Anand Murugesan publishes a new paper in the Review of Development Economics examining the adverse health externalities from drains

Over a billion people lack access to clean drinking water, and twice as many do not have access to hygienic sanitation facilities. Diarrhea, a waterborne disease, kills 2,195 children daily, more than AIDS, malaria, and measles combined. Over the past two decades, programs and policies in South Asia have emphasized toilet construction combined with personal hygiene but overlooked overall sanitation infrastructure. In a new paper forthcoming in the Review of Development Economics, Anand Murugesan and his co-authors highlight an overlooked channel of disease transmission in developing countries: open dirty drains. They make the case that sanitation efforts should move to improve the condition of drains to build on increased toilet provision since drains are a key transmission channel for waterborne diseases. They develop an economic model of sanitation externalities that incorporates the role of drains and then empirically examine the relationship between the sanitary quality of neighborhood drains and household ill-health incidence using a primary survey of 1,530 households from rural Uttarakhand, India. They show a strong and positive association between household ill-health incidence and dirty neighborhood drains while controlling for household toilet usage, community-level toilet availability, and various other household attributes. The findings suggest that bringing the policy focus to overall sanitation infrastructure will have substantial health returns.