Dirty drinking water and open defecation, particularly in rural areas of many developing countries, are threatening to subvert gains in child survival rates and other health measurements, two major United Nations agencies said Tuesday in a joint report on global progress in sanitation.

The report by the World Health Organization and Unicef, the United Nations Children’s Fund, said one in three people worldwide, or 2.4 billion, still live without sanitation facilities. That includes 946 million people who defecate in the open, raising the risk that reservoirs and wells will be contaminated.

More access to clean drinking water and improved hygiene are among the so-called millennium development goals established by the United Nations in 2000 to help measure improvements in quality of life. They are to be superseded by “sustainable development goals,” a new set of benchmarks to track progress through 2030. Debates on how to reach the new goals will be a major theme of the annual gathering of world leaders before the United Nations General Assembly in September.

The W.H.O.-Unicef report noted that access to cleaner drinking water had improved markedly in recent years and that child survival rates had advanced as well. Today, fewer than 1,000 children younger than 5 die each day from diarrhea caused by inadequate water, sanitation and hygiene, compared with more than 2,000 in 2000.

“On the other hand, the progress on sanitation has been hampered by inadequate investments in behavior change campaigns, lack of affordable products for the poor, and social norms which accept or even encourage open defecation,” the report said.

As of today, the report said, only 68 percent of the world’s population uses an improved sanitation facility — nine percentage points below the millennium development target of 77 percent. An improved sanitation facility is defined as one that hygienically separates human excrement from human contact.

“Until everyone has access to adequate sanitation facilities, the quality of water supplies will be undermined, and too many people will continue to die from waterborne and water-related diseases,” Maria Neira, director of the W.H.O.’s Department of Public Health, Environmental and Social Determinants of Health, said in announcing the report.

To eliminate open defecation by 2030, one of the sustainable development goals, the current rates of reduction will have to double, especially in South Asia and sub-Saharan Africa, the report said.

The report echoed some of the themes in a Unicef report issued June 22, describing grim trends for the world’s poorest children despite gains as measured by the millennium development goals. Because countries were encouraged to measure improvements through national averages, that report said, many focused on improvements in the easiest-to-reach populations, not those in the greatest need.

“The global model so far has been that the wealthiest move ahead first, and only when they have access do the poorest start catching up,” Sanjay Wijesekera, head of Unicef’s global water, sanitation and hygiene programs, said in a news release accompanying the report. “If we are to reach universal access to sanitation by 2030, we need to ensure the poorest start making progress right away.”

http://www.nytimes.com/2015/07/01/world/americas/dirty-water-and-open-defecation-threaten-gains-in-child-health.html