Towards safe drinking water and clean cooking for all.

Area of Science:

• Public Health
• Environmental Health
• Poverty Studies

Background:

• Decades of research highlight the importance of safe water, sanitation, and hygiene (WASH) and clean cooking fuels for health in low- and middle-income countries.
• Numerous low-cost technologies for WASH and reducing household air pollution have been developed, yet health outcomes remain disappointing.
• Poor adoption or inconsistent use of these technologies by low-income households is a significant barrier to improving public health.

Purpose of the Study:

• To argue that public health research has oversimplified the understanding of poverty.
• To emphasize the need to incorporate insights from the lived experience of poverty into the design of health interventions.
• To propose a shift from household-scale to utility-scale service models for transformative investments in WASH and clean cooking.

Main Methods:

• This viewpoint synthesizes existing research and presents a critical analysis of current public health approaches.
• It draws upon an understanding of the lived realities of poverty, including uncertainty, scarcity, and fear.
• It advocates for a re-evaluation of technology adoption barriers within the context of socioeconomic challenges.

Main Results:

• Public health researchers have historically underestimated the complexities of poverty, leading to interventions with suboptimal health outcomes.
• The lived experience of poverty significantly influences the adoption and consistent use of essential technologies like safe water and clean cooking solutions.
• Current household-scale delivery models are insufficient for achieving widespread adoption and impact.

Conclusions:

• Transformative progress in safe water and clean cooking requires utility-scale service models, not just improved household-level technologies.
• Future research and interventions must address the multifaceted nature of poverty to ensure the successful implementation of public health solutions.
• Interim solutions should be developed with a clear direction towards eventual utility-scale service models.