More than half the world’s population already lives in cities – about 58 percent today, and by 2050 nearly seven in ten people will call a city home. The promise of the urban future largely depends on the availability of essential services, such as sanitation. Where services are safely managed, health improves, children stay in school, productivity rises, and investment follows. Yet 3.5 billion people still lack safely managed sanitation—holding back households, local economies, and entire cities.
The vicious spiral of poor sanitation
When sanitation fails, losses compound. Health is hit first as unsafe services spread diarrheal disease, typhoid, and intestinal parasites; pregnant women face higher risks of preterm birth and low birth weight; and early-life exposure contributes to undernutrition and stunting that limit growth and cognitive development. In 2019, access to safely managed WASH (Water, Sanitation, and Hygiene) could have prevented about 1.4 million deaths and 74 million disability-adjusted life years (DALYs)—nearly 3 percent of the global burden.
These health impacts spill into classrooms and, later, into the workplace. An estimated 429 million children attend schools without toilets, undermining attendance, achievement, attitude and dignity—especially for adolescent girls. Lost learning reduces earnings and productivity over a lifetime, while households without safe services face higher medical costs and more days of missed work.
The economic consequences mirror these household losses. Inadequate sanitation drains over 2 percent of GDP in East Asia, the Pacific, and Sub-Saharan Africa, and nearly 4% in South Asia. In rapidly growing cities, service failures divert scarce resources to emergencies instead of productive investments, undermining the very benefits cities are meant to deliver.
The virtuous cycle when sanitation works
The reverse is equally powerful. When sanitation is safe, reliable, and inclusive, it becomes an engine of growth and prosperity.
Health improves, stunting falls, women and girls gain dignity, privacy, and safety—opening doors to fuller participation in school, work, and public life. Schools with toilets see higher enrollment and retention. Every extra year of quality education can boost future earnings by about 8 percent. A healthier, better educated generation forms the backbone of stronger human capital.
The economic benefits ripple across the entire economy. Achieving universal safely managed WASH is estimated to generate about $86 billion annually in higher productivity and lower healthcare costs. In Africa, every $1 invested in water and sanitation yields at least $7, and adequate investment could boost the continent’s GDP by more than 5 percent —about $200 billion a year.
Healthier people learn more, earn more, and contribute more, while reliable sanitation reduces fiscal shocks and builds investor confidence.
Tailoring the pathways
Every city needs its own path to universal sanitation. In lower-income contexts, the priority is to quickly reduce exposure through basic, safe services while building in resilience from the start, which is far more cost-effective than retrofitting later. In middle-income settings, expanding coverage must go hand in hand with stronger operations, maintenance, and institutions to reduce pollution, use resources efficiently and ensure services perform even under stress. In higher-income countries, cities can lead the way—by developing innovative solutions that protect the environment, reduce emissions, and maximize resources efficiency.
The urgency is clear. To reach universal sanitation by 2030, global progress must accelerate six-fold. In Africa, safely managed sanitation would need to expand 23 times faster, and even basic access about 13 times faster. Prioritization matters as well. Millions of urban residents in low- and middle-income countries face a “triple burden” of poverty, climate risk, and poor sanitation. Investing first in these communities—where water stress or flooding make service failures worse—delivers the biggest social and economic gains while reducing future fiscal shocks.
A systems approach to reliable, inclusive service
Effective cities manage the entire sanitation chain—from toilets to treatment to safe reuse —and align investments, operations, and regulation accordingly. Sanitation works best when it is integrated with water, waste, and drainage, and when financing is predictable and sustained.
Inclusion is integral: extending services to informal settlements and ensuring safe, dignified facilities for women and girls, people with disabilities, sanitation workers, and other marginalized groups determines whether access turns into effective use and lasting benefits.
Data and skills make systems reliable. Cities that track assets, monitor services, and build capacity can prevent failures and respond quickly. And by turning waste into value – through compost, energy, or water reuse – they cut costs, create jobs and strengthen long-term sustainability.
Breaking the cycle
Shared prosperity in cities does not happen by chance; it rests on the everyday reliability of services that protect health, dignity, and time. Reliable sanitation requires sustained operations and maintenance, clear institutional roles, and service models that reach communities often left behind. When cities plan holistically and commit to long-term funding, sanitation shifts from overlooked infrastructure to a quiet catalyst of human capital, economic opportunity, and environmental resilience.
The World Bank’s “Global Sanitation Crisis: Pathways for Urgent Action” report shows how resilient urban sanitation benefits people, economies, and the planet, and sets out actions to accelerate universal, safely managed access. Read the full report here.
