It’s complicated! That should pretty much sum up the relationship between WASH strategies and nutrition outcomes. Obviously, when there are unsafe water, pitiable and inadequate sanitation conditions with woeful hygiene practices, it will inadvertently lead to public health implications. This is especially critical when we talk about the imminent health hazards in crowded and densely populated spaces filled with the undernourished urban poor population of a low economic background.

The reason and outcome of poverty itself are mutually exclusive for undernourishment in the urban poor populations. In addition to that, undernourished people with poor health are obviously more prone and vulnerable to WASH-related infections, such as faecally transmitted infections including, but not limited to, diarrhoea, environmental enteropathy, nematode infections and other intestinal infections.

There is an active, nasty cycle of WASH-related infections and undernutrition. For instance, an undernourished person who is recently infected by diarrhoea due to poor WASH practices, will have lower stamina and strength left in his or her body, as their capacity to absorb nutrients will have reduced on their way to recovery. So in the context of the urban poor, the nutrients absorption rate or the capacity of the undernourished person to take advantage of the nutrient or calories intake is significantly reduced. With poor immunity, undernutrition and lack of access to good healthcare, they will be more susceptible to subsequent infections, and the cycle continues, adding to their cup of woes.

The impact of poor sanitation practices and the resulting diarrhoeal infections on undernourished children is much worse. It has been proven to cause growth stunting (low height-for-age), wasting (low weight-for-height), and underweight (low weight-for-age), and even child deaths. The micronutrients deficiency (in terms of vitamin A, B12, riboflavin, folic acid, iron and zinc) that is evident among children and also women, exacerbates their vulnerability to WASH-related infections. I don’t want to sound like an emissary of doomsday but other associated fallouts that dampen the functioning of the system besides malnutrition, stunting in children, premature deaths, are wasted time and loss of productivity.

So, in order to achieve a universal and sustainable outcome, it is imperative that we start to think along the lines of linking and establishing synergies between WASH plans and policies with nutrition strategies. We need to work towards demonstrating and bringing in WASH interventions by coalescing with nutrition programmes.

The key priorities would be to reduce the high malnutrition rate, address the micronutrient deficiency, improve quality, coverage and access to water, sanitation and hygiene services and practice, adopt nutrition sensitive sanitation and holistic WASH-related interventions, to improve the overall health of the populations and well, the betterment of humanity. Easier said than done, right! But in this so-called post-truth and self-awareness era, if we do our bit to instill a systematic progressive change in our midst, then we just might make a positive difference in the world.

Suneethi Sundar is a specialist, TNUSSP. This is one of a series of blog posts written by experts from the Tamil Nadu Urban Sanitation Support Programme (TNUSSP). The TNUSSP supports the Government of Tamil Nadu (GoTN) and select cities in making improvements along the entire urban sanitation value chain. The TNUSSP is being implemented by a consortium of organisations led by the Indian Institute for Human Settlements (IIHS), in association with CDD Society, Gramalaya and Keystone Foundation. You can find out more about TNUSSP at http://muzhusugadharam.co.in/tnussp/