.za/Documents/Policies/National%20Sanitation%20Policy.pdf [Accessed: December 26,
2022].

Postma, L., Getkate, R. and van Wijk, C. (2004). Life Skills-Based Hygiene Education A guidance document
on concepts, development and experiences with life skills-based hygiene education in school sanitation
and hygiene education programmes [online] p. 35. Available at: https://www.ircwash.org/sites/default/ les/
Postma-2004-Lifeskills.pdf [Accessed 26 Dec. 2022].

Powell, E. (no date) India | WaterAid US. [online] Available at: https://www.wateraid.org/us/where-we-work/
india [Accessed 26 December 2022].

World Bank Group (2022). Improving Sanitation to Secure Communities and Their Human Capital. [online]
Available at: https://www.worldbank.org/en/news/feature/2022/06/14/improving-sanitation-to-secure-
communities-and-their-human-capital [Accessed: December 26, 2022].

World Health Organization (1986). First International Conference on Health Promotion, Ottawa, 21 November
1986 (no date). [online] World Health Organization. Available at: https://www.who.int/teams/health-
promotion/enhanced-wellbeing/ rst-global-conference. [Accessed: December 26, 2022)].

WHO (2021). Social determinants of health. [online] www.who.int. Available at: https://www.who.int/health-
topics/social-determinants-of-health#tab=tab_3. [Accessed: December 26, 2022].
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