So Much to Keep Up With, So Much to Learn

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“Has it ever pained us that our mothers and sisters have to defecate in the open?” With these words, the new Indian Prime Minister Narendra Modi last week pushed sanitation up the hierarchy of national concerns. Using the solemn speech in the annual commemoration of the Independence Day, Modi announced a new campaign to eliminate open defecation – the practice of people relieving themselves in the open – by 150th anniversary of Gandhi’s birth in 2019.
Every year, around 2.4 million deaths worldwide (4.2% of all deaths) could be prevented if everyone practised appropriate hygiene and had good, reliable sanitation and drinking water. The majority of these deaths are children in developing countries dying from diarrhoea and subsequent malnutrition, and from other diseases attributable to malnutrition.
How is an opportunity to prevent so many deaths (and 6.6% of the global burden of disease in terms of disability-adjusted life years or DALYs failing to attract the attention of the international public health community?
Children in West Bengal and Bangladesh are presumed to share the same distribution of genetic height potential. In West Bengal they are richer, on average, and are therefore slightly taller. However, when wealth is held constant, children in Bangladesh are taller. This gap can be fully accounted for by differences in open defecation, and especially by open defecation in combination with differences in women’s status and maternal nutrition.