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What it Measures

Access to Drinking Water describes the portion of a country’s population with access to an “improved drinking water source” as a main source. An improved drinking water source is defined as a facility or delivery point that protects water from external contamination, particularly fecal contamination. This improved source could mean piped water into a dwelling, plot, or yard; a public tap or standpipe; a tubewell or borehole; a protected spring; and rainwater collection.

Access to Sanitation describes the portion of a country’s population that has access to toilets that provide the safe disposal of human waste. Improved sanitation sources include connection to a public sewer, septic system, pour-flush latrine, simple pit latrine, or ventilated pit latrine. The system is considered “improved” if it hygienically separates waste from human contact and is not a public or shared facility.

The 2016 EPI pairs access to drinking water and sanitation with exposure variables that assess the health risk when exposed to unsafe water and poor sanitation. Safe drinking water is derived from reports on the water’s treatment methods (e.g., boiling or filtering; chlorinating or solar filtering, or no treatment). Sanitation is assessed using the proportion of households with access to different types of waste-removal facilities (e.g., unimproved, improved except sewer, sewer connection). Based on these appraisals, risk factors are assigned according to the likelihood of unsafe exposure for each sanitation facility type.  

Why we include it

Access to safe drinking water reduces exposure to toxins, disease vectors, and harmful contaminants, promoting general health and wellbeing. Diarrhea, for instance, the leading cause of death among children, is caused chiefly by contaminated water consumption. Access to Sanitation is a vital measure tracking a nation’s ability to maintain healthy drinking water supplies, minimize its population’s contact with dangerous bacteria and viruses, and diminish other environmental threats associated with improper waste management. We augment these indicators with new data on risk exposure to gauge health outcomes associated with unsafe drinking water and lack of sanitation.

Where the data come from

Data for access to sanitation and drinking water come from the World Health Organization (WHO)/United Nations Children’s Fund (UNICEF) Joint Monitoring Programme for Water Supply and Sanitation (JMP). For more information, see 2016 EPI Metadata.

Data for the risk exposure variables for unsafe drinking water and sanitation are based on household surveys and modeled by the Institute for Health Metrics and Evaluation’s Global Burden of Disease, Injuries, and Risk Factors 2013 (GBD) study, the world’s most comprehensive comparative risk assessment of epidemiological trends.[footnote 1] For more about GBD methods, see the Health Impacts Issue Profile.

What are the targets

100% for Access to Drinking Water; 100% for Access to Sanitation. The 5th and 95th percentiles are used as targets for the Unsafe Water and Sanitation risk exposure variables.

Inadequate access to safe drinking water and sanitation sickens and kills thousands of children every day. Poor sanitation degrades the quality of life for millions of people, exacerbates gender inequality, and stunts economic development. Data from WHO and UNICEF indicate that the poorest, children, the elderly, excluded groups, and women and girls suffer most from poor sanitation.[footnote 5]

Global data on drinking water and sanitation access has improved sharply since the MDGs were launched nearly a decade ago. JMP, which has refined its methods over time, is a success story in coordinated international data collection.[footnote 6] Prior to 1990, WHO relied on self-reported data provided by country agencies and ministries of health to assess the global status of water supply and sanitation. By the late 1990s, the limitations of self-reported data had become clear, as definitions of access to water and sanitation varied between and within countries.

As the official UN mechanism tasked with monitoring progress towards the MDGs related to drinking water and sanitation, JMP made improvements in data collection, standardization, and reporting beginning in 2000. Today, JMP estimates are derived from user-based data from nationally representative household surveys. Provider-based data is only used when no other source is available. The number of national surveys available to JMP has increased over the years and currently includes over 1,600 national datasets,[footnote 7] most of which are nationally representative household surveys and censuses. JMP’s 2015 update includes detailed information on the breakdown between private versus shared sanitation services. Some countries with new data on shared facilities saw their scores fall slightly because shared facilities were not being counted as “improved.”

Though rigorous, these datasets do not comprehensively address concerns relating water to environmental and public health outcomes. Some key information is from the Access to Water dataset, including the price of water (a factor for access) and whether the water is actually safe for consumption.[footnote 8] Providing adequate sanitation and access to improved drinking water minimizes the risk of coming into contact with dangerous bacteria and viruses, yet the dataset that informs the Access to Sanitation indicator does not record what proportion of waste is treated before being released back into the environment. Untreated sewage pollutes freshwater sources and ocean ecosystems and puts human health at risk. To address this deficiency we provide a global dataset on wastewater treatment in the EPI’s Ecosystem Vitality objective (see Water Resources Issue Profile.)

While nations across the globe have made progress to improve access to sanitation and drinking water millions of individuals still lack this basic human right.[footnote 2] SDG-6, supported with robust indicators that quantify “safe,” along with new datasets, such as IHME’s risk exposure data, can ensure that improving access to and quality of water and sanitation go hand in hand.