Improved Sanitation Increases Long-Term Cognitive Test Scores

54 Pages Posted: 12 Jul 2019 Last revised: 5 Aug 2019

Date Written: July 11, 2019


Poor sanitation has large negative impacts on environmental quality, health, and well-being. Sanitation infrastructure is particularly lacking in India, where in 2011, 66% of households did not own a toilet. Inadequate sanitation is a large contributor to diarrheal-related diseases, which cause 300,000 deaths in Indian children each year. We exploit an experimental sanitation campaign in rural Odisha, India to examine the relationship between sanitation improvements in early childhood and long-term cognitive development. We build on literature linking child health improvements to cognitive development and labor market outcomes and show that improvements in sanitation coverage can have large human capital returns. Using treatment assignment as an instrument for village latrine coverage, we find that children who belonged to a village with higher latrine coverage scored significantly higher on a cognitive test measuring analytic ability ten years later. We find that this elect is much stronger among girls than boys.

Keywords: India, sanitation, child health, human capital, cognition

Suggested Citation

Orgill-Meyer, Jennifer and Pattanayak, Subhrendu K., Improved Sanitation Increases Long-Term Cognitive Test Scores (July 11, 2019). Duke Global Working Paper Series No. 2019/07, Available at SSRN: or

Jennifer Orgill-Meyer

Franklin and Marshall College ( email )

415 Harrisburg Pike
Lancaster, PA 17603
United States

Subhrendu K. Pattanayak (Contact Author)

Duke University ( email )

100 Fuqua Drive
Durham, NC 27708-0204
United States

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