# Aging Population and Lacking Sanitation Governance: Global Challenges in Alleviating Deaths from Unsafe Rural Sanitation

## TL;DR

This study estimates deaths caused by unsafe rural sanitation globally, highlighting the need for improved sanitation governance to address risks in aging populations.

## Contribution

The study introduces a comprehensive evaluation framework for global deaths attributable to unsafe rural sanitation from 2000 to 2030.

## Key findings

- 12.2% of rural populations will lack access to sanitary toilets in 2030.
- Unsafe rural sanitation is projected to cause 243,000 deaths (CI: 147,000–441,000) in 2030.
- Aging populations and declining fertility rates are key drivers of DAUSRs.

## Abstract

With the rapid pace of global urbanization, health risks
faced
by rural communities are often overlooked. Deaths Attributable to
Unsafe Sanitation in Rural areas (DAUSRs) are influenced by demographic
factors, disease mortality rates, and environmental sanitation conditions.
However, most studies have been limited in scope and scale and lack
a comprehensive evaluation framework for global DAUSRs. Therefore,
this study estimated the global DAUSRs from 2000 to 2030, using data
from the Global Burden of Disease (GBD) and the World Health Organization
(WHO). We employed methods such as comparable risk assessment, Bayesian
age (period) models, and AutoRegressive Integrated Moving Average
(ARIMA) models. Changes in the DAUSRs and their influencing factors
were evaluated by applying a decomposition method to assess the impact
of population dynamics, sanitation conditions, age structure, and
disease mortality rates. The results indicated that despite improvements
in rural sanitation, 12.2% of rural populations will still lack access
to sanitary toilets in 2030, with an estimated 243,000 deaths (CI:
147,000–441,000) due to unsafe rural sanitation environments.
This outcome highlights the need for better rural sanitation governance
to provide for demographic shifts, such as aging and declining fertility
rates, which are key drivers of DAUSRs. Regions such as Africa and
Southeast Asia are at a higher risk with higher diarrhea-related mortality
rates in rural areas. We suggest comprehensive measures, including
enhancing rural medical facilities, improving sanitation infrastructure,
and focusing on vulnerable groups, such as the elderly and children.
These measures could inform global rural environmental and public
health policies.