“Who cares about toilets? 3.6 billion people do. Because they don’t have one that works properly. “That is the starting point of this 2021 UN Campaign for World Toilet Day. The Observance celebrates toilets and raises awareness of the 3.6 billion people living without access to safely managed sanitation. When some people in a community do not have safe toilets, everyone’s health is threatened. Poor sanitation contaminates drinking-water sources, rivers, beaches and food crops, spreading deadly diseases among the wider population. 
This year’s theme is about valuing toilets. The campaign draws attention to the fact that toilets – and the sanitation systems that support them – are underfunded, poorly managed or neglected in many parts of the world, with devastating consequences for health, economics and the environment, particularly in the poorest and most marginalized communities.
On the other hand, the advantages of investing in an adequate sanitation system are immense. For instance, every US$ 1 invested in basic sanitation returns up to US$ 5 in saved medical costs and increased productivity, and jobs are created along the entire service chain. For women and girls, toilets at home, school and at work help them fulfill their potential and play their full role in society, especially during menstruation and pregnancy.
The solution is about taking action to tackle the global sanitation crisis and achieve Sustainable Development Goal 6: water and sanitation for all by 2030.
Even though sanitation is a human right recognized by the United Nations, we urgently need massive investment and innovation to quadruple progress all along the ‘sanitation chain’, from toilets to the transport, collection and treatment of human waste.
Access to toilets
As part of a human rights-based approach, governments must listen to the people who are being left behind without access to toilets and allocate specific funding to include them in planning and decision-making processes.
Sanitation is vital to health, child development, and social and economic progress. Safe sanitation is also a human right – essential for the fulfillment of child rights and the achievement of good physical, mental and social well-being – recognized as a distinct right by the General Assembly of the United Nations in 2015. In the same year, Member States committed to the 2030 Agenda for Sustainable Development, including target 6.2 of the SDGs: “By 2030, achieve access to adequate and equitable sanitation and hygiene for all and end open defecation, paying special attention to the needs of women and girls.”
An estimated 673 million people have no toilets at all and practice open defecation (2017), while nearly 698 million school-age children lacked basic sanitation services at their school. At the current rate of progress, it will be the twenty-second century before sanitation for all is a reality. While the challenge is significant, history shows that rapid progress is possible.
The world is alarmingly off-track to deliver sanitation for all by 2030. Despite progress in global sanitation coverage in recent years, over half the world’s population, 4.2 billion people, use sanitation services that leave human waste untreated, threatening human and environmental health.
Sanitation targets
With only nine years left until 2030, the rate at which sanitation coverage is increasing will need to quadruple if the world is to achieve the SDG sanitation targets. At the current rate of progress, it will be the twenty-second century before sanitation for all is a reality. Clearly this is too slow. While the challenge is significant, history shows that rapid progress is possible. To accelerate progress, sanitation must be defined as an essential public good – one that is foundational for a healthy population and prosperous society.
Many countries have made rapid progress in sanitation coverage within a generation, transforming lives, the environment and the economy. Every country that has made rapid progress has had strong political leadership, with government playing an important role in policy, planning, mobilizing investment and regulating services. Sanitation is a human right. 
Everyone is entitled to sanitation services that provide privacy, ensure dignity and safety, and that are physically accessible and affordable. Sanitation is also a public good, providing benefits across society in improved health as well as economic and social development. The lack of safe sanitation leads to illness and disease that disproportionately affect children, including diarrhoea, worm infections and stunting. But poor sanitation affects everyone, and a polluted environment impacts the entire community, whether or not an individual household has a sanitation facility. In addition to hard-to-quantify effects on dignity, safety and gender equality, there are significant financial costs related to lack of sanitation, including increased health care costs, lost income, forgone educational opportunities and costs resulting from pollution. Poor sanitation disproportionately affects the most vulnerable and disadvantaged, particularly women and people living with disabilities.
Sanitation workers, often stigmatized and marginalized, face unacceptable health risks and indignities in an unhealthy and unregulated environment. Achieving universal access to safe sanitation will be expensive, but inaction brings greater costs. Investments in sanitation – particularly safely managed sanitation services – generate positive externalities across society.
The economic benefits of sanitation have been estimated at about five times the cost – a cost-benefit ratio greater than that of water supply alone. Investment in five key ‘accelerators’ – governance, financing, capacity development, data and information, and innovation – identified under the UN-Water SDG 6 Global Acceleration Framework – can be a pathway towards achieving universal and safe sanitation for all.
Achieving universal access to sanitation by 2030 will require dramatic acceleration in current rates of progress. Global rates of progress need to double to achieve basic sanitation for all, and universal access to safely managed sanitation requires them to quadruple. However, these global averages mask the fact that some countries, and some communities within countries, are starting from a much lower baseline. In these places, the rate of change must be even greater if the pledge to ‘leave no one behind’, made by Member States when they adopted the 2030 Agenda, is to be honoured.
Public health hazards
Governments have a critical role to play. Sanitation is a public good in need of public funding that will allow everyone to benefit from improved health as well as social and economic development. Poor sanitation creates serious negative externalities, creating public health hazards and jeopardizing economic development for all. Conversely, good sanitation generates economic benefits and unlocks human productivity. Regulation throughout the sanitation chain is crucial to ensure that the benefits are realized by everyone.
History shows it can be done. There are many countries that have been successful in making rapid progress in sanitation coverage, transforming lives, the environment and the economy within a generation. With strong political leadership, sufficient resources and a ‘whole-of-government’, multi-stakeholder approach, governments can quickly transform sanitation and find ways to put the last first. In the 1960s and 1970s, Malaysia, the Republic of Korea, Singapore and Thailand produced rapid and remarkable results.
More recently, India has created a mass movement which has dramatically reduced and almost eliminated the undignified and dangerous practice of open defecation, which disproportionately affects the rural poor. Since 2000, Cambodia and Ethiopia reduced open defecation by more than 50 percentage points, and Cambodia, Indonesia, the Lao People’s Democratic Republic and Nepal increased the use of at least basic sanitation services by more than 40 percentage points. Governments in many other countries are helping individuals and communities move up the sanitation ladder towards universal access to safely managed sanitation services – by mobilizing communities, strengthening markets and service providers, deploying a range of funding and financing mechanisms to build resilient sanitation services that make better use of scarce resources, recycling waste for economic and environmental benefits, and building the circular economy.
The COVID-19 pandemic has exacerbated many sanitation challenges. People have been isolated at home, where they have unsafe sanitation facilities or are forced by their lack of sanitation facilities into unsafe, communal areas, such as poorly managed public latrines or open defecation areas. Sanitation workers, obliged to keep working as they perform an essential service, add one more health hazard to what is often a long list. The pandemic has reinforced what the evidence makes clear: poor sanitation puts everyone at risk.
The lack of safe sanitation systems leads to a range of adverse health impacts, including: Diarrhoea, a major public health concern and a leading cause of disease and death among children under five years of age in low and middle-income countries. This includes cholera, an acute diarrhoeal disease that can kill within hours if left untreated; neglected tropical diseases such as soil-transmitted helminth infections, schistosomiasis and trachoma, which account for a significant burden of disease globally; vector-borne diseases such as West Nile virus or lymphatic filariasis (through poor sanitation facilitating the proliferation of Culex mosquitos); stunting, which affects almost one quarter of children under five years of age globally through several mechanisms, including repeated Diarrhoea, helminth infections and environmental enteric dysfunction related to unsanitary conditions, and leads to poor physical and cognitive development.
Antimicrobial resistance, by increasing the risk of preventable infections that are treated with antibiotics and by spreading excreted resistant organisms in the environment though untreated wastewater and sludge; Anaemia and spontaneous abortion and pre-term birth associated with soil-transmitted helminth infections (worms). Globally, it is estimated that 1.9 million deaths and the loss of over 120 million disability-adjusted life years (DALYs) could have been prevented with adequate WASH in 2016. Inadequate sanitation contributes directly or indirectly - via contaminated drinking-water and hands - to approximately 830,000 deaths and over 49 million DALYs due to diarrhoeal diseases and many more from other diseases and conditions including soil-transmitted helminth infections, malnutrition, trachoma, schistosomiasis, lymphatic filariasis and those linked to inadequate wastewater management. - UN News
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