Measuring Progress: Sanitation

This post is part of an ongoing series of posts on measuring progress in the world. In each of the post, I focus on one specific metric. This post focuses on sanitation. The series starts with “How Do We Measure Progress?

Sanitation systems are one of the most important public health innovations in world history. Nobody likes to live surrounded by human waste, and the failure to avoid it is life threatening. In measuring levels of sanitation, I will use the percentage of all persons with access to improved sanitation.

According to the World Health Organization, “Improved sanitation includes sanitation facilities designed to hygienically separate excreta from human contact.” The flush toilet and pit latrines with covered pits are two of the simplest technologies that qualify. This data is generally available from 1990 to 2015.

I could show overall global averages, but global averages can be quite deceptive. National numbers are much more useful. Since there are over 200 nations, however, it is not realistic to examine development metrics for every one of them in this blog. And averages can cover up variation between rich and poor nations.

We need a way to narrow the sample to a manageable number, but not do so in a way that creates a distorted impression of overall trends. In order to ensure that the data covers a very broad segment of the world’s population, I decided to focus on four distinct categories of nations: the Wealthy 12, the Populous 12, the Bottom 20 and the Transformative 15, which I describe in detail below.

Together, the Wealthy 12, Populous 12, Bottom 20 and Transformative 15 are a solid set of groups to test to whether the world has experienced widespread progress over the last few decades. Given the breadth and diversity of the four groups it seems unlikely that any broad trends will be missed by narrowing the sample from all nations in the world. In some cases, I will supplement these four groups with other data that seems relevant. To reduce visual clutter I will show each group in a separate graph along with an average in black.

The first group, which I will call the “Wealthy 12”, consists of twelve Western nations that industrialized early and currently have very high standards-of-living. Those nations are the United States, United Kingdom, Australia, Belgium, Canada, France, Germany, Netherlands, New Zealand, Norway, Sweden, and Switzerland. The Wealthy 12 gives us a good overview of the trends within the wealthiest nations.

For the Wealthy 12, almost universal access to improved sanitation was achieved before 1990, so improvement was impossible.

The Populace 12 Nations

The second group that I will show data for is what I call the “Populace 12”. This group consists of twelve of the most populous nations that did not have high per capita GDP in 2018. This group consists of China, India, Brazil, Congo, Egypt, Ethiopia, Indonesia, Iran, Mexico, Nigeria, Pakistan, and Turkey. Together these nations make up 58% of the world’s population and cover every continent except Australia and Antarctica. The Populous 12 gives us a broad overview of trends for people who live outside the wealthiest nations.

For the Populous 12, very important improvements in access to improved sanitation were made. In 1990 45% of the citizens of Wealthy 12 nations had access to improved sanitation  facilities. This improved to 67% in 2015.

Some nations had relatively high levels of access in 1990, but still managed to improve: Turkey, Egypt, Iran, Brazil and Mexico. All the other nations, but Nigeria, which declined, and Congo, which showed only modest progress, showed important progress. China, Indonesia, Pakistan and Ethiopia showed the most progress.

The Bottom 20 Nations

The third group is what I call the “Bottom 20”. This group consists of the 20 nations with the lowest scores on the United Nations Human Development Index in 1990 (the earliest year available). The nations in this group consist of Afghanistan, Benin, Burma, Burundi, Central African Republic, Congo, Gambia, Guinea, Malawi, Mali, Mauritania, Mozambique, Niger, Papua New Guinea, Rwanda, Senegal, Sierra Leone, Sudan, Tanzania and Uganda. The Bottom 20 gives us a good overview in trends in the most desperately poor nations in the world. If there is any group of nations that should lack evidence of progress, it is these twenty nations.

Among the Bottom 20, access to improved sanitation improved, but at a slower rate.  In 1990 19% of the people had access to improved sanitation. By 2015 the rate had almost doubled to 34%.

Burma, Rwanda and Mauritania showed the most progress, while only Gambia declined (although it had the highest level in 1992).  Overall, there are clear signs of progress, although the levels are much less than we see for the Populous 12. In almost every country, the levels are under 50% access to improved sanitation and many are still below 20%.

The Transformative 15 nations

The last group of nations is what I call the “Transformative 15”. This group consists of the nations that experienced at least one generation of very strong economic growth after 1950 (or 20+ years of per capita GDP growth of over 3 percent). This level of economic growth would lead to a doubling of the standard-of-living of their people within one generation.

The Transformative 15 includes representatives from many different regions and cultures: Spain, Ireland, Japan, Hong Kong, Taiwan, Thailand, Singapore, South Korea, Indonesia, China, India, Israel, Botswana, Trinidad, Puerto Rico and Chile. The Transformative 15 gives us a good overview of the nations who experienced the fastest economic growth. It tests whether very rapid economic growth translates into positive changes throughout the society.

For the Transformative 15, most had achieved very high levels of access to improved sanitation before we have data. Among the three nations that relatively low access to improved sanitation – China, India and Indonesia – all made substantial progress by 2015.  The average increased from 79% in 1990 to 88% in 2015. Today only India has access levels under 60%. While India obviously still has a long way to go to get 100%, the positive trend is clear and there is no reason to expect the progress to be interrupted.


Overall, we see the following trends in access to improved sanitation since 1990:

  • The wealthiest nations are at or near 100% access to improved sanitation.
  • Most of the nations that experienced transformative economic growth in the late 20th Century have similar levels of access.
  • Very populous nations that experienced transformative economic growth (China, India and Indonesia) have improved rapidly, though they are still well below 100% access. The delay is likely due to sheer population size.
  • The poorest nations in 1990 have almost doubled access, but the majority of their citizens lack access.
  • Very few nations that are below 90% access failed to show significant progress

If you would like to learn more about this or other related topics, read my book From Poverty to Progress.


Michael Magoon is the author of the “From Poverty to Progress” series of books. The first book in the series is already published with many more to follow.


The writings above are under the same copyright as the main book “From Poverty to Progress”
Copyright © 2021 Michael Magoon

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