Introduction

Diseases associated with poor water, sanitation, and hygiene comprise on average 6–7% of the annual mortality in less developed countries (World Health Organization 2004; Prüss-Üstün et al. 2008). A growing body of research suggests that a variety of different types of water, sanitation, and hygiene (WASH) interventions are effective and capable of delivering large health benefits to target populations (Hutton and Haller 2004; Fewtrell et al. 2005; Luby et al. 2005; Clasen et al. 2007; Hutton et al. 2007). Many of these interventions – the provision of improved community water supplies, point-of-use water treatment, hygiene education, on-site sanitation – can be delivered at very low cost, but their adoption remains surprisingly low (Whittington et al. 2012). Piped water and sewerage services, the gold standard for water and sanitation in the developed world, do not seem to be necessary to achieve many of the health benefits from improving existing water and sanitation conditions. Household demand for these network services, however, is much higher than for low-cost interventions, perhaps because they bring other types of improvements that households value, such as time savings and greater convenience (Whittington et al. 2009).

In this chapter we present a global analysis of the “economic losses” associated with inadequate water and sanitation from 1950 to 2050. These estimates provide an entry point for thinking about the challenges of ameliorating water and sanitation services in poor countries. Using a simple simulation model, we calculate the economic losses from the morbidity and mortality associated with inadequate water and sanitation services, and from the time spent collecting water from outside the home, in less developed countries during the period 1950 to 2008. We then use projections of GDP and population growth to forecast economic losses from 2008 to 2050. We compare total economic losses with non-monetary measures of disease burden, such as deaths due to WASH-related diseases.