Drain on your health: Sanitation externalities from dirty drains in India

We highlight an overlooked channel of disease transmission in developing countries: dirty drains. We make the case that sanitation efforts should move to improve the condition of drains to build on increased toilet provision since they are a key transmission channel for waterborne diseases. We 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. We find a strong and positive association between household ill-health incidence and dirty neighborhood drains, controlling for household toilet usage, community-level toilet availability, and an array of other household attributes. We employ a variety of robustness checks to validate our findings. Our findings suggest that bringing the policy focus to overall sanitation infrastructure will have substantial health returns.