Access to safe water, sanitation, poverty and discrimination as factors in global health status and human development for VCE Health and Human Development Unit 4 AoS 1

What this dot point is asking

This key knowledge sits beside the characteristics of low-, middle- and high-income countries. The matching key skills are to analyse factors that contribute to health status and human development in different countries and to compare health data and other information to analyse reasons for health inequalities within and between countries.

The previous study design had a longer list (gender equality, education, food security, conflict, global marketing). In the 2025 design, conflict and the marketing of tobacco and processed foods now sit under global trends, and gender inequality is covered through discrimination based on sex. You can still mention education and food security, but as consequences or links in a chain that starts with one of the four named factors.

Access to safe water

The data.

Source: World Bank, World Development Indicators (WHO/UNICEF JMP data, accessed September 2026). Australia is not separately reported for safely managed water in this dataset.

• In 2024, 2.1 billion people lacked safely managed drinking water, including 106 million who still drank untreated surface water from rivers, lakes and ponds. Since 2015, 961 million people gained safely managed water (WHO/UNICEF JMP, 2025).
• At least 1.7 billion people use a drinking water source contaminated with faeces, and contaminated water is estimated to cause about 505,000 diarrhoeal deaths each year (WHO drinking-water fact sheet).
• In fragile and conflict-affected contexts, safely managed water coverage is 38 percentage points lower than in other countries (JMP, 2025).

How it affects health status. Contaminated water transmits diarrhoea, cholera, dysentery, typhoid and polio. Young children are most vulnerable because dehydration and loss of nutrients hit small bodies fastest. Diarrhoeal disease kills about 443,832 children under 5 every year and is the third leading cause of death in children aged 1 to 59 months; there are nearly 1.7 billion cases of childhood diarrhoeal disease each year, and diarrhoea is a leading cause of malnutrition in children under 5 (WHO, March 2024). The result: higher morbidity, higher under-5 mortality, higher burden of disease and lower life expectancy in low-income countries.

How it affects human development. When water is not on premises, someone has to collect it, usually women and girls. Time spent walking and queuing is time not spent at school or in paid work, which reduces access to knowledge and income. The 2025 VCAA stimulus described a mother in the Central African Republic who could only fill her 20-litre jerrycans at dawn or midday because fountains were scarce and fetching water from the bush risked armed attack: water access also affects safety and freedom of movement.

Sanitation

The data.

Source: World Bank, World Development Indicators (WHO/UNICEF JMP data, accessed September 2026).

• In 2024, 3.4 billion people lacked safely managed sanitation, including 354 million practising open defecation (in street gutters, behind bushes or into open water). Since 2015, 1.2 billion people gained safely managed sanitation (JMP, 2025).
• Open defecation rates in low-income countries remain four times the global average, and low-income countries are the only income group not on track to eliminate open defecation by 2030 (JMP, 2025).
• 1.7 billion people lacked basic hygiene services in 2024, including 611 million with no handwashing facility at all (JMP, 2025).
• Unsafe sanitation accounts for about 564,000 deaths a year, and inadequate water, sanitation and hygiene together about 1.4 million, the vast majority in low- and middle-income countries (WHO sanitation fact sheet).

How it affects health status. Faeces that are not safely contained contaminate water, soil and food. This spreads diarrhoeal disease, cholera, typhoid, intestinal worms and polio. Repeated gut infections stop children absorbing nutrients, contributing to stunting, and poor sanitation spreads antimicrobial resistance (WHO). The health status results are higher morbidity from water-borne and diarrhoeal disease, higher under-5 mortality and higher DALYs.

How it affects human development. The WHO lists anxiety, risk of sexual assault and lost opportunities for education and work as effects of poor sanitation. Girls who have no private, safe toilet at school, especially once they start menstruating, are more likely to miss school, which reduces their access to knowledge and later their income. Open defecation at night exposes women and girls to violence.

Poverty

The data.

Source: World Bank, World Development Indicators (accessed September 2026).

About one in ten people in the world still lives in extreme poverty, and food insecurity affects 2.3 billion people, still well above 2015 levels; more than 150 million children are stunted (UN, SDG Report 2026 key messages).

How poverty affects health status. Poverty works through almost every other determinant:

• Food: people cannot afford enough nutritious food, causing undernutrition, stunting, micronutrient deficiencies and weaker immunity, which raises child mortality.
• Health care: out-of-pocket payments make up 44.5 per cent of health spending in low-income countries compared with 13.4 per cent in high-income countries (World Bank, 2023), so the poorest delay or skip care, and illness can push a household deeper into poverty.
• Housing and environment: poor households are more likely to live in overcrowded or informal housing (61 per cent of the urban population in low-income countries lived in slums in 2022, World Bank) and to cook with solid fuels indoors, increasing respiratory disease.
• Water and sanitation: poor households cannot pay for piped connections or toilets.

How poverty affects human development. Extreme poverty removes choices: children leave school to work, families cannot afford uniforms or fees, and adults have little chance of a decent standard of living. The cycle runs both ways: ill health reduces the ability to work and earn, keeping families poor.

Discrimination

Discrimination is treating people unfairly because of who they are. The study design names five grounds: race, religion, sex, sexual orientation and gender identity. Discrimination affects health through access (to education, work, health care and housing), safety (violence and persecution) and stress (chronic stress and exclusion harm mental and physical health). The UN reports that one in five people worldwide still experience everyday discrimination (SDG Report 2026).

Sex. Discrimination against women and girls is the most widely measured:

• About 1 in 3 women worldwide (31.6 per cent, 840 million women and girls) have experienced physical and/or sexual violence from an intimate partner or sexual violence from a non-partner in their lifetime (WHO, June 2026).
• Girls in low-income countries are far less likely to finish school: the female primary completion rate was 61.0 per cent in low-income countries compared with 97.5 per cent in high-income countries; adult female literacy in low-income countries was 56.4 per cent against a world average of 84.6 per cent (World Bank, 2023 and 2024).
• Adolescent births, a result of early and forced marriage and limited access to contraception and education, were 90.7 per 1,000 girls aged 15 to 19 in low-income countries compared with 8.7 in high-income countries (World Bank, 2024).
• None of the gender equality targets in SDG 5 are on track (UN, 2026).

These link directly to maternal mortality, HIV/AIDS, injury and mental ill health, and to lower human development through less schooling, lower income and less say in decisions.

Race

Racism and ethnic discrimination reduce access to jobs, housing, education and culturally safe health care. In Australia, the life expectancy of Aboriginal and Torres Strait Islander people (71.9 years for males and 75.6 for females in 2020-2022) remains about 8 to 9 years below that of non-Indigenous Australians, and racism in health services is one of the barriers to care that community-controlled health services work to overcome (see Closing the Gap). Globally, ethnic minorities are more likely to live in poorer, more remote areas with fewer services.

Religion

Religious discrimination ranges from exclusion from jobs and schools to persecution and violence. When religious or ethnic groups are persecuted, people may be forced to flee, losing homes, income and access to health care, and living in crowded camps with limited water and sanitation, which increases infectious disease and trauma (see mass migration on global trends).

Sexual orientation and gender identity

In some countries same-sex relationships are criminalised; in many, LGBTIQA+ people face harassment, violence, family rejection, and discrimination in employment and health care. The 2024 examiners' report listed the benefits of reducing this discrimination: better access to education, employment and health care, freer participation in the community, reduced violence and abuse, reduced self-harm and reduced isolation. Fear of discrimination also means people delay testing and treatment (for example for HIV), which raises morbidity.

How the factors connect

The strongest answers show that the factors reinforce each other:

1. Poverty means households and governments cannot pay for piped water and sewerage, so water and sanitation access is low.
2. Poor sanitation spreads diarrhoea, which keeps children out of school and adults out of work, deepening poverty.
3. Discrimination by sex means women and girls collect water and miss school; without education and income, they are more likely to stay poor.
4. Discrimination by race or religion can exclude whole communities from water, sanitation and health services, or force them to flee.

Similarities as well as differences

The key knowledge says "similarities and differences". These factors also produce similarities:

• Within-country inequality everywhere. In high-income countries, including Australia, groups experiencing poverty or discrimination have poorer health than the national average.
• Poverty harms health in every country. The mechanism (food, housing, access to care, stress) is the same even if the scale is different.
• Discrimination on the basis of sex, race, religion, sexual orientation and gender identity occurs in all income groups, with similar effects on mental health, safety and access to services.

Command terms for this dot point

• Identify / what is (1 mark): define sanitation or name a factor. Be precise: sanitation is not hygiene.
• Explain (2 to 4 marks): factor, mechanism, health status outcome. For burden of disease questions, name DALY, YLL or YLD (2023 Q9b).
• Discuss (4 marks): for a "reducing discrimination" question, show how the reduction promotes a specific aspect of a dimension (2024 Q9b).
• Analyse (6 to 10 marks): use data from both income groups, more than one factor or characteristic, and a specific indicator with a direction (2025 Section B).

How this dot point appears in the VCE exam

• Definitions (1 mark): sanitation (2023 Q9a, 59 per cent scored zero).
• Short explanations (2 to 4 marks): water, sanitation or hygiene and burden of disease (2023 Q9b); reducing discrimination and health and wellbeing (2024 Q9b).
• Extended response (10 marks): 2025 Section B on water and sanitation (average 3.7 out of 10) and 2023 Section B on inequality and discrimination in Afghanistan and Australia (average 2.4 out of 10).