Economic and Social Impacts on Well-Being: A Cross-National Multilevel Analysis of Determinants of Access to Water and Sanitation

Development research identifies water and sanitation access as vital indicators of well-being. Despite recent improvements, billions still lack access. Case studies and cross-national research reveal that economic and social processes are associated with water and sanitation access. However, prior research does not control for factors associated with access at multiple levels of analysis. This analysis uses hierarchical generalized linear models for 640,506 households nested within 49 nations to fill this gap. The findings suggest that household wealth and education have robust effects on water and sanitation access, while national characteristics have smaller effects. Furthermore, intraclass correlation coefficients demonstrate that cross-national analyses miss up to 78 percent of variation by not accounting for subnational variation. While the results highlight the importance of subnational factors, cross-level interactions between household wealth and education and national characteristics reveal how household wealth and education affect access differently depending on national context. This study synthesizes theories of economic growth and societal capabilities at multiple levels of analysis for understanding water and sanitation access within and between countries.