Additionally, within urban areas, disparities exist in access between the urban rich and the urban poor ( Hawkins et al., 2013 WHO/UNICEF Joint Monitoring Programme for Water Supply, 2017). In some places, the proportion of the urban population with access to basic sanitation or piped water on premises has fallen ( WHO/UNICEF Joint Monitoring Programme for Water Supply, 2017 Satterthwaite, 2016). However, while rural access to drinking water has improved steadily since 1990, urban access has stagnated or improved only marginally ( Dos Santos et al., 2017). Within countries, urban populations are far more likely to have sewer connections and piped water supplies ( WHO/UNICEF Joint Monitoring Programme for Water Supply, 2017). The SDGs also emphasize equity, both between and within countries ( Hutton and Chase, 2016). Notably, whereas the MDGs only considered toilets, the indicators for the SDGs have been expanded to require “safely managed” water supplies and sanitation. The Sustainable Development Goals (SDGs), which succeeded the MDGs, aimed to further increase attention to WASH by seeking to ensure safe drinking water and basic sanitation for all ( UN, 2017). In 2015, 2.3 billion people still lacked basic sanitation, and 844 million people lacked a basic drinking water service ( WHO/UNICEF Joint Monitoring Programme for Water Supply, 2017). In addition, inadequate water and sanitation have been associated with other adverse outcomes including helminth infections, child under-nutrition, and impaired cognitive development ( Dangour et al., 2013 Sclar et al., 2017 Strunz et al., 2014).ĭespite widespread awareness of the importance of safe water and sanitation, including through the Millennium Development Goals (MDGs) and the United Nations (UN) International Decade for Action “Water for Life” 2005–2015 ( UN, 2015), substantial gaps remain. Studies suggest that interventions to provide improved water or sanitation can significantly reduce diarrhea ( GBD Diarrhoeal Diseases Collaborators, 2017 Clasen et al., 2015 Wolf et al., 2014). Inadequate WASH is one of the primary risk factors for diarrheal disease, a leading cause of mortality and disability-adjusted life-years (DALYs) worldwide ( GBD Diarrhoeal Diseases Collaborators, 2017). Water, sanitation, and hygiene (WASH) have long been recognized as important determinants of human health. Global burden of unsafe water and sanitation

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