(Bloomberg News) A lack of toilets costs India more than $50 billion a year, mostly through premature deaths and hygiene-related diseases, a study found.

Illness, lost productivity and other consequences of fouled water and inadequate sewage treatment trimmed 6.4% from India's gross domestic product in 2006, or the equivalent of $53.8 billion, according to the study by the World Bank's Water and Sanitation Program.

The finding suggests India bears a higher cost than other Asian countries from inadequate collection of human excreta: $48 per person, compared with $9.30 per person in Vietnam, $16.80 in the Philippines, $28.60 in Indonesia and $32.40 in Cambodia, the study's authors found. More than three-quarters of the premature mortality-related economic losses are due to deaths and diseases in children younger than 5, according to the report.

"For decades we have been aware of the significant health impacts of inadequate sanitation in India," Christopher Juan Costain, the program's team leader for South Asia, said in a statement yesterday. "This report quantifies the economic losses to India, and shows that children and poor households bear the brunt of poor sanitation."

Inadequate Sanitation

Diarrhea among children younger than 5 years accounts for more than 47% of the total health-related economic impacts, the study found. Premature mortality and other health-related impacts of inadequate sanitation were the most costly at $38.5 billion, 72% of the total economic burden, followed by productive time lost to access sanitation facilities or sites for defecation at $10.7 billion, or 20%, and drinking water-related impacts at $4.2 billion, or 7.8%.

"The cost is more than I expected," Clarissa Brocklehurst, water, sanitation and hygiene chief at the United Nations Children's Fund, said in a telephone interview from New York. "Yet, if you know the scale of open defecation in India, it's not all that surprising."

More than half of India's 1.17 billion people were mobile-phone subscribers, yet only 366 million people had access to proper sanitation in 2008, a study published in April by the United Nations University, a UN research organ, found.

Eighteen percent of India's urban population and 69% of rural dwellers defecated daily in fields, bushes, beaches and other open spaces, according to a March report by the World Health Organization and Unicef.

"It's a long hard slog to change social norms around open defecation, to create an enabling environment where everybody can buy a toilet," said Brocklehurst, who has lived and worked in New Delhi. "There is no glitzy solution."