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Abstract
Improving household health is a fundamental pillar of sustainable development, yet the transition from infrastructure provision to improved health outcomes often encounters significant structural and behavioral barriers. This study investigates the impact of housing adequacy and access to Water, Sanitation, and Hygiene (WASH) facilities on household morbidity in West Sumatra, Indonesia. Utilizing household-level microdata from the 2024 SUSENAS (National Socioeconomic Survey with a sample of 43,201, this research employs binary logistic regression to estimate the likelihood of household health complaints. The empirical findings are that housing adequacy, access to safe drinking water, and improved sanitation are significant positive determinants of household health. Conversely, the study finds that the mere physical presence of hygiene facilities and higher household expenditure are negatively associated with health status, suggesting that economic capacity alone does not guarantee well-being without corresponding health-seeking behaviors and targeted investments. Furthermore, significant rural-urban disparities and the influence of sociocultural factors, such as Minangkabau settlement patterns, highlight the complexity of the infrastructure-health nexus. These findings underscore the need for integrated, multisectoral policies that combine physical infrastructure expansion with educational interventions to promote effective hygienic practices and bridge the health-infrastructure gap in decentralized governance frameworks.
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References
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- Bhattacharjee, S., Ismail, M., & Ferdous, N. (2025). Exploring the Spatial Nexus of Wash and Child Health in Khulna using Geospatial Techniques. City and Environment Interactions, 28(October), 100256. https://doi.org/10.1016/j.cacint.2025.100256
- Biswas, S., Adhikary, M., Alam, A., Islam, N., & Roy, R. (2024). Disparities in Access to Water, Sanitation, and Hygiene (WASH) Services and the Status of SDG-6 Implementation across Districts and States in India. Heliyon, 10(18), e37646. https://doi.org/10.1016/j.heliyon.2024.e37646
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- Ulman, P., & Awiek, M. (2020). Housing Poverty in Polish Households and its Diversity. Folia Oeconomica Stetinensia, 20(1), 437–455. https://doi.org/10.2478/foli-2020-0026
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- Wolf, J., Johnston, R. B., Ambelu, A., Arnold, B. F., Bain, R., Brauer, M., Brown, J., Caruso, B. A., Clasen, T., Colford, J. M., Mills, J. E., Evans, B., Freeman, M. C., Gordon, B., Kang, G., Lanata, C. F., Medlicott, K. O., Prüss-Ustün, A., Troeger, C., Boisson, S., & Cumming, O. (2023). Burden of Disease Attributable to Unsafe Drinking Water, Sanitation, and Hygiene in Domestic Settings: A Global Analysis for Selected Adverse Health Outcomes. The Lancet, 401(10393), 2060–2071. https://doi.org/10.1016/S0140-6736(23)00458-0
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References
Abubakar, I. R. (2017). Access to Sanitation Facilities among Nigerian Households: Determinants and Sustainability Implications. Sustainability (Switzerland), 9(4), 1–17. https://doi.org/10.3390/su9040547
Agusmal, Y., Lisa, M., Hikmi, N., Irawati, S., Rizki, A., & Hijratul, D. (2025). Association of inadequate WaSH, housing , and infectious diseases with undernutrition hotspots among children under five: findings from a national survey in Indonesia. Clinical Epidemiology and Global Health, 36(August), 102211. https://doi.org/10.1016/j.cegh.2025.102211
Bentley, R., Mason, K., Jacobs, D., Blakely, T., Howden-chapman, P., Li, A., Adamkiewicz, G., & Reeves, A. (2025). Series Housing as a Determinant of Health 1 Housing as a Social Determinant of Health: A Contemporary Framework. The Lancet Public Health, 10(10), e855–e864. https://doi.org/10.1016/S2468-2667(25)00142-2
Bhattacharjee, S., Ismail, M., & Ferdous, N. (2025). Exploring the Spatial Nexus of Wash and Child Health in Khulna using Geospatial Techniques. City and Environment Interactions, 28(October), 100256. https://doi.org/10.1016/j.cacint.2025.100256
Biswas, S., Adhikary, M., Alam, A., Islam, N., & Roy, R. (2024). Disparities in Access to Water, Sanitation, and Hygiene (WASH) Services and the Status of SDG-6 Implementation across Districts and States in India. Heliyon, 10(18), e37646. https://doi.org/10.1016/j.heliyon.2024.e37646
Brown, C., Calvi, R., & Penglase, J. (2021). Sharing the Pie: An Analysis of Undernutrition and Individual Consumption in Bangladesh. Journal of Public Economics, 200, 104460. https://doi.org/10.1016/j.jpubeco.2021.104460
Brown, C., Ravallion, M., & van de Walle, D. (2023). Child health and the housing environment. World Development, 168, 106265. https://doi.org/10.1016/j.worlddev.2023.106265
Cameron, L., Chase, C., Haque, S., Joseph, G., Pinto, R., & Wang, Q. (2021). Childhood Stunting and Cognitive Effects of Water and Sanitation in Indonesia. Economics and Human Biology, 40(May 2019), 100944. https://doi.org/10.1016/j.ehb.2020.100944
De, I. (2018). Determinants of Rural Sanitation in India and Implications for Public Policy. Journal of Water Sanitation and Hygiene for Development, 8(4), 650–659. https://doi.org/10.2166/washdev.2018.038
Ghosh, P., Hossain, M., & Alam, A. (2022). Water, Sanitation, and Hygiene (WASH) Poverty in India: A District-level Geospatial Assessment. Regional Science Policy and Practice, 14(2), 396–416. https://doi.org/10.1111/rsp3.12468
Hanri, M., Dewi, C. E., & Puspita, S. D. (2025). Urgent Choices: Evaluating the Impact of Housing and Wash Programs in Indonesia. Journal of Developing Economies, 10(1), 132-150. https://doi.org/10.20473/jde.v10i1.60247
Irianti, S., & Prasetyoputra, P. (2021). Rural–urban Disparities in Access to Improved Sanitation in Indonesia: A Decomposition Approach. Sage Open, 11(3). https://doi.org/10.1177/21582440211029920
Krieger, J., & Higgins, D. L. (2002). Housing and Health: Time Again for Public Health Action. American Journal of Public Health, 92(5), 758–768. https://doi.org/10.2105/AJPH.92.5.758
Künn, S., & Palacios, J. (2024). Health Implications of Housing Retrofits: Evidence from a Population-Wide Weatherization Program. Journal of Health Economics, 98, 102936. https://doi.org/10.1016/j.jhealeco.2024.102936
Njuguna, J. (2019). Progress in Sanitation among Poor Households in Kenya: Evidence from Demographic and Health Surveys. BMC Public Health, 19(1), 1–8. https://doi.org/10.1186/s12889-019-6459-0
Okesanya, O. J., Eshun, G., Ukoaka, B. M., Manirambona, E., Olabode, O. N., Adesola, R. O., Okon, I. I., Jamil, S., Singh, A., Eliseo, D., Prisno, L., Ali, H. M., & Chowdhury, A. B. M. A. (2024). Water, Sanitation, and Hygiene (WASH) Practices in Africa: Exploring the Effects on Public Health and Sustainable Development Plans. Tropical Medicine and hEalth, 52(1), 68. https://doi.org/10.1186/s41182-024-00614-3
Osei, R. D., & Owoo, N. S. (2024). Multi-dimensional Poverty and Health Outcomes in Ghana. Social Sciences and Humanities Open, 10(October 2023), 101108. https://doi.org/10.1016/j.ssaho.2024.101108
Priyadarshini, M., & Gundimeda, H. (2025). Analyzing the Health Impact of Substandard Housing Environment and Access to Water, Sanitation and Hygiene in India. BMC Public Health, 25(1), 4181. https://doi.org/10.1186/s12889-025-25028-6
Sahiledengle, B., & Agho, K. (2021). Determinants of Childhood Diarrhea in Households with Improved Water, Sanitation, and Hygiene (WASH) in Ethiopia: Evidence from a Repeated Cross-sectional Study. Environmental Health Insights, 15, 11786302211025180. https://doi.org/10.1177/11786302211025180
Spears, D. (2020). Exposure to Open Defecation can Account for the Indian Enigma of Child Height. Journal of Development Economics, 146(July 2018), 102277. https://doi.org/10.1016/j.jdeveco.2018.08.003
Tustingi, L. S., Gething, P. W., Gibsoni, H. S., Greenwoodi, B., Knudseni, J., Lindsayi, S. W., & Bhattid, S. (2020). Housing and Child Health in Sub-Saharan Africa: A Cross-sectional Analysis. PLoS Medicine, 17(3), 1–18. https://doi.org/10.1371/JOURNAL.PMED.1003055
Ulman, P., & Awiek, M. (2020). Housing Poverty in Polish Households and its Diversity. Folia Oeconomica Stetinensia, 20(1), 437–455. https://doi.org/10.2478/foli-2020-0026
Winter, J. C., Darmstadt, G. L., & Davis, J. (2021). The Role of Piped Water Supplies in Advancing heAlth, Economic Development, and Gender Equality in Rural Communities. Social Science and Medicine, 270(January), 113599. https://doi.org/10.1016/j.socscimed.2020.113599
Wolf, J., Johnston, R. B., Ambelu, A., Arnold, B. F., Bain, R., Brauer, M., Brown, J., Caruso, B. A., Clasen, T., Colford, J. M., Mills, J. E., Evans, B., Freeman, M. C., Gordon, B., Kang, G., Lanata, C. F., Medlicott, K. O., Prüss-Ustün, A., Troeger, C., Boisson, S., & Cumming, O. (2023). Burden of Disease Attributable to Unsafe Drinking Water, Sanitation, and Hygiene in Domestic Settings: A Global Analysis for Selected Adverse Health Outcomes. The Lancet, 401(10393), 2060–2071. https://doi.org/10.1016/S0140-6736(23)00458-0
World Health Organization. (2020). WHO Global Strategy on Health, Environment and Climate Change: The Transformation Needed to Improve Lives and Well-being. World Health Organization. https://www.who.int/publications/i/item/9789240000377
Yan, H., Gallant, A. J., Delahunty-pike, A., Langley, J. E., Zsager, A., Abaga, E., Ziegler, C., Karabanow, J., Hwang, S. W., & Pinto, A. D. (2025). Social Science & Medicine Addressing Housing Insecurity as A Social Determinant of Health: A Systematic Review of Interventions in Healthcare Settings. Social Science & Medicine, 384(August), 118557. https://doi.org/10.1016/j.socscimed.2025.118557
