Poor sanitation remains a major challenge to rural development and human capital accumulation across many Asian countries. One of the biggest risks is the mismanagement of human waste, which leads to the contamination of drinking water and food—a key driver of infectious diseases that trap rural populations in poverty. In fact, over 80% of human infectious diseases, such as hepatitis A, diarrhea, and COVID-19, are spread through exposure to human feces.
Flush toilets offer a promising solution. Flush toilets safely contain human waste, reducing contamination and improving overall sanitation. Recognizing this, many Asian countries are working to accelerate flush toilet adoption, and progress has been made. As a result, 73% of households in the People’s Republic of China (PRC), 50% in India, and 46% in Cambodia have access to flush toilets (NBSC 2024; Tiwari et al. 2022; Yamada and Vu 2024). However, rural areas still lag behind, highlighting the urgent need for further improvements.
Benefits of Using Flush Toilets
Despite the low adoption rates, flush toilets significantly improve the quality of life in rural areas. As shown in Figure 1, they contribute to better health outcomes for rural residents, advance economic welfare, and boost well-being.
Figure 1: Flush Toilet Use and Quality of Life
Source: Authors.
Improving health outcomes
Since over 80% of human infectious diseases are spread through human waste, improving sanitation is critical (Han and He 2021; Park et al. 2021). Poor waste management can contaminate food and drinking water, leading to vomiting, diarrhea, and other health issues.
Flush toilets effectively reduce open defecation and contain human waste, preventing waterborne disease outbreaks. Research in India found that toilet upgrades reduced diarrhea cases by 30%–50%, while in Cambodia, flush toilets have significantly lowered child mortality rates linked to fecal contamination.
Advancing economic welfare
Data released by the World Health Organization suggest that about 100 billion people fall into abject poverty every year because of increasing medical expenses. This is prevalent especially in developing Asian countries like the PRC, India, and Cambodia. By reducing the spread of disease, the use of flush toilets can directly reduce rural medical expenditures and consequently advance economic welfare. In particular, they lead to less money spent on treating infectious diseases and injuries, relieving the burden of medical expenses and allowing rural residents to spend more on non-medical purchases (Li et al. 2025). Flush toilet users have even been found to have greater access to high-salary job opportunities and higher earnings (Wang and Shen 2022).
Boosting well-being
Beyond the health and economic benefits, flush toilets also improve overall well-being. Poor sanitation leads to low life satisfaction, stress, and even personal safety concerns. In rural India, for instance, open defecation negatively impacts women’s dignity and security, lowering their quality of life.
By improving sanitary conditions and reducing health risks, flush toilets contribute to greater life satisfaction and confidence among rural residents. Flush toilets can even help to strengthen rural residents’ self-affirmation and thus enhance their confidence in the future. Li et al. (2023) found that in the PRC, using flush toilets improved rural residents’ life satisfaction. Meanwhile, older adults in Thailand using flush toilets reported higher happiness levels (Pekalee and Gray 2023).
Pathways to Increasing Flush Toilet Penetration and Use
Given the clear benefits of flush toilets but low penetration levels in rural areas, efforts must continue to increase their adoption.
Raising awareness among rural residents
Many rural residents lack awareness of the health benefits of flush toilets. Long accustomed to latrines, they often see flush toilets as unnecessary luxuries rather than essential tools for disease prevention (Li et al. 2025).
Governments should actively promote the benefits of flush toilets for improving environmental quality, reducing infectious diseases, and enhancing welfare, in particular through online platforms and via smartphones and the Internet. Meanwhile, rural organizations—such as cooperatives, self-help groups, and local associations—can also play a key role in spreading awareness.
Enhancing financial support
The construction and maintenance of flush toilets are cost-intensive for rural residents. In many low-income rural areas, these costs create a major barrier to adoption.
Policymakers in Asia should introduce flush toilet-targeted subsidies and bonuses to accelerate the penetration of flush toilets. The PRC’s approach offers a useful model—it provides flush toilet construction subsidies but only after verifying that the toilet has been built, ensuring funds are used correctly (Cheng et al. 2018).
Ensuring training for proper use and maintenance
The technical and knowledge barriers to the use of flush toilets can discourage their adoption among rural residents. Government-provided training programs through home guidance and night schools are two approaches that can help. Similarly, rural residents’ organizations can play a significant role in increasing access to training. Women’s groups can also play a key role, as research shows that women are more likely to adopt and promote good sanitation habits (Basu and Maitra 2020).
With the right policies, rural Asia can achieve universal access to flush toilets—improving lives, boosting economies, and securing a healthier future for millions.
Junpeng Li acknowledges the National Natural Science Foundation of China (Grant Number: 72103075), the National Statistical Science Research Project (Grant Number: 2023LY033), and the 2024 Jiangsu Higher Education “Qinglan Project”.
References
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