Out of the WASH box – Towards a wider contextualization of the water, sanitation, and hygiene sector

Water, sanitation, and hygiene (WASH) have perennially been recognized as a key approach to improved health in low-income areas. Whereas water sector proponents tend to emphasize it as the key approach, there are many other factors that are important and deeply interwoven with WASH. This interdisciplinary dissertation revisits this premise by attempting to provide "out-of-the-box" insight the water sector has been calling for with four contrasting studies. To generate such novel insight, we have expanded the WASH context to uncharted territory (impacts on mental health – Paper II, and functionality in new climates – Paper III). Additionally, we have turned WASH actors that are commonly research subjects (WASH professionals – Paper IV, and municipalities – Paper I) into research objects. In practice, the role of WASH was scrutinized with tools of quantitative analysis (Paper I), psychology frameworks (Paper II), empirical microbiology (Paper III), and qualitative interview analysis (Paper IV). Based on our results, the traditional thinking of the water field that adequate drinking water is the most essential need of people may be somewhat insufficient. We showed how waste management may be more strongly associated with severe diarrhea in the context of Brazil (Paper I). Moreover, if overall health equals "physical, mental, and social well-being" as defined by the WHO ever since 1948, then mental health impacts of suboptimal WASH also require attention. We found this to be essential in Paper II, especially in terms of drinking water service inequalities. Considering WASH in new contexts is also an important way to help improve health globally. The Russian full-scale war in Ukraine has made frugal point-of-use water treatment in Europe more relevant than in decades. In Paper III, we discovered that one of the most inexpensive drinking water treatment methods around, solar drinking water disinfection (SODIS), also works in cold climates and is hence a potential method for places such as Ukraine. Finally, we found that the unresearched views of WASH practitioners and innovators play significant roles in determining which WASH methods are used at a local level (Paper IV). In short, this dissertation showed how improving health especially in low- and middle-income areas would benefit from contextualizing WASH more widely than before and managing other equally important housing-related factors alongside it.