Access to sanitary toilets and health outcomes: A panel data analysis using two-way fixed effects model

Health effects and externalities of the popularization of sanitary toilets: evidence from Rural China

BACKGROUND

This study aimed to assess the impact of the increased prevalence of sanitary toilets in rural areas on the health of rural residents, and whether the popularity thereof has a positive externality. This study investigates whether the broader use of sanitary toilets has had a positive effect on the health of people who do not have access to them.

METHODS

Data from the China Family Panel Studies from 2012 to 2014 and a two-way fixed effect model were used to investigate the relationship between the prevalence of village sanitary toilets and the health of rural residents of all ages.

RESULTS

The results showed that: (1) the increase in the prevalence of sanitary toilets in villages is conducive to improving the health level of rural residents; (2) the widespread adoption of sanitary toilets in rural areas has improved the health of not only residents with access to these toilets but also residents without access; (3) the health of children is more sensitive to improvements in sanitary conditions of toilets; and (4) there are significant regional differences in the impact of the popularity of sanitary toilets on the health of rural residents.

CONCLUSIONS

This study found that the popularity of sanitary toilets has externalities, improving not only the health of residents who use them but also the health of other residents. This study enriches the literature in the field of health effects of sanitation improvement, while providing a reference for developing countries to further enhance the living environment in rural areas. In the future, the popularization of sanitary toilets should be vigorously promoted to reduce the incidence of diseases.

Effect of household toilet accessibility on physical health of ethnic minority adolescents: a longitudinal study from the China Education Panel Survey 2013 and 2014

BACKGROUND

Accessing household toilets is vital for adolescent health during crucial stages of growth and development; however, some ethnic minority families in China lack toilets. The relationship between household toilet accessibility and the physical health of adolescents in China's ethnic minority areas has been underexamined.

METHODS

Using two waves of data from the China Education Panel Survey (2013 and 2014), this study explored the effect of household toilet accessibility on Chinese ethnic minority adolescents' physical health. The sample consisted of 576 ethnic minority adolescents with an average age of approximately 13 years. To test the health effect of household toilet accessibility on ethnic minority adolescents, a fixed effects ordinary least squares model and difference-in-differences combined with propensity score matching method were used.

RESULTS

The results of the fixed effects model and difference-in-differences combined with propensity score matching showed a significant and positive effect of household toilet accessibility on adolescents' physical health. The heterogeneity analysis indicated that among the toilet types of soil cesspits, cement cesspits, squat toilets, and flush toilets, the flush toilets were proven to be the most efficient in improving adolescents' physical health. Moreover, the family living arrangement was proven to play a moderating role in the effect of household toilet accessibility on the physical health of ethnic minority adolescents. The average marginal effects of household toilet accessibility on the physical health of ethnic minority adolescents who lived without parents were more evident and significant than those who lived with their parents.

CONCLUSION

Promoting household toilet accessibility in China's ethnic minority areas is essential for improving adolescents' health. Moreover, having a household toilet is not sufficient, the quality and dignity of household toilets are also important.

Potential barriers in implementing the rural toilet retrofitting project: A qualitative study in Jiaozuo, China

Background

China has launched a large "toilet revolution" in rural areas, but the results show that sanitation has not always been markedly improved. Few scholars have paid attention to this issue, and the list of the reasons is scattered and incomplete.

Method

Using the qualitative research method, this study interviewed seven village cadres and 39 villagers in three villages of Jiaozuo City to examine the implementation barriers to rural toilet retrofitting (RTR) projects in China.

Results

Using the Van Meter and Van Horn policy implementation approach, the research has found that: (a) unreasonable standards and objectives fail to incorporate local conditions and improve the actual quality; (b) lack of capital and human resources cannot renovate new toilets; (c) uncoordinated inter-organizational communication and enforcement activities by top-down mechanism lead to policy implementers and target groups' dissatisfaction with the policy; (d) weak and unenthusiastic, inadequate implementing agencies, reduce their working ability; (e) inappropriate economic, social and political conditions impede the villagers' acceptance; and (f) an attitude of passive acceptance by the implementers reduce the working motivation.

Conclusion

To improve sanitation in rural China, it is necessary to solve the six barriers. The findings of this study can provide recommendations and guidance for implementing the RTR and related public health policies.