Externalities and Spillovers from Sanitation and Waste Management in Urban and Rural Neighborhoods

Abstract

Proper sanitation and waste management has important health benefits, both directly for the household making the decision and indirectly for its neighbors due to positive externalities. Nevertheless, construction and use of improved sanitation systems in much of the developing world continues to lag. Many recent interventions such as Community Led Total Sanitation (CLTS) have attempted to harness the power of social interactions to increase take‐up of improved sanitation. Most evidence to date mobilizes social pressure in rural areas, yet evidence is more scarce in urban neighborhoods where high population density may lead to larger externalities from poor sanitation decisions. We review the recent literature on how sanitation decisions are inter‐related within neighborhoods: the health externalities that sanitation decisions have on neighbors, and the social decision spillovers that drive take‐up. We explore potential explanations for the low take‐up and maintenance of sanitation systems, including the possibility of nonlinearities and thresholds in health externalities; the roles of social pressure, reciprocity, learning from others, and coordination in decision spillovers; and differences between urban and rural contexts.

Neighborhood Sanitation and Infant Mortality

“…The implied importance of open defecation for infant mortality in the modern Indian context fits with evidence by Bleakley (2007), Cutler and Miller (2005), and Watson (2006), regarding the role of sanitation and water in determining health and human capital outcomes in the historical United States. 5 In particular, Cutler and Miller (2005) shows that clean water and sanitation interventions in US citites explain large shares of the decline in infant mortality in the United States at the turn of the twentieth century. 6 Our estimates are also consistent with the most credible data on cause of death during early-life in India, which show that a large share 4 To give a sense of how large a 10 percentage point decline in open defecation would be, we note that despite India's rapid economic growth over the last two decades and a large government investment specific to open defecation (Spears 2013), open defecation rates have fallen in India by no more than 1 percentage point per year between 2001 and 2011 on average (Government of India 2011).…”

“…6 Our estimates are also consistent with the most credible data on cause of death during early-life in India, which show that a large share 4 To give a sense of how large a 10 percentage point decline in open defecation would be, we note that despite India's rapid economic growth over the last two decades and a large government investment specific to open defecation (Spears 2013), open defecation rates have fallen in India by no more than 1 percentage point per year between 2001 and 2011 on average (Government of India 2011). 5 Watson (2006) studied federal interventions to improve water and sanitation on US Indian reservations, finding effects on local infant mortality and spillovers to neighboring localities. Bleakley (2007) studied the eradication of hookworm in school-aged children in the US South at the turn of the twentieth century, documenting impacts on school enrollment and attendance and on later-life income.…”

Geography matters for sanitation! Spatial heterogeneity of the district‐level correlates of open defecation in India

“…However, we regard this finding as quite an interesting basis for future research that could examine how mechanisms underlying the nexus between spatial concentrations of Muslims, SCs, sanitation conditions and health operate (e.g. Kresch et al, 2020).…”

“…Since such externalities have a higher chance of arising in more densely populated areas (e.g. Hathi et al, 2014;Kresch et al, 2020), we expect that an area's population density shall moderate (amplify) the negative relationship between the share of Muslims and general OD rate. On the contrary, many studies have found that socially backward classes such as SCs in India generally have higher OD rates (Kumar, 2014;Lamba & Spears, 2013;O'Reilly et al, 2017).…”

When nature calls back: sustaining behavioural change in rural Pakistan

“…However, we are likely underpowered due to a small sample size in terms of detecting significant differences for other dimensions, as we will show through robustness checks in Section 5. 24 As highlighted by Crocker et al (2017), and in a review by Kresche et al (2020), higher sanitation adoption can make it more worthwhile, or easier, for other households to follow improved sanitation behaviour. It is therefore possible, that these village-level heterogenous effects might be driven by initial OD rates.…”