sanitation sanitation sanitation refers to public health conditions related to clean drinking water and treatment and disposal of human excreta and sewage. preventing human contact with feces is part of sanitation, as is hand washing with soap. sanitation systems aim to protect human health by providing a clean environment that will stop the transmission of disease, especially through the fecal–oral route. for example, diarrhea, a main cause of malnutrition and stunted growth in children, can be reduced through adequate sanitation. there are many other diseases which are easily transmitted in communities that have low levels of sanitation, such as ascariasis (a type of intestinal worm infection or helminthiasis), cholera, hepatitis, polio, schistosomiasis, and trachoma, to name just a few. the sanitation system: collection, transport, treatment, disposal or reuse. part of a series onpublic health outline subfields community health dental public health environmental health epidemiology health economics health education health promotion health policy health politics mental health occupational safety sexual and reproductive health sanitation world health (global health - international health) prevention disease surveillance health promotion (behavior change) health indicators lists and categories terminology journals national public health agencies medicine portal society portal a range of sanitation technologies and approaches exists. some examples are community-led total sanitation, container-based sanitation, ecological sanitation, emergency sanitation, environmental sanitation, onsite sanitation and sustainable sanitation. a sanitation system includes the capture, storage, transport, treatment and disposal or reuse of human excreta and wastewater. reuse activities within the sanitation system may focus on the nutrients, water, energy or organic matter contained in excreta and wastewater. this is referred to as the "sanitation value chain" or "sanitation economy". the people responsible for cleaning, maintaining, operating, or emptying a sanitation technology at any step of the sanitation chain are called "sanitation workers".: 2 several sanitation "levels" are being used to compare sanitation service levels within countries or across countries. the sanitation ladder defined by the joint monitoring programme in 2016 starts at open defecation and moves upwards using the terms "unimproved", "limited", "basic", with the highest level being "safely managed". this is particularly applicable to developing countries. the human right to water and sanitation was recognized by the united nations (un) general assembly in 2010. sanitation is a global development priority and the subject of sustainable development goal 6. the estimate in 2017 by jmp states that 4.5 billion people currently do not have safely managed sanitation. lack of access to sanitation has an impact not only on public health but also on human dignity and personal safety. definitions urban improved sanitation facilities versus rural improved sanitation facilities, 2015. there are some variations on the use of the term "sanitation" between countries and organizations. the world health organization defines the term "sanitation" as follows: "sanitation generally refers to the provision of facilities and services for the safe disposal of human urine and faeces. the word 'sanitation' also refers to the maintenance of hygienic conditions, through services such as garbage collection and wastewater disposal." sanitation includes all four of these technical and non-technical systems: excreta management systems, wastewater management systems (included here are wastewater treatment plants), solid waste management systems as well as drainage systems for rainwater, also called stormwater drainage. however, many in the wash sector only include excreta management in their definition of sanitation. another example of what is included in sanitation is found in the handbook by sphere on "humanitarian charter and minimum standards in humanitarian response" which describes minimum standards in four "key response sectors" in humanitarian response situations. one of them is "water supply, sanitation and hygiene promotion" (wash) and it includes the following areas: hygiene promotion, water supply, excreta management, vector control, solid waste management and wash in disease outbreaks and healthcare settings.: 91 hygiene promotion is seen by many as an integral part of sanitation. the water supply and sanitation collaborative council defines sanitation as "the collection, transport, treatment and disposal or reuse of human excreta, domestic wastewater and solid waste, and associated hygiene promotion." despite the fact that sanitation includes wastewater treatment, the two terms are often used side by side as "sanitation and wastewater management". another definition is in the dfid guidance manual on water supply and sanitation programmes from 1998: "for the purposes of this manual, the word ‘sanitation’ alone is taken to mean the safe management of human excreta. it therefore includes both the ‘hardware’ (e.g. latrines and sewers) and the ‘software’ (regulation, hygiene promotion) needed to reduce faecal-oral disease transmission. it encompasses too the re-use and ultimate disposal of human excreta. the term environmental sanitation is used to cover the wider concept of controlling all the factors in the physical environment which may have deleterious impacts on human health and well-being. in developing countries, it normally includes drainage, solid waste management, and vector control, in addition to the activities covered by the definition of sanitation." sanitation can include personal sanitation and public hygiene. personal sanitation work can include handling menstrual waste, cleaning household toilets, and managing household garbage. public sanitation work can involve garbage collection, transfer and treatment (municipal solid waste management), cleaning drains, streets, schools, trains, public spaces, community toilets and public toilets, sewers, operating sewage treatment plants, etc.: 4 workers who provide these services for other people are called sanitation workers. purposes access to safe drinking water and sanitation (2016) the overall purposes of sanitation are to provide a healthy living environment for everyone, to protect the natural resources (such as surface water, groundwater, soil), and to provide safety, security and dignity for people when they defecate or urinate. the human right to water and sanitation was recognized by the united nations (un) general assembly in 2010. it has been recognized in international law through human rights treaties, declarations and other standards. it is derived from the human right to an adequate standard of living. effective sanitation systems provide barriers between excreta and humans in such a way as to break the disease transmission cycle (for example in the case of fecal-borne diseases). this aspect is visualised with the f-diagram where all major routes of fecal-oral disease transmission begin with the letter f: feces, fingers, flies, fields, fluids, food. sanitation infrastructure has to be adapted to several specific contexts including consumers' expectations and local resources available. sanitation technologies may involve centralized civil engineering structures like sewer systems, sewage treatment, surface runoff treatment and solid waste landfills. these structures are designed to treat wastewater and municipal solid waste. sanitation technologies may also take the form of relatively simple onsite sanitation systems. this can in some cases consist of a simple pit latrine or other type of non-flush toilet for the excreta management part. providing sanitation to people requires attention to the entire system, not just focusing on technical aspects such as the toilet, fecal sludge management or the wastewater treatment plant. the "sanitation chain" involves the experience of the user, excreta and wastewater collection methods, transporting and treatment of waste, and reuse or disposal. all need to be thoroughly considered. economic impacts the benefits to society of managing human excreta are considerable, for public health as well as for the environment. as a rough estimate: for every us$1 spent on sanitation, the return to society is us$5.50.: 2 for developing countries, the economic costs of inadequate sanitation is a huge concern. for example, according to a world bank study, economic losses due to inadequate sanitation to the indian economy are equivalent to 6.4% of its gdp. most of these are due to premature mortality, time lost in accessing, loss of productivity, additional costs for healthcare among others. inadequate sanitation also leads to loss from potential tourism revenue. this study also found that impacts are disproportionately higher for the poor, women and children. availability of toilet at home on the other hand, positively contributes to economic well-being of women as it leads to an increase in literacy and participation in labor force. types and concepts (for excreta management) percentage of population served by different types of sanitation systems example of sanitation infrastructure: shower, double-vault urine-diverting dry toilet (uddt) and waterless urinal in lima, peru the term sanitation is connected with various descriptors or adjectives to signify certain types of sanitation systems (which may deal only with human excreta management or with the entire sanitation system, i.e. also greywater, stormwater and solid waste management) – in alphabetical order: basic sanitation in 2017, jmp defined a new term: "basic sanitation service". this is defined as the use of improved sanitation facilities that are not shared with other households. a lower level of service is now called "limited sanitation service" which refers to use of improved sanitation facilities that are shared between two or more households. container-based sanitation this section is an excerpt from container-based sanitation. container-based sanitation (abbreviated as cbs) refers to a sanitation system where toilets collect human excreta in sealable, removable containers (also called cartridges) that are transported to treatment facilities. this type of sanitation involves a commercial service which provides certain types of portable toilets, and delivers empty containers when picking up full ones. the service transports and safely disposes of or reuses collected excreta. the cost of collection of excreta is usually borne by the users. with suitable development, support and functioning partnerships, cbs can be used to provide low-income urban populations with safe collection, transport and treatment of excrement at a lower cost than installing and maintaining sewers. in most cases, cbs is based on the use of urine-diverting dry toilets. community-based sanitation community-based sanitation is related to decentralized wastewater treatment (dewats). community-led total sanitation this section is an excerpt from community-led total sanitation. community-led total sanitation (clts) is an approach used mainly in developing countries to improve sanitation and hygiene practices in a community. the approach tries to achieve behavior change in mainly rural people by a process of "triggering", leading to spontaneous and long-term abandonment of open defecation practices. it focuses on spontaneous and long-lasting behavior change of an entire community. the term "triggering" is central to the clts process: it refers to ways of igniting community interest in ending open defecation, usually by building simple toilets, such as pit latrines. clts involves actions leading to increased self-respect and pride in one's community. it also involves shame and disgust about one's own open defecation behaviors. clts takes an approach to rural sanitation that works without hardware subsidies and that facilitates communities to recognize the problem of open defecation and take collective action to clean up and become "open defecation free". dry sanitation the term "dry sanitation" is not in widespread use and is not very well defined. it usually refers to a system that uses a type of dry toilet and no sewers to transport excreta. often when people speak of "dry sanitation" they mean a sanitation system that uses urine-diverting dry toilet (uddts). ecological sanitation this section is an excerpt from ecological sanitation. ecological sanitation, commonly abbreviated as ecosan (also spelled eco-san or ecosan), is an approach to sanitation provision which aims to safely reuse excreta in agriculture. it is an approach, rather than a technology or a device which is characterized by a desire to "close the loop", mainly for the nutrients and organic matter between sanitation and agriculture in a safe manner. one of the aims is to minimise the use of non-renewable resources. when properly designed and operated, ecosan systems provide a hygienically safe system to convert human excreta into nutrients to be returned to the soil, and water to be returned to the land. ecosan is also called resource-oriented sanitation. emergency pit lining kits by evenproducts emergency sanitation this section is an excerpt from emergency sanitation. emergency sanitation is the management and technical processes required to provide sanitation in emergency situations. emergency sanitation is required during humanitarian relief operations for refugees, people affected by natural disasters and internally displaced persons. there are three phases of emergency response: immediate, short term and long term. in the immediate phase, the focus is on managing open defecation, and toilet technologies might include very basic latrines, pit latrines, bucket toilets, container-based toilets, chemical toilets. the short term phase might also involve technologies such as urine-diverting dry toilets, septic tanks, decentralized wastewater systems. providing handwashing facilities and management of fecal sludge are also part of emergency sanitation. environmental sanitation environmental sanitation