research paper on sustainable development in india

Overview of Sustainable Development Initiatives in India

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• Shekhar Vishnu Nagargoje 12 ,
• Deva Dutta Dubey 12 ,
• Pradeep Rajanna Hampannaver 12 &
• Sanjay Govind Patil 12  

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According to UN estimates, by 2050, about 70% of the world's population will live in cities, making cities the primary source of more than 80% of all greenhouse gas (GHG) emissions, with transportation accounting for 25% of these emissions, the built environment for 32%, and municipal solid waste for 5%. These factors lead to climate change and environmental degradation further adding pressure on city infrastructure such as urban water supply, sewage, solid waste management, and urban heat island effects, among others. This paper presents an overview of Critical Aspects of Sustainable Cities and Government Initiatives for Sustainable Development in India.

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Shekhar Vishnu Nagargoje, Deva Dutta Dubey, Pradeep Rajanna Hampannaver & Sanjay Govind Patil

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Nagargoje, S.V., Dubey, D.D., Hampannaver, P.R., Patil, S.G. (2024). Overview of Sustainable Development Initiatives in India. In: Bajaj, D., Gajendran, T., Patil, S. (eds) Sustainable Built Environment. ICSBE 2023. Lecture Notes in Civil Engineering, vol 451. Springer, Singapore. https://doi.org/10.1007/978-981-99-8842-6_8

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India's achievement towards sustainable Development Goal 6 (Ensure availability and sustainable management of water and sanitation for all) in the 2030 Agenda

• Sourav Biswas   ORCID: orcid.org/0000-0002-2715-2704 1 ,
• Biswajit Dandapat 2 ,
• Asraful Alam 3 &
• Lakshminarayan Satpati 4  

BMC Public Health volume  22 , Article number:  2142 ( 2022 ) Cite this article

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Clean water and sanitation are global public health issues. Safe drinking water and sanitation are essential, especially for children, to prevent acute and chronic illness death and sustain a healthy life. The UN General Assembly announced the 17 Sustainable Development Goals (SDGs) and 169 targets for the 2030 Agenda on 25 September 2015. SDG 6 is very important because it affects other SDG (1, 2,3,5,11,14 and 15). The present study deals with the national and state-wise analysis of the current status and to access deficiency of India's achievement towards SDG 6 (clean water and sanitation for all) for the 2030 agenda based on targets 6.1, 6.2,6.4,6.6 from 2012 to 2020.

Materials and methods

Data of different indicators of SDG 6 are collected from different secondary sources—NSS 69th (2012) and 76th (2018) round; CGWB annual report 2016–2017 and 2018-2019; NARSS (2019–2020); SBM-Grameen (2020). To understand overall achievement towards SDG 6 in the 2030 agenda, the goal score (arithmetic mean of normalised value) has been calculated.

Major findings

According to NSS data, 88.7% of Indian households had enough drinking water from primary drinking water sources throughout the year, while 79.8% of households had access to toilet facilities in 2018. As per the 2019–2021 goal score for States and UTs in rural India based on SDG 6 indicator, SDG 6 achiever States and UTs (100%) are Sikkim, Himachal Pradesh, Andaman and Nicobar Islands.

Drinking water and sanitation for all ensure a healthy life. It is a matter of concern for the government, policymakers, and people to improve the condition where the goal score and indicator value of SDG 6 are low.

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Clean Water and sanitation are global public health issues. "Water collected from sources like—piped water into dwelling, piped water into yard/plot, household connection, public standpipes/tap, boreholes/tube well, protected dug wells, protected springs and rainwater collection and bottled water are considered as improved sources of drinking water. Drinking water collected from improved sources located on-premises, available when needed and free from faecal and contamination is known as safely managed drinking water" [ 1 ]. "Hygiene refers to conditions and practices that help maintain health and prevent the spread of diseases” [ 2 ]. Water, sanitation and hygiene are known as WASH. WASH includes the use of safe drinking water; safe disposal and management of human faecal matter, human waste (solid and liquid). Open defecation is much more common in rural India than in urban India. About 70% of the Indian population lives in rural areas. In fact, 89% of households without toilets were in rural areas, according to the 2011 census. Although the Indian government has spent decades building latrines and the country has had consistent economic progress, rural open defecation statistics have remained stubbornly high [ 3 ].Control of vector-borne diseases, handwashing practices. Open Defecation Free (ODF) is the termination of faecal-oral transmission in an open space or ending open defecation using a toilet. India has progressed in access to safe drinking water (tap/hand-pump/tube well) in the household from 38% in 1981 to 85.5% in 2011. Water, sanitation, and hygiene-related diseases are Infectious Diarrhoea, Typhoid and paratyphoid fevers, Acute hepatitis A, Acute hepatitis E and future F, Fluorosis, Arsenosis, Legionellosis, Methamoglobinamia, Schistosomiasis, Trachomaa, Ascariasis, Trichuriasis, Hookworm, Dracunculiasis, Scabies, Dengue, Filariasis, Malaria, Japanese encephalitis, Leishmaniasis, Onchocerciasisa, Yellow fever, Impetigo and Drowning [ 4 ]. The United Nations General Assembly declared 2008 the International Year of Sanitation to recognise the critical need for increased political awareness and action on sanitation. The purpose is to promote awareness and speed up progress toward the Millennium Development Goal of decreasing the proportion of people without access to basic sanitation by 2015. Due to poor sanitation, people suffer from bad health, lost income, inconvenience, and indignity. Despite this, billions of people worldwide do not have access to basic sanitation [ 4 , 5 ]. According to WHO (2015), 2.4 billion people lack sanitation facilities, and 663 million people still lack access to safe and clean drinking water facilities [ 6 ]. WHO (2019) state that 3.3% of global death and 4.6% of DALYs is attributed to inadequate water, sanitation and hygiene condition. "Unsafe sanitation is responsible for 775,000 deaths per year, 5% death in low-income countries due to unsafe sanitation, 15% of the world still practising open defecation [ 7 ]. "Age-standardized death rate attributable to unsafe water, sanitation, and hygiene (WaSH) (per 100,000 population) 268.587 in 1990, 239.719 in 1995, 210.642 in 2000, 180.757 in 2005, 143.453 in 2010 and 104.202 in 2016″ [ 7 ]. So safe drinking water and sanitation are essential, especially for children, to prevent acute and chronic illness death and sustain a healthy life. After the Millennium Development goal, on 25 September 2015, in UN general assembly 17th sustainable development goal (SDG) and 169 targets set up for 2030 agenda [ 8 , 9 ]. "SDG 6 is essential because it affects other SDG (1 – poverty eradication, 2 – ending hunger, 3 – healthy life and well–being, 4 – quality education, 5 – gender equality, 11 – inclusive cities, 14 – life below water and 15 – terrestrial ecosystem)" [ 10 ]. The present study deals with the national and state-wise analysis of current status and to access deficiency of India's Achievement towards SDG 6 (clean water and sanitation for all) for the 2030 agenda based on targets 6.1, 6.2, 6.4, 6.6 from 2012 to 2020. In this study, special focus is given to rural India.

Census of India continuously collecting data about drinking water and sanitation from all households in house listing and housing. “The National Statistical Office (NSO) Ministry of Statistics and Programme Implementation” (MOSPI), Government of India has been collecting data on housing condition, drinking water, sanitation and hygiene; those were collected by NSO from NSS 7th round (October 1953—March 1954) to NSS 23rd round (July 1968—June 1969), 28th round (October 1973—June 1974), 44th round (July 1988—June 1989), 49th round (January—June 1993), 54th round (January—June 1998) 58th round (July—December 2002), 65th round (July 2008—June 2009), 69th round (July—December 2012), and latest NSS 76th round. The Indian government has undertaken attempts to enhance drinking water and sanitation.

1949: The Environment Hygiene Committee advises that a clean water supply be provided to 90% of India's population within a 40-year timeframe.

1969: The National Rural Drinking Water Supply Program was initiated with UNICEF's technical assistance, and Rs.254.90 crore is spent on 1.2 million bore wells and 17,000 piped water supply systems during this phase.

In 1972–73, the Government of India launched the Accelerated Rural Water Supply Programme (ARWSP) to assist states and union territories in expanding drinking water supply coverage.

1986: The National Drinking Water Mission (NDWM) was established. The National Drinking Water Mission was renamed the Rajiv Gandhi National Drinking Water Mission in 1991 (RGNDWM). The 73rd Constitutional Amendment mandates the provision of drinking water by Panchayati Raj institutions (PRIs).

In 1986, the Central Rural Sanitation Programme (CRSP) was established to provide safe sanitation in rural regions. The Total Sanitation Campaign (TSC) was launched in 1999 to promote local sanitary marts and various technical choices to develop supply-led sanitation.

1999: The Total Sanitation Campaign (TSC) was launched in 1999 as part of the reform principles to provide sanitation facilities in rural regions to eliminate open defecation. Swajal Dhara, a national scale-up of sector reform, was launched in 2002. All drinking water programmers were placed under the RGNDWM's umbrella in 2004.

2005: The Indian government begins the Bharat Nirman Programme, aiming to improve housing, roads, power, telephone, irrigation, and drinking water infrastructure in rural regions [ 11 ].

In 2009, the ARWSP was renamed the National Rural Drinking Water Programme (NRDWP). One of the goals was to allow all households, to the extent practicable, to have access to and utilise safe and adequate drinking water inside the premises.

In 2012, The Nirmal Bharat Abhiyan was reformed and renamed (rural sanitation).

The Swachh Bharat Mission was launched across the country on 2 October 2014 to achieve the objective of a clean India by 2 October 2019. (PM India).

The current National Rural Drinking Water Programme (NRDWP) was reformed and incorporated under Jal Jeevan Mission (JJM) on 15 August 2019 to provide Functional Household Tap Connection (FHTC) to every rural household, i.e. Har Ghar Nal Se Jal (HGNSJ) by 2024. Jal Jeevan Mission (JJM) is a non-profit organisation.

The goals of SBM(Gmain) are to enhance the general quality of life in rural areas by fostering cleanliness, hygiene, and the elimination of open defecation. The Individual Household Latrines (IHHL) unit cost was increased from Rs. 10,000 to Rs. 12,000 rupees to accommodate for water availability. To meet the Swachh Bharat aim, improve rural sanitation coverage by 2 October 2019. Raising awareness and providing health education encourages communities and Panchayati Raj institutions to adopt sustainable sanitation practices and infrastructure. Encourage the use of cost-effective and suitable sanitation methods that are environmentally safe and long-lasting. Develop community-managed sanitation systems in rural regions, concentrating on scientific Solid and Liquid Waste Management systems for overall cleanliness [ 11 , 12 ].

In New York in 2000, 189 nations approved the Millennium Declaration for 2015, promising to work together to create a safer, more prosperous, and equal world. There are eight objectives, seven of which deal with sanitation and hygiene (target 7. C – Reduce the share of the population without sustainable access to clean drinking water and basic sanitation by 2015). (Millennium Development Goal of the United Nations) Following the millennium development goal (SDG), the United Nations General Assembly approved 17 sustainable development goals and 169 targets for the 2030 Agenda for Sustainable Development on 25 September 2015. Out of 17 SDGs, SDG 6 ensures availability and sustainable water and sanitation management. SDG 6 has different target for the year 2030—6.1: Achieve universal and equitable access to safe and affordable drinking water for all; 6.2: Achieve access to adequate and equitable sanitation and hygiene for all and end open defecation, paying particular attention to the needs of women and girls and those in vulnerable situations; 6.3: Improve water quality by reducing pollution, eliminating dumping and minimizing release of hazardous chemicals and materials, halving the proportion of untreated wastewater and substantially increasing recycling and safe reuse globally; 6.4: By 2030, substantially increase water-use efficiency across all sectors and ensure sustainable withdrawals and supply of freshwater to address water scarcity and substantially reduce the number of people suffering from water scarcity; 6.5: Implement integrated water resources management at all levels, including through transboundary cooperation as appropriate; 6.6: Protect and restore water-related ecosystems, including mountains, forests, wetlands, rivers, aquifers and lakes; 6.a: Expand international cooperation and capacitybuilding support to developing countries in water- and sanitation-related activities and programmes, including water harvesting, desalination, water efficiency, wastewater treatment, recycling and reuse technologies; 6.b: Support and strengthen the participation of local communities in improving water and sanitation management [ 8 ].

As the nodal institution for SDGs, NITI Aayog, the Government of India has striven to provide the necessary encouragement and support to forge collaborative momentum among them. Since 2018, the SDG India Index & Dashboard has worked as a powerful tool to bring SDGs clearly and firmly into the policy arena in our States and UTs [ 13 ]. Ministry of Statistics and Programme Implementation (MoSPI), Government of India developed a National Indicator Framework (NIF), which is the backbone for facilitating monitoring of SDGs at the national level and provides appropriate direction to the policymakers and the implementing agencies of various schemes and programmes [ 14 ].

The main objective of this study is to find out the status of SDG target 6.1, 6.2, 6.4 and 6. towards the achievement of SDG 6 in the 2030 agenda in India (National and State level) and to assess deficiency towards the Achievement of clean Water and sanitation for all in 2030 agenda India (National and State level).

The present study is based on seven indicators of SDG 6;

a: those are % population having improved source of drinking water- SDG 6.1,

b: % of individual household toilets constructed against target (SBM(G))- SDG 6.2,

c: % of districts verified to be ODF (SBM(G))- SDG 6.2,

d: % of school has a separate toilet for boys and girls- SDG 6.2,

e: % of households having safe disposal of liquid waste- SDG 6.a,

f: % of blocks/ mandals / taluka having safe groundwater extraction—SDG 6.4, and.

g: % of blocks/ mandals / taluka over-exploited- SDG 6.4. Data of those indicators are collected from the following secondary sources:

The present study is based on percentage distribution, normalization and arithmetic mean methods. The percentage of groundwater extraction from extractable groundwater resource annually is calculated by the formula: \(\left(\frac{\mathrm{total}\;\mathrm{annual}\;\mathrm{groundwater}\;\mathrm{extraction}}{\mathrm{annual}\;\mathrm{extractable}\;\mathrm{groundwater}\;\mathrm{resource}}\times100\right)\%\) . And goal score for SDG 6 indicators is calculated by target setting, followed by normalizing the raw data of indicator arithmetic mean of the normalizing value of indicators. The methodology of goal score calculation was developed by the Ministry of Statistics and Programme Implementation (MoSPI) in 2019. The target of those indicators was set by United Nations at the global level. The national target value for indicator a:100%, b:100%, c:100%, d:100%, e:100%, f:100% and g:0%. The next step is normalizing the raw data. It is important to maintain a standard indicator value between 0 and 100. An indicator higher value = lower performance, following formula, was used – the normalized value of an indicator \(({N}_{V})=\left(1-\frac{\mathrm{Actual }\;\mathrm{value}\;\mathrm{of}\;\mathrm{an}\;\mathrm{indicator}\;\left(\mathrm i\right)-\mathrm{target}\;\mathrm{value}\;\mathrm{of}\;\mathrm{the}\;\mathrm{indicator}\;(\mathrm i)}{\mathrm{maximum}\;\mathrm{value}\;\mathrm{of}\;\mathrm{the}\;\mathrm{indicator}(i)-\mathrm{Target}\;\mathrm{value}\;\mathrm{of}\;\mathrm{the}\;\mathrm{indicator}\;\left(\mathrm i\right)}\right) \times100\) . Normalization does not require for indicators a, b, c, d, e & f because values of that indicator are already in percentage and g have been done using the above formula. The goal score for all indicators of SDG 6 for each state and UTs have been done by the arithmetic mean of normalized value, using the following formula- Goal score of indicator(GSI) = ( \({\sum }_{i=1}^{Ni}Nv\) and \(Av\) × \(\frac{1}{\mathrm{Ni}}\) ). Whereas Ni means = the number of non-null indicators and \(Nv\) means the normalized value of the indicator and Av means the actual value of the indicator.

Result and Discussion

Result of households having access to Drinking Water (SDG 6.1) in India (National level and state level) as per National Sample Survey (NSS) data. Figure  1 depicts the sources of safe drinking from households accessing the drinking water throughout the year.

Percentage of households with access to principle sources of safe drinking water in India with resident type, 2018. Source: NSS 76th round (July—December 2018), graph prepared by the author. Notes: 0.0% indicate the least or negligible Percentage of household

In India 2018, most of household collect safe drinking water from hand pump (30.5%) followed by piped water into dwelling (21.4%), piped water to yard / plot (12.3%), tube well (10.7%), public tap / standpipe (9.2%), bottled water (6.8%), protected well (2.5%), piped water from neighbour (1.0%), private tanker truck (0.4%), public tanker truck (0.3%), protected spring (0.2%) and rainwater collection (0.2%). In urban areas, a higher percentage of households use piped water into the dwelling (40.9%), piped water into yard/plot (16.0%), bottled water (12.2%), public tanker truck (0.8%), private tanker track (0.5%) than a rural area. In rural area higher percentage of household using hand pump (42.9%), tube well (10.9%), public tap / standpipe (10.3%), protected well (2.9%), protected spring (0.3%) and rainwater collection (0.2%) [ 14 ].

"Bottled water, piped water into dwelling, piped water to yard/plot, public tap/standpipe, tube well/borehole, protected well, protected spring and rainwater collection are considered as improved sources of drinking water" [ 15 ]. As of 2018, 88.7% of households have access to drinking water from principal drinking water sources throughout the year, but 95.5% of household’s access improved drinking water sources in India. In contrast, the urban area has a higher percentage of access to principle (90.9%) and improved (97.4%) drinking water sources throughout the year than the rural area 87.6% and 94.5%, respectively. In India, 1.7% of principle sources and 4.9% improved drinking water sources increased from 2012 to 2018. As of 2018, 11.3% of households have a deficit in case of access principle sources of drinking water, and 4.5% of households have an obligation in case of access to improved sources of drinking water throughout the year for achieving safe and affordable drinking water for all (SDG 6.1) in 2030 agenda. Table 1 showing the percentage of households with access and deficit to drinking water with resident type in India.

From Fig.  2 , we can say the performance of states and UTs in India towards the Achievement of SDG 6 of target SDG 6.1 by using the percentage of households having access to improved sources of drinking water indicator. As per 2018, SDG 6.1 target achiever ( 100%) states and UTs are Chandigarh, Daman and Diu, Sikkim; Front Runner (65%– 99%) States and UTs are Bihar, Haryana, Punjab, Delhi, Goa, Tamil Nadu, Dadra and Nagar Haveli, Puducherry, Group of UTs, Uttar Pradesh, Gujarat, Telangana, Arunachal Pradesh, West Bengal, Andaman and Nicober Islands, Himachal Pradesh, Andhra Pradesh, Uttarakhand, Mizoram, Maharashtra, Karnataka, Chhattisgarh, Rajasthan, Madhya Pradesh, Assam, Odisha, Jammu and Kashmir, Meghalaya, Jharkhand, Group of NE States, Tripura, Nagaland, Lakshadweep and Manipur; performer state (50%—64%) in Kerala. Kerala has lower access to improved safe drinking water sources. Deficit of performance to achieve SDG 6.1 target based on the above indicator for states and UTs in India are Bihar 0.1%, Haryana 0.1%, Punjab 0.1%, Delhi 0.2%, Goa 0.2%, Tamil Nadu 0.2%, Dadra and Nagar Haveli 0.4%, Puducherry 0.6%, Group of UTs 0.7%, Uttar Pradesh 0.8%, Gujarat 0.9%, Telangana 0.9%, Arunachal Pradesh 1.2%, West Bengal 1.8%, Andaman and Nicober Islands 1.9%, Himachal Pradesh 1.9%, Andhra Pradesh 2.6%, Uttarakhand 2.8%, Mizoram 3.7%, Maharashtra 3.8%, Karnataka 4.6%, Chhattisgarh 4.8%, Rajasthan 7.4%, Madhya Pradesh 8.5%, Assam 8.6%, Odisha 8.8%, Jammu and Kashmir 9.1%, Meghalaya 9.1%, Jharkhand 12%, Tripura 12.2%, Nagaland 15.5%, Lakshadweep 24.1%, Manipur 25.1% and Kerala 43.3%. Although Kerala has a higher socio-economic development performance, Kerala faces a water crisis. "Urbanisation, modernisation, increasing material prosperity, the disintegration of traditional joint family structure, pressure on land, replacing open dug well with bore well, overexploitation of groundwater contribution to the water crisis in Kerala" [ 16 ]. "Kerala received 80% less rainfall than normal after a flood. So more dry spells and drops in groundwater levels are one of the reasons for the water crisis." (V P Dineshan). In terms of households having toilet facilities, all northeastern states exceed the national average. However, except with Arunachal Pradesh and Sikkim, all northeastern states are below the national average regarding access to improved drinking water sources.

Percentage of households having access to improved sources of drinking water in states & UTs in India, 2018. Source: NSS 76th round (July—December 2018), graph prepared by the author

Similarly, the percentage of villages in Arunachal Pradesh, Assam, Manipur and Meghalaya where the “Village Health and Sanitation Committee” exist is less than the national figure. Efforts should be made to form a "Village Health and Sanitation Committee" in an increasing number of villages. Financial assistance should promote family toilets and provide safe drinking water [ 17 ].

Result of households having access to latrine facility (SDG 6.2) in India (National level and state level) as per National Sample Survey (NSS) data.

As per 2018, in India, 79.8% of households have access to latrine facilities, whereas urban area has a higher percentage of household having access to latrine facility (96.2%), than rural areas (40.6%) given in the Fig.  3 . From 2012 to 2018, India had a 23.2% improvement in accessing latrine facilities, where the urban area has 5%, and the rural area has 30.7% improvement. As of 2018, in India, 20.2% of households have a deficit in accessing latrine facilities towards achieving SDG 6.2 in 2030, whereas in an urban area, it is a low deficit (3.8%) and in rural areas, it is a higher deficit  (28.7%).

Percentage of households having access to latrine facility with resident type, 2012 & 2018. Sources: NSS 76th round (July—December 2018) & 69th round (July—December 2012), graph prepared by the author

As per NSS 76th round, it is seen that in 2018 in India, 2.8% of the population never used a toilet. Although households have latrine facilities, it is higher in rural areas at 3.5% and lowers in an urban area at 1.7%. The various reasons behind not using the toilet are that 2.8% there is no superstructure, 8.2% impure unclear and insufficient water, 3% malfunctioning of the latrine, 0.5% deficiency of latrines, 1.3% lack of safety, 6.3% personal preference, 0.6% cannot bear the charge of the paid latrine, and another reason is 76.9%. It is also observed that the female population uses toilets more than the male population. 74.1% of households washed their hands with water and soap/detergent, and 13.4% washed their hands with water only after defecation [ 14 ]. Infrastructure is inadequate in the rural sanitation sector that must be addressed through immediate legislative reforms and government subsidies to develop appropriate and adequate facilities [ 18 ].

Figure  4 showing the Percentage of households having access to latrine facilities. A higher percentage of households having access to latrine facilities is found in Manipur, Mizoram, Nagaland, Sikkim, Lakshadweep, etc. A lower percentage of households below the national level are found in Odisha, Uttar Pradesh, Jharkhand, Bihar, Rajasthan, Madhya Pradesh and Tamil Nadu. Inadequacies in rural infrastructure are undoubtedly a significant source of the 'failure.' It has multiple causes, which can be baffling at times. Government-subsidized latrines in rural areas are often inappropriate, especially for women, due to a lack of roofs, doors, walls, buried pits, and adequate spatial dimensions, each of which depends on the convenience of latrine usage and, more crucially, privacy [ 18 ]. Performance of states and UTs in India towards the Achievement of SDG 6 of target SDG 6.2 by using the percentage of households having access to latrine facility indicator.

Percentage of households having access to latrine facilities in states & UTs in India, 2018. Source:NSS 76th round (July—December 2018), graph prepared by the author

As per 2018, SDG 6.2 target achiever (100%) states and UTs are Manipur, Mizoram, Nagaland, Sikkim, Chandigarh and Lakshadweep; front runner ( 65%– 99%) states and UTs are Daman and Diu, Kerala, Delhi, Tripura, Meghalaya, Uttarakhand, Assam, Himachal Pradesh, Haryana, Andaman and Nicober Islands, Punjab, Goa, Chhattisgarh, Dadra and Nagar Haveli, Jammu and Kashmir, West Bengal, Arunachal Pradesh, Puducherry, Telangana, Maharashtra, Gujarat, Andhra Pradesh, Karnataka, Tamil Nadu, Madhya Pradesh, Rajasthan, Bihar and Jharkhand; performer (50% to 64%) states are Uttar Pradesh and Odisha. As per 2018, deficit of performance towards achievement of SDG 6.2 target in 2030 agenda in States and UTs in India are Daman and Diu 0.1%, Kerala 0.2%, Delhi 0.5%, Tripura 0.6%, Meghalaya 1.5%, Uttarakhand 2.1%, Assam 2.2%, Himachal Pradesh 2.6%, Haryana 2.7%, Andaman and Nicober Islands 3.4%, Punjab 3.9%, Goa 7%, Chhattisgarh 7.4%, Dadra and Nagar Haveli 7.7%, Jammu and Kashmir 11.7%, West Bengal 11.9%, Arunachal Pradesh 12%, Puducherry 12.5%, Telangana 12.7%, Maharashtra 12.8%, Gujarat 14.2%, Andhra Pradesh 16%, Karnataka 18.5%, Tamil Nadu 21.5%, Madhya Pradesh 22.5%, Rajasthan 26.3%, Bihar 32.8%, Jharkhand 33.6%, Uttar Pradesh 37.7% and Odisha 45.1%. The result of the Percentage of blocks/mandals/talisie safe extraction of groundwater (SDG 6.4 and 6.6) in India (National level and state level) as per NSS 76 th round data. Infections and illnesses tend to be exacerbated by a lack of latrine facilities. Women and girls are usually disadvantaged due to several socio-cultural and economic factors that deny them equal rights with males. They have distinct physical needs from males, but they also have a greater need for privacy and safety regarding personal cleanliness. Actions such as going long distances in search of a good defecation site and carrying water are a sign of added load, which may be physically unpleasant and hard for women, particularly pregnant women [ 19 ].

Figure  5 showing the Percentage of blocks/mandals/talisie safe extraction of groundwater. As per 2017, the performance of States and UTs in India towards the Achievement of SDG 6.4 and 6.6 in 2030 agenda based on indicator percentage of blocks/mandals/taluka are safe extraction of groundwater (groundwater extraction does not exceed the total annual groundwater recharge, which is below 70% extraction) shows achiever (100%) States and UTs are Arunachal Pradesh, Assam, Goa, Jammu and Kashmir, Manipur, Meghalaya, Mizoram, Nagaland, Sikkim, Tripura, Dadra and Nagar Haveli; Front Runner (65%-99%) are Andaman and Nicobar Islands, Odisha, Jharkhand, Total UT's, Chhattisgarh, Bihar, Gujarat, Kerala, Madhya Pradesh, Maharashtra, Andhra Pradesh, Uttarakhand, West Bengal, Lakshadweep, Uttar Pradesh; performer (50%-64%) are India, Karnataka, Daman and Diu, Puducherry; aspirant (0%-49%) are Telangana, Himachal Pradesh, Tamil Nadu, Haryana, Punjab, Rajasthan, Delhi and Chandigarh. InIndia 63% blocks/mandals/taluka are safe extraction of groundwater.

Percentage of blocks/mandals/taluka are safe extraction of groundwater in States & UTs in India,2017. Source: CGWB annual report 2019–2020, graph prepared by the author

Result of the percentage of groundwater extraction (SDG 6.4) in India (National level and state level) as per 2017:

As per the "National Compilation on Dynamic Ground Water Resources of India (2017)" report by the CGWB, groundwater extraction below 70 per cent is considered a Safe extraction. Over extraction of groundwater annually (groundwater extraction exceed extractable groundwater annually) is found in Punjab (165.80%), Rajasthan (139.87%), Haryana (136.91%) and Delhi (120.00%); safe groundwater extraction is found in Karnataka, Telangana, Gujarat, India, Uttarakhand, Madhya Pradesh, Maharashtra, Kerala, Daman and Diu, Lakshadweep, Bihar, West Bengal, Chhattisgarh, Andhra Pradesh, Odisha, Goa, Jammu and Kashmir, Ladakh, Dadra and Nagar Haveli, Jharkhand, Assam, Tripura, Mizoram, Andaman and Nicobar Islands, Manipur, Meghalaya, Nagaland, Arunachal Pradesh and Sikkim. In India, 63.33% of groundwater is extracted annually as per 2017. The States and UTs with safe groundwater extraction achieve the SDG 6.4 target based on the indicator – the annual percentage of groundwater extraction from extractable groundwater resources. Figure  6 showing the Percentage of groundwater extraction from extractable groundwater resource annually in States and UTs.

Percentage of groundwater extraction from extractable groundwater resource annually in States & UTs in India,2017. Source: CGWB annual report 2019–2020, graph prepared by the author

"In India as per 2017 Total Annual Groundwater Recharge is 431.86 billion cubic meters (bcm) out of which Annual Extractable Ground Water Resource is 392.7 bcm and Current Annual Ground Water Extraction is 248. 7 bcm" (CGWB annual report 2019–2020).

Result of the overall performance of SDG 6 in India (National level and state level) 2019 – 2021.

Table 2 shows the achievements towards SDG 6 of all States and UTs. Overall goal score of the indicator—Percentage of the rural population having improved source of drinking water (SDG 6.1), percentage of individual household toilets constructed against target (SBM(G)) (SDG 6.2), percentage of districts verified to be ODF (SBM(G)) (SDG 6.2), the school has a separate toilet for boys and girl (%) ( SDG 6.2), percentage of Household Safe Disposal of Liquid waste (SDG 6.a), percentage of blocks/ mandals/ taluka having safe groundwater extraction (SDG 6.4) and percentage of blocks/ mandals/ taluka over-exploited (6.4) reveal that states and UTs belonging in achiever stage are Chandigarh, Dadra & Nagar Haveli, Ladakh, Lakshadweep, Sikkim and Goa. The states and UTs belonging to front runner stage (66–99%) are Mizoram, Andaman & Nicobar Islands, Jharkhand, Odisha, Kerala, Gujarat, Chhattisgarh, Jammu & Kashmir, Meghalaya, Arunachal Pradesh, Maharashtra, Uttarakhand, Assam, West Bengal, Nagaland, Tripura, Bihar, Andhra Pradesh, Madhya Pradesh, Uttar Pradesh, Daman and Diu, Puducherry, Telangana, Karnataka, Manipur, Tamil Nadu, Himachal Pradesh, Haryana, Rajasthan and Punjab. Delhi is the only Union Territory belonging to the aspirant stage.

As per January 2021, the performance of States and UTs in Rural towards Achievement of SDG 6.1 based on indicator Percentage of the rural population having improved source of drinking water shows achiever States and UTs are; Ladakh, Sikkim, Goa, Mizoram, Andaman & Nicobar Islands, Gujarat, Meghalaya, Nagaland, Telangana, Karnataka, Manipur and Himachal Pradesh; front runner are Jammu & Kashmir, Andhra Pradesh, Jharkhand, Madhya Pradesh, Haryana, Chhattisgarh, Uttar Pradesh, Kerala, Tamil Nadu, Uttarakhand, Odisha, Bihar, Puducherry, West Bengal, Arunachal Pradesh, Punjab, Rajasthan, Maharashtra, Tripura and Assam.

From Fig.  7 , we can see that most of the states and union territories belong to the green colour shade. That means all these states and union territories are in the Front Runner (65–99%) stage as per the Goal Score Indicator (GSI). Andaman & Nicobar Islands, Chandigarh, Dadra & Nagar Haveli, Ladakh, Lakshadweep, Sikkim and Goa are all states and Union Territories observing blue colour shade, indicating that all these states and union territories have reached the achiever stage as per the Goal Score Indicator (GSI). Delhi is the only union territory where orange colour is observed, indicating that the union territory is still at the performer (50–64%) stage.

Overall performance of different indicators of SDG 6 (Goal score of the indicator). Sources: Department of Drinking Water and Sanitation, Ministry of Jal Shakti, January 2021; Swachh Bharat Mission Gramin Dashboard,2020; NARSS round 3, 2019–2020; map prepared by the author

Figure  8 shows the spatial distribution of households having access to improved sources of drinking water and Fig.  9 shows the spatial distribution of households having access to latrine facilities in States and UTs in India.

Spatial distribution of households having access to improved sources of drinking water (%) in states & UTs in India, 2018. Source: NSS 76th round (July—December 2018), map prepared by the author

Spatial distribution of households having access to latrine facility (%) in states & UTs in India, 2018. Source: NSS 76th round (July—December 2018), map prepared by the author

From Fig.  8 , light green indicates states and union territories with 95–99% coverage of improved drinking water sources. Moreover, deep green indicates those states and union territories with more than 99% coverage of improved drinking water sources. The red colour indicates below 90% coverage of improved drinking water sources. Furthermore, orange indicates those states and union territories with 90–95% coverage of improved drinking water sources. All South Indian states except Kerala fall into more than 95% coverage of improved drinking water sources. Almost all States and Union Territories above and near the Tropic of Cancer have < 95% coverage of Improved Sources of Drinking Water except Chhattisgarh and Gujarat. Almost all states of North India except Jammu and Kashmir have more than 95% coverage of improved drinking water sources.

From Fig.  9 , light green indicates states and union territories with 80–90% coverage of access to latrine facilities. Moreover, deep green indicates those states and union territories with 90–100% coverage of access to latrine facilities. The red indicates below 50–60% coverage of access to latrine facilities. Furthermore, pink indicates those states and union territories with 60–70% coverage of access to latrine facilities. Whitish Grey indicates states and union territories with 70–80% coverage of access to latrine facilities. Delhi, Uttar Pradesh, Bihar, Jharkhand, and Odisha fall into less than 70% coverage of access to latrine facilities. Rajasthan, Madhya Pradesh and Tamil Nadu are found to have 70–80% coverage of access to latrine facilities. The rest of the states and union territories have found more than 80% coverage of access to latrine facilities.As per NSS data in 2018, 30.5% of households collect safe drinking water from the hand pump; in the case of urban areas 40.9% of households use piped water into the dwelling; and in rural areas 42.9% of households use the hand pump. 88.7% of households have access to a principle source of drinking water, and 95.5% use improved drinking water sources throughout the year. 100% of households having access to improved sources of drinking water (SDG 6.1 target achiever) in Chandigarh, Daman and Diu, Sikkim and Kerala has the lowest percentage 56.7%. In India, 79.8% of households have access to latrine facilities, whereas urban area has a higher percentage of household having access to latrine facility 96.2%, than rural areas (40.6%). The female population are more using toilets than the male population. 100% of households have access to latrine facilities (SDG 6.2 target achiever) in Manipur, Mizoram, Nagaland, Sikkim, Chandigarh, Lakshadweep; and the lowest found in Odisha 54.9%. Safe groundwater extraction from extractable groundwater resources annually (SDG 6.4 target achiever) in States and UTs in India, 2017 are found in Karnataka, Telangana, Gujarat, India, Uttarakhand, Madhya Pradesh, Maharashtra, Kerala, Daman and Diu, Lakshadweep, Bihar, West Bengal, Chhattisgarh, Andhra Pradesh, Odisha, Goa, Jammu & Kashmir, Ladakh, Dadra and Nagar Haveli, Jharkhand, Assam, Tripura, Mizoram, Andaman and Nicobar Islands, Manipur, Meghalaya, Nagaland, Arunachal Pradesh and Sikkim. In India, 63.33% of groundwater is extracted annually as per 2017. As of 2020, all the States and UTs in Rural India 100% individual household toilets constructed against target (SBM(G)) and 100% districts verified to be ODF (SBM(G)) (SDG 6.2 target achiever). As per January 2021, 100% rural population has improved source of drinking water (SDG 6.1 target achiever) in Ladakh, Sikkim, Goa, Himachal Pradesh, Gujarat, Karnataka, Mizoram, Andaman and Nicobar Islands, Telangana, Meghalaya, Nagaland and Manipur. As per 2019–2020, 100% school having a separate toilet for boys and girl (SDG 6.2 target achiever) in Dadra and Nagar Haveli, Sikkim, Himachal Pradesh, Andaman and Nicobar Islands and Puducherry. Goa achieves 100% safe disposal of liquid waste. Overall goal score expresses all the states belong to front runner stage (65% to 99%). Based on SDG 6.1 and SDG 6.2, it is observed that in Rural India achiever (100%) state is Sikkim, Himachal Pradesh, Andaman and Nicobar Islands in 2019–2021.Since the population is increasing, the number of sustainable water resources is not. Future population expansion will likely result in further reduced renewable water available per capita. Most changes in India's overall and rural regions, moderate changes in the world's overall and rural areas, and very little change in both India's and the world's urban areas have been seen in terms of access to essential drinking water services [ 20 ]. The top eight states are Gujarat, Jammu & Kashmir, Madhya Pradesh, Andhra Pradesh, Odisha, Maharashtra, Karnataka, and Telangana; the bottom eight are Delhi, Uttarakhand, Haryana, Uttar Pradesh, Bihar, Kerala, and West Bengal. Due to their location in the Ganges basin, most of the eight lowest performing states have abundant water resources, in contrast to the higher performing states, which are comparatively water scarce. Severe droughts have recently affected Gujarat, Maharashtra, Madhya Pradesh, Andhra Pradesh, Karnataka and Telangana. From an endowment standpoint, this focuses the attention of water concerns in India toward improved management and control of water resources. The top five states in terms of performance are Goa, Delhi, Kerala, Gujarat, and Telangana, whereas the worst five are Chhattisgarh, Bihar, Odisha, Andhra Pradesh, and Jharkhand. In Jharkhand, Bihar, and Uttar Pradesh, childhood malnutrition and stunting have increased due to poor sanitation services. Individually, these indices point to significant disparities in access to sanitary facilities and clean water throughout the states. Few states have been able to implement comprehensive planning to meet the key objectives [ 21 , 22 ].

The WHO/UNICEF, joint monitoring program estimated in 2012 that 60% of the world's open defecation occurs in India. While this trend is declining rapidly in other countries, it continues stubbornly in India. According to the 2011 Census of India data, about 90% of rural people in India defecate in the open. Social context always plays a vital role in countries like India, where households with higher income and better education are more likely to use latrines and toilets. Previous research has shown that Muslims are 25% less likely to defecate in the open than Hindus. Although Hindus have 6% more per capita consumption than non-Hindus, Hindus are less likely to use latrines [ 23 ].

Open defecation at the individual level is a more accurate reflection of the disease environment than latrine ownership at the household level. It is particularly true in rural India, where earlier research has shown that many residents of homes with latrines do not use their latrines. The literature indicates that the Indian government's policy of subsidizing pit latrines has not achieved large-scale behaviour change and may still represent a misguided focus. This policy has continued mainly under the current Swachh Bharat Mission (2014–present). Despite the evidence, understanding latrine demand is critical to understanding latrine uptake [ 24 , 25 ]. Sanitation practices and social norms receive minimal consideration in sanitation programmes. Sanitation policy would probably be more effective if it addressed the underlying social environment in which judgments about where to defecate and what kind of latrine is socially acceptable since even the well-educated and wealthiest households adopt latrines at such a slow pace [ 26 ].

After lunch of Swachh Bharat Mission and other programmes related to sanitation and drinking water, sanitation coverage and accessibility of drinking water rise which has reinforcement substantially in accelerating the Achievement of Sustainable Development goal 6. States and UTs having the lower status of sanitation, drinking water, groundwater and hygiene need to improve those condition by increasing availability, accessibility and affordability of the WASH facility. Localisation or bottom-up approach by giving responsibility to rural and urban local body enforced Achievement of SDG 6. Total water withdrawal per capita was 576.96 m 3 in 1975, which was 602.3 m 3 in 2010. Total water withdrawal has increased by about 3.07% in these few decades. From 1962 to 2014, 64.29% per capita of total internal renewable water resources decreased. From 1979 to 2011, 18.4% increase in water stress. To fulfil essential human needs and attain sustainable development aims, central and local governments must collaborate. These initiatives and actions for recyclable and reusable, sufficient, and treated water, as well as enhancing sanitation and hygiene infrastructure, are linked to creating opportunities that improve economic sustainability. Additionally, establishing sanitation, hygiene and drinking water infrastructure in households grants social dignity, which can assist in social sustainability.

Those States and Union Territories that have not achieved the goal of 100% overall SDG-6 should fulfil the goals through a specific regional development approach. If successful locally, it will help the country's overall progress on a large scale. India and other underdeveloped and developing countries need to fulfil the goals of SDG-6. If successful in achieving the target, it will accelerate overall health improvement and help reduce regional disparities. Developed countries need to help developing and underdeveloped countries. Finally, the various organizations of the United Nations should try to solve the problems at the local level through each country-specific regional approach that will accelerate the overall achievement.

To prevent and reduce acute and chronic illness death and sustain a healthy life, we need to increase awareness and facilities to access safe and adequate drinking water, sanitation and hygiene. For raising awareness, different days are celebrated on 22 March as World Water Day for Water, 19 November as World Toilet Day for sanitation and 15 October as Global Handwashing Day for hygiene. Still, we need to maintain safe drinking water, sanitation and hygiene all day. 

Availability of data and materials

The study is based on secondary data analysis. No data was collected for this study. The datasets generated and/or analysed during the current study are available in the NSS (Download Reports | Ministry of Statistics and Program Implementation | Government Of India), Central ground water control board (Department of Drinking Water and Sanitation, GOI (jalshakti-ddws.gov.in)), NARSS (Department of Drinking Water and Sanitation, GOI (jalshakti-ddws.gov.in)) NITI Aayog (Reports on SDG | NITI Aayog) repository.

Abbreviations

National Sample Survey

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Acknowledgements

The authors are grateful to NSS and NARSS for making the data available for this study.

We did not receive any grants from any funding agency in public, commercial, or non-profit sectors for conducting this study.

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Biswajit Dandapat

Department of Geography, Serampore Girls’ College, University of Calcutta, Serampore, 712201, India

Asraful Alam

Professor of Geography & Director, UGC-HRDC, University of Calcutta, Kolkata, 700019, India

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Biswas, S., Dandapat, B., Alam, A. et al. India's achievement towards sustainable Development Goal 6 (Ensure availability and sustainable management of water and sanitation for all) in the 2030 Agenda. BMC Public Health 22 , 2142 (2022). https://doi.org/10.1186/s12889-022-14316-0

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Early childhood caries, climate change and the sustainable development goal 13: a scoping review

• Morẹ́nikẹ́ Oluwátóyìn Foláyan 1 , 2 ,
• Robert J Schroth 1 , 3 ,
• Olunike Abodunrin 4 ,
• Ola B. Al-Batayneh 1 , 5 , 6 ,
• Arheiam Arheiam 1 , 7 ,
• Tshepiso Mfolo 1 , 8 ,
• Jorma I. Virtanen 1 , 9 ,
• Duangporn Duangthip 1 , 10 ,
• Carlos A Feldens 1 , 11 &
• Maha El Tantawi 1 , 12  

BMC Oral Health volume  24 , Article number:  524 ( 2024 ) Cite this article

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Sustainable development goal 13 centres on calls for urgent action to combat climate change and its impacts. The aim of this scoping review was to map the published literature for existing evidence on the association between the Sustainable Development Goal (SDG) 13 and early childhood caries (ECC).

The scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. In August 2023, a search was conducted in PubMed, Web of Science, and Scopus using search terms related to SDG13 and ECC. Only English language publications were extracted. There was no restriction on the type of publications included in the study. A summary of studies that met the inclusion criteria was conducted highlighting the countries where the studies were conducted, the study designs employed, the journals (dental/non-dental) in which the studies were published, and the findings. In addition, the SDG13 indicators to which the study findings were linked was reported.

The initial search yielded 113 potential publications. After removing 57 duplicated papers, 56 publications underwent title and abstract screening, and two studies went through full paper review. Four additional papers were identified from websites and searching the references of the included studies. Two of the six retrieved articles were from India, and one was China, Japan, the United States, and the United Kingdom respectively. One paper was based on an intervention simulation study, two reported findings from archeologic populations and three papers that were commentaries/opinions. In addition, four studies were linked to SDG 13.1 and they suggested an increased risk for caries with climate change. Two studies were linked to SDG 13.2 and they suggested that the practice of pediatric dentistry contributes negatively to environmental degradation. One study provided evidence on caries prevention management strategies in children that can reduce environmental degradation.

The evidence on the links between SDG13 and ECC suggests that climate change may increase the risk for caries, and the management of ECC may increase environmental degradation. However, there are caries prevention strategies that can reduce the negative impact of ECC management on the environment. Context specific and inter-disciplinary research is needed to generate evidence for mitigating the negative bidirectional relationships between SDG13 and ECC.

Peer Review reports

Introduction

Worldwide, the mean temperatures have climbed by approximately 1 °C (1.7 °F) since 1880, with projections indicating a potential warming of around 1.5 degrees Celsius (2.7 °F) by 2050 and a more substantial increase of 2–4 degrees Celsius (3.6–7.2 degrees Fahrenheit) by 2100 [ 1 ]. This alteration holds significance due to the immense heat energy required to elevate the earth’s average annual surface temperature, even by a slight margin, considering the vast extent and heat-retaining capacity of oceans. The approximately 2-degree Fahrenheit (1-degree Celsius) upswing in the global average surface temperature since the pre-industrial period (1880–1900) might appear modest, yet it equates to a substantial accumulation of heat [ 2 ].

Climate change is a huge concern for health, and its impact is felt globally. According to the World Meteorological Organization, greenhouse gas emissions are more than 50% higher now than in 1990 [ 3 ], and the World Health Organization (WHO) reports that global warming is causing long-lasting changes to the climate system that threatens irreversible consequences [ 4 ]. About 91% of geo-physical disasters are climate-related and they have tremendous human impact. Between 1998 and 2017, there were about 1.3 million deaths and 4.4 billion injuries due to the consequences of climate change [ 5 ].

The suggested health effects of climate change include changes in the prevalence and geographical distribution of respiratory diseases [ 6 , 7 ]. Respiratory diseases such as asthma and its medicines increase the risk of caries [ 8 , 9 , 10 ]. The increase in greenhouse gas emissions and global warming are associated with an increase in geophysical disasters [ 11 ]. These disasters result in humanitarian crises [ 12 ] which likely increase the burden of dental disease, including early childhood caries (ECC) [ 13 ]. The emitted gases that deplete the ozone layer include methane and nitrous oxide emissions [ 14 ]. Methane is suggested to have an inverse association, and nitrous oxide has a direct association with global ECC prevalence [ 15 ].

Climate change is also associated with food insecurity, which is linked to caries [ 16 , 17 ]. The risk of ECC may also increase with economic development, industrialization, and urbanization [ 18 , 19 ], a phenomenon associated with increased gas emission and ozone depletion [ 20 ]. On the other hand, climate change also leads to arid conditions and high alkalinity in the ground waters, which promote fluoride release from clay and fluorite-bearing minerals [ 21 , 22 ]. High temperatures promote longer residence times of ground waters, thereby leading to high fluoride contents of the water from water-rock interactions [ 21 , 22 ]. Although fluorides in water are beneficial for dental health leading to reduced risk of ECC, excessive exposure to fluoride can result in severe fluorosis [ 23 ] which increases the risk of caries [ 24 , 25 ].

The plausible link between climate change and ECC makes the Sustainable Development Goal 13 (SDG13) a subject of interest for pediatric dental care. The SDG 13 is focused on preventing and or tackling problems posed by climate change. It acknowledges that climate change is causing a rise in the occurrence and severity of extreme weather events, including floods, heatwaves, droughts, and tropical cyclones. These, in turn, heighten health risks due to damage to vital infrastructure, disruption of essential services like water and sanitation, education, energy, health, and transportation, exacerbation of water management challenges, and a decrease in agricultural output and food security [ 26 , 27 , 28 ]. These micro-, meso- and macro-level effects of climate change may increase the risk of ECC as it may cause disruption in access to preventive and curative care, limited access to health promotion, prevention information and education and increase the impact of food insecurity on ECC [ 29 , 30 ].

A positive impact on ECC control may be linked with efforts at strengthening the resilience and adaptive capacity to climate-related hazards and natural disasters (SDG13.1); improving education, awareness and human and institutional capacity on climate change mitigation, adaptation, impact reduction and early warning (SDG 13.2); and integrating climate change measures into national policies, strategies, and planning (SDG 13.3) [ 26 ]. . Furthermore, incorporating the commitment made by developed-country parties to the United Nations Framework Convention on Climate Change, aimed at addressing the requirements of developing nations (13.A); and promoting mechanisms for raising capacity for effective climate change-related planning and management with focus on marginalized communities among others (SDG 13.B) [ 24 ], could also influence ECC control. This is because the prevalence of ECC is higher in developing countries [ 31 ] and among marginalized communities [ 32 ]. The conceptual framework for the association between climate change and ECC is presented in Fig.  1 .

Conceptual framework for the relationship between climate change and ECC. Target 13.1 | Strengthen Resilience and Adaptive Capacity to Climate Related Disasters. Target 13.2 | Integrate Climate Change Measures into Policies and Planning. Target 13.3 | Build Knowledge and Capacity to Meet Climate Change.Target 13.A | Implement the UN Framework Convention on Climate Change. Target 13.B | Promote Mechanisms to Raise Capacity for Climate Planning and Management

The aim of this scoping review was to identify the existing evidence on the association between climate change and climate change-related factors (disasters, sustainable management of natural resource, and human security) with ECC.

We conducted a systematic search to identify scientific literature on the association between climate change and ECC. Our scoping review was conducted according to the JBI guidelines for scoping review [ 33 ] and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines (PRISMA-ScR) [ 34 ].

Research questions

The following questions guided this review: (i) What is the existing evidence on the association between climate change and ECC? and (ii) What are the factors related to climate change (disasters, sustainable management of natural resource, human security) associated with ECC?”

Articles identification

The initial search was conducted on three electronic databases (PubMed, Web of Science and Scopus) in August 2023. The search was performed using the key terms as shown in Appendix 1. Publications from the inception of each database to August 2023 were screened. No protocol was published for this review. Additional search was conducted by reviewing the references of eligible publications and by searching the semantics scholar website.

Selection of articles

Article inclusion was performed in four phases. The first phase was conducted by one reviewer (MET) who conducted the search in the three databases for the information. In the second phase, two reviewers (OA, MOF) screened the titles and abstracts of all identified manuscripts and removed the duplicates. In phase three, two reviewers (OA, MOF) reviewed the full text of the manuscripts independently and compared results to achieve consensus. In addition, and reference lists of potentially relevant publications were manually searched. Lastly, the information generated was shared with two experts for their review (MET and RJS).

Eligibility criteria

Articles were included if they focused on children younger than 6 year of age or if they did not specifically exclude this age group. In addition, studies that identified ECC as dependent or independent factors in relation to climate change or climate change related factors were included. No study design was excluded based on study design. There was no language restriction for the search conducted in the three databases. Language restrictions were introduced at the phase of review of the full texts. Articles not published in English were excluded. We also excluded studies that focused on the prevalence of ECC or on climate change exclusively.

Data charting

Specific information from the included publications was extracted. This includes information on the first author’s name, year of publication, study location, World Health Organization’s region where the study was conducted (African (AFR), Eastern Mediterranean (EMR), European (EUR), Region of the Americas (AMR), South-East Asian (SEAR), and Western Pacific (WPR)) [ 35 ], study design, study objectives, main findings and conclusion on the association between SDG13 and ECC, and whether the article was published in dental or non-dental journal. Information from each publication was compiled and summarized in Table  1 . The summarized data were then shared with two experts (RJS and AA) for their review. Publications were included only when there was a consensus between the experts and the earlier three reviewers. The final consensus document was also shared with members of the Early Childhood Caries Advocacy Group ( www.eccag.org ) to identify any other relevant publication that might not have been retrieved by the original search strategy.

Data analysis

We performed a descriptive analysis of the extracted items. These descriptions encompassed the World Health Organization’s region and countries where the studies were conducted, the study designs employed, the journals (whether dental or non-dental) in which the studies were published, and the findings. Interpretive inductive analyses of the objectives and conclusions of the studies were also conducted. In addition, an analysis was conducted linking the study findings with an SDG13 indicator.

Role of the funding source

The study was funded out-of-pocket. This had no role in the study design, data collection, analysis, decision to publish, or preparation of the manuscript.

Figure  2 shows the process undertaken to identify relevant literature. The initial search of the three databases yielded 113 potential publications. Fifty-seven duplicated papers were removed, leaving 56 papers that underwent title and abstract screening. Of these, 54 papers were excluded leaving only two papers for study inclusion [ 36 , 37 ]. In addition, two publications were identified from search in the semantic scholar website and another two identified by searching the references of one of the studies that met the eligibility criteria [ 36 ]. These additional four papers provided data on potential connections between climate change and caries [ 16 , 38 , 39 , 40 ]. One of the six papers assessed the impact of management of ECC on climate change and ECC [ 37 ]. Table  1 presents further details regarding the six included publications.

Flow diagram based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 flowchart template of the search and selected process

Overview of studies

Two of the six retrieved articles were from India (SEAR) [ 36 , 38 ], one was from China (the SEAR) [ 37 ], the US (AMR) [ 16 ], the UK (EUR) [ 39 ] and Japan (WRP) [ 40 ], respectively. The three papers from 2021 to 2023 were published in dental journals [ 16 , 36 , 39 ] while the three older papers were published between 2007 and 2019 in non-dental journals [ 37 , 38 , 40 ]. One paper was an intervention simulation study [ 39 ], two reported findings from archeologic populations [ 37 , 40 ] and three papers that were commentaries/opinions [ 16 , 36 , 38 ].

The study objectives covered a range of topics from highlighting the need for environmentally-friendly solutions within dental practices to mitigate the ecological footprint of dental procedures [ 36 ], to the exploration of how environmental factors like climate may have influenced dental health in ancient populations [ 37 , 40 ], and broader discussions on considerations and adaptation strategies to address the evolving environmental challenges of oral health management and outcomes in the context of global climate disruption [ 16 , 39 ].

The study conclusions highlighted the interconnectedness between climate change, environmental sustainability, subsistence patterns, and oral health outcomes. It highlighted that the use of environmentally harmful dental materials contributes to environmental degradation and climate change [ 36 ]; climate change-induced shifts in subsistence economy, heat and oxidative stress, air quality that can significantly impact oral health outcomes [ 37 ] including increasing the risk for caries [ 16 , 38 , 39 ]. Alternative materials should be explored to mitigate these detrimental effects [ 36 ], and strategic approaches can be adopted to manage the impact of dental caries preventive on the climate [ 39 ].

In addition, the studies were linked to two targets of SDG13: specifically, SDG 13.1, which emphasizes enhancing resilience and adaptive capacity to climate-related hazards and natural disasters globally [ 16 , 37 , 38 , 40 ]; and SDG 13.2, which focuses on integrating climate change measures into national policies, strategies, and planning [ 36 , 39 ]. The four studies linking caries to SDG 13.1 suggests that adaptive measures to climate changes may increase the risk of caries. The two studies linking caries to SDG 13.2 indicate that pediatric dental practices have a negative impact on environmental degradation, consequently contributing adversely to climate change. However, one of the two studies proposes that specific actions can be taken to mitigate the environmental impact of caries prevention practices in children [ 39 ].

This scoping review identified articles that discussed how the discipline of pediatric dentistry’s carbon footprint can contribute to climate change. The studies identified a bi-directional relationship between caries and climate change. First, that adaptive processes for climate change can increase the prevalence of caries. Second, that the management of caries contributes to environmental degradation. Third, that purposeful strategic approaches to caries prevention in children can reduce the detrimental impact of caries management on the environment. These findings support our study hypothesis on the possible links between ECC and climate change.

However, the evidence supporting the study hypothesis are limited to commentaries, suggested archeological evidence and simulation studies. Studies on the impact of climate change are only starting to evolve. Methodological challenges may have limited the investigations into the link between climate change and ECC. Martens and McMichael identified a range of methodologies that could be used for studying the impact of climate change on health [42]. These methodologies are applicable for the study of the impact of climate change on oral health such as the evaluation of the impact of climate changes on shifts in the range and densities of caries predisposing organisms in the oral cavity, and children’s vulnerability to ECC. The current study identified an investigation that used implementation science approach to demonstrate how caries preventive practices in children can reduced the negative impact of dental practice on the environment [ 37 ]. It is therefore feasible to not only conduct studies to provide evidence on the link between ECC and climate change, but to demonstrate how the management of ECC can reduce environmental degradation. More studies are needed to identify context specific management strategies for ECC management that can be brought to scale.

One of the studies suggests a link between heat related climate changes and ECC [ 37 ]. We postulate that this link may result from the warming phenomenon that triggers an increase in water consumption. Existing evidence suggests that variations in water consumption levels between the coldest and warmest periods can fluctuate from 20% to as high as 60% [ 41 ]. Additionally, the intake of fluids per unit of body weight is most pronounced among infants and diminishes with advancing age [ 42 ]. Consequently, there may be a probable cumulative rise in children’s fluoride consumption due to global warming. This stems from multiple sources, including fluoride present in drinking water, fluoride-containing toothpaste, fluoride supplements, infant formula, beverages made with fluoridated water, cow’s milk from animals raised in fluoride-containing environments [ 43 , 44 ], and crops cultivated in soil with elevated fluoride content due to interactions with water and rocks [ 17 , 20 ]. The permissible threshold for fluoride intake is influenced by climatic conditions [ 45 ], with severely elevated fluoride intake, severe fluorosis, and a potential elevated risk of dental caries [ 22 , 23 , 46 ]. Geothermal temperature has been viewed as one cause for high fluoride levels recorded in groundwater (from deep aquifers and geothermal springs) [ 47 ]. On the other hand, Beltrán-Aguilar et al. demonstrated no association between outdoor temperature and the total water consumption of children aged 1 to 10 in the United States. This observation remained consistent even after accounting for age, gender, race/ethnicity, or poverty status [ 48 ]. . We, however, found no study addressing the link between outdoor temperature, consumption of water including fluoridated water and the prevalence of ECC. Future studies are needed to identify the pathophysiological pathways between climate change and ECC risks if there is truly a link.

It is also possible that the oxidative stress associated with climate change, arising from a disparity in the generation of pro-oxidant elements and the presence of antioxidant defenses [ 49 ] may be associated with enamel hypoplasia as highlighted by Temple [ 40 ]. Enamel hypoplasia may result from SOD1-mediated ROS accumulation disruption of normal enamel structure through alternative cervical loop cell proliferation and downregulation of RhoA and ROCK in ameloblasts [ 50 ]. Enamel hypoplasia is associated with an increased in the risk for ECC [ 51 , 52 ].

There are, however, other possible pathophysiological pathways for the increased risk of ECC due to climate change not highlighted in the publications mapped in this scoping review. One plausibility may be linked to global warming that has the potential to induce pronounced aridification [ 53 ]. A temperature increases of 2 degrees Celsius would precipitate further arid conditions in 15% of semi-arid climates, potentially impacting over 25% of the globe [ 54 ]. This intensified aridification historically led to the desiccation of crops and increased dependence on marine resources for sustenance, akin to occurrences around 2000 B.C [ 55 ]. . This shift towards marine food sources is likely to encourage diets lacking in essential nutrients, potentially resulting in an increased rate of new bone formation on the outer surface of bones (periosteal new bone formation) [ 55 ]. However, there is a suggestion that carious lesions, premature tooth loss, and dental enamel hypoplasia might not necessarily experience an upswing due to aridification [ 55 ]. Studies on the pathways to link ECC and climate change are therefore, critically needed, to be able to take collective global actions to mitigate the negative oral health impact climate change may have on children.

Another pathophysiological pathway that may link climate change with an increase in the risk for ECC is the impact of rapid climate shifts on soil composition, solubility, and plant absorption [ 56 ]. These alterations could lead to a notable shift in the concentration of certain trace elements within plants, attributed to heightened translocation, improved photosynthetic capacity, and enhanced growth. Conversely, the warming process might result in reduced trace element concentrations in tubers, indicating that the tuber growth rate surpasses its ability to take in metals at elevated temperatures [ 57 ]. The presence of trace elements in plants contributes to the development of enamel and dentin [ 58 ], although the precise mechanisms governing the integration of trace elements into soils and, subsequently into human teeth require further elucidation [ 59 ]. The plausibleness of these interactions requires further investigations as the current study highlights that the objectives of the accessible studies on ECC and climate change are limited in the scope of their explorations.

In addition, the necessity for studies tailored to specific contexts highlights the limited regional coverage in current research examining the connections between ECC and climate change. Notably, our investigation revealed very few studies on this sub a lack of studies conducted in the AFR and EMR regions. Despite expectations that climate changes will alter rainfall patterns, impacting agriculture and diminishing food security while exacerbating water security issues in Africa [ 60 ], there is a notable absence of corresponding studies. Similarly, anticipated climate changes in the EMR region are expected to result in under-nutrition, respiratory illnesses, mental health issues, allergic reactions, and pulmonary diseases due to dust storms [ 61 ]. Despite being the two-worst impacted region in terms of health consequences resulting from climate change [ 62 ], these regions are currently underrepresented in evidence generation regarding the impact of climate change on health, including oral health. Consequently, significant gaps exist in our awareness and understanding of these links, potentially limiting mitigation and adaptation efforts [ 61 ]. It is, therefore, important to strengthen efforts to generate evidence from all regions with particular attention paid to AFR and EMR.

The suggested pathophysiological pathways for linking ECC and climate change clearing indicates the interconnectedness between climate change, environmental sustainability, subsistence patterns, and oral health outcomes. There is, therefore, the need for interdisciplinary and collaborative studies. One method that can be used to study the link between ECC and climate change is the integrated eco-epidemiologic models to identify the impact of climate change or stratospheric ozone depletion on the profile of organisms that cause caries; the thermal-related impact of climate change on the fluoride content of ground waters and its impact on caries risks; or the impact of ozone depletion on tooth structure and caries risk. These forms of study may present major scientific challenges in conceptualizing and technical difficulty with assessing the oral health impacts of these changes [42]. Eco-epidemiologic models will require a lot more anticipatory thinking and mathematical modelling of potential future impacts, which will be useful for policymakers [ 63 ].

Other study methods include the use of epidemiological surveillance techniques, assessment of the oral health impact of climate change using ecological frameworks, monitoring of the direct oral health impact of seasonal variations, natural disasters, marine ecosystems and ecosystems health, food production and food security, and emerging and resurgent infectious diseases [ 63 ]. Other methods include the use of retrospective study, integrated assessment modelling on oral health, and landscape epidemiology of caries profiles using remote censoring, Geographic Information system and spatial statistics [ 63 ]. The study methodologies, however, need to promote interdisciplinary research adapted for the modelling of complex processes and handling of attendant uncertainties [ 64 ].

The results confirmed the hypothesis regarding the connection between ECC and climate change, and mapping exercise highlighted areas where existing evidence has focused and identified new areas for further research. This is crucial not only for establishing links between ECC and all SDG13 indicators but, more importantly, for identifying ways to mitigate the negative bidirectional relationships between ECC and SDG13. Of interest are the archaeological studies identified in this study [ 37 , 40 ]. These archaeological studies provide valuable insights into the historical and cultural determinants of caries, offering a unique perspective on the complex interplay between environmental, dietary, and sociocultural factors. By incorporating archaeological evidence into research and policy, stakeholders can advance efforts to address ECC and promote oral health within the framework of Sustainable Development Goal 13. Climate change is a major public health concern, and stakeholders need to proactively engage in mitigating the risk of poor oral health associated with poor climate controls using evidence that can be generated through multiple research strategies.

This scoping review, however, has a few limitations. First, our search was restricted to English literature only, potentially resulting in the omission of studies on the correlation between ECC and climate change published in other languages. This language restriction was solely applied during the article selection process for full-text review, ensuring transparency regarding the number of eligible reports available in languages other than English [ 65 ]. The decision to limit our search to English literature was made due to the inability to read and interpret literature written in other languages. Second, our search was limited to three data bases which may have led to the omission of relevant articles not captured by the search strategy, potentially introducing selection bias. The scope of the study is also limited to children under 6 years limiting the generalizability of findings to other age groups. Despite the limitations the study highlights plausible links between ECC and climate change that can be explored empirically in future studies.

In conclusion though there is the plausibility of climate change having an impact on the health of the dentition and the risk for caries. Studies are needed to generate empirical evidence of the impact of climate change on caries risk in children. This will help with the formulation of policies and the design of programs that can help policymakers and decision-makers proactively prevent the increase in the prevalence of ECC as we move into the future. Addressing these complex relationships is essential for developing holistic strategies to promote both environmental sustainability and oral health.

Data availability

No datasets were generated or analysed during the current study.

Abbreviations

Cumulative Index to Nursing and Allied Health Literature

ScR-Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines

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Morẹ́nikẹ́ Oluwátóyìn Foláyan, Robert J Schroth, Ola B. Al-Batayneh, Arheiam Arheiam, Tshepiso Mfolo, Jorma I. Virtanen, Duangporn Duangthip, Carlos A Feldens & Maha El Tantawi

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M.O.F conceived the study. The Project was managed by M.O.F., Data curating was done by O.A., M.ET. and M.O.F. Data analysis was conducted by M.O.F., O.A. and M.ET. M.O.F. developed the first draft of the document. D.D. drew the figure of the conceptual framework. O.A., A.A., T.M., O.B.A-B., R.J.S., D.D. J.I.V., C.A.F., and M.E.T. read the draft manuscript and made inputs prior to the final draft. All authors approved the final manuscript for submission.

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Foláyan, M.O., Schroth, R.J., Abodunrin, O. et al. Early childhood caries, climate change and the sustainable development goal 13: a scoping review. BMC Oral Health 24 , 524 (2024). https://doi.org/10.1186/s12903-024-04237-2

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• 30 April 2024

Why doing social science research is difficult in India today

• Yamini Aiyar 0

Yamini Aiyar is the former president and chief executive of the Centre for Policy Research, based in New Delhi.

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India’s academic freedom has been in steady decline for a decade. This is well documented: in the 2024 Academic Freedom Index update produced by V-Dem, a project on democracy based in Gothenburg, Sweden, India is ranked in the bottom 20% of a list of 179 countries and territories on metrics such as ‘institutional autonomy’ and ‘freedom to research and teach’.

Historically, academic freedoms were certainly not perfect in India. Yet even a cursory glance at the evidence reveals that the scale of restrictions and the misuse of laws to curb academic freedom has increased. In the interests of preserving India’s global competitiveness, whoever wins the election should seek to reverse this trend.

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The documented drop in academic freedom is part of a broader decline in India’s vibrant culture of public debate. I have personally witnessed the growing restrictions during my 15 years as a researcher at the New Delhi-based Centre for Policy Research (CPR), where I served as president for 7 years until I stepped down in March.

My own research community — think tanks that aim to support evidence-based policies — engages deeply with the global academic and policy ecosystem. Given that public funds have many competing priorities, much of our research relies on international philanthropic funding. That is becoming increasingly difficult to come by, owing to a tightening of the Foreign Contribution (Regulation) Act (FCRA), which controls licences to access foreign funding.

For instance, after amendments to this law in 2020, recipients of foreign funding cannot give subgrants to other organizations, making collaborative research impossible. And since 2014, nearly 17,000 civil-society organizations have lost their FCRA licences altogether . For those that still have a licence, the renewal process is onerous. Many organizations receive temporary extensions of three to six months, rather than the full period of five years allowed under law.

Why Joe Biden’s bid to restore scientific integrity matters

It seems that tax laws are also increasingly being used against institutions. Some research organizations are facing penalties and, in extreme cases, the loss of their tax-exempt status, which is required for accessing charitable donations. In September 2022, six institutions, including the CPR, were subject to tax ‘surveys’ that eventually resulted in them having both their FCRA licences and their tax-exempt statuses revoked . This has left them mired in legal minutiae and struggling to fund their work.

Similar challenges to the freedom to pursue independent research are visible on university campuses. In 2022, the India Academic Freedom Network (IAFN) prepared a status report for the United Nations special rapporteur on freedom of opinion and expression. It lists 78 instances in which seminars, lectures or talks at public universities were disrupted by politically aligned groups or the permission to organize such events was denied. It also lists 25 cases of faculty arrests, including some under anti-terror and sedition laws — mostly for speaking on issues of public interest, on campus or in social-media posts. A further 37 incidents pertain to the arrest of students. The IAFN report also points to difficulties associated with foreign researchers obtaining visas and entering India — even for people who hold Overseas Citizenship of India cards.

All this comes at a juncture when critical feedback and effective consultation are required to secure the country’s long-term growth and prosperity. But rather than engage with ideas and challenge them in the spirit of inquiry and public debate, in my view, it has now become increasingly common for technocrats in government to seek to discredit researchers and suppress research. In late 2023, for instance, the World Bank removed from its website an important study that highlighted reversals of progress recorded under a flagship sanitation programme. The bank cited procedural issues , but was presumably under government pressure.

How to protect US science from political meddling after Trump

Even crucial government data are now hard to obtain. The decennial census, for example, was last conducted in 2010–11; the public report on the 2017–18 household consumption expenditure survey was junked and only partial data have been released from the 2022–23 survey. The consequences of this are significant. In my field, development and social policy, the data gaps make it harder to measure changes in well-being. The debate on poverty reduction is bogged down in estimates, leaving the public with relatively little objective analysis on the reach and effectiveness of economic policies.

To reverse these trends, researchers must make their voices heard and be willing to defend the principle and value of academic freedom in the public domain. Research bodies should engage more effectively with philanthropists in India and find ways to preserve the space for civil discourse. An alliance with broader civil society is also required to push back against draconian regulations that undermine scientific freedoms.

India’s experience is not unique, but a reflection of a broader malaise. The V-Dem report makes it clear that several countries — including the United States, where university campuses are in turmoil — have witnessed a deterioration in the space available to pursue independent research. Researchers in India and elsewhere should fight to retain that space. It will be a long and difficult battle. But it is an essential one.

Nature 629 , 9 (2024)

doi: https://doi.org/10.1038/d41586-024-01214-1

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