Evaluation of the Health Effects of Toilet Revolution Policies in Rural Revitalization: From the Perspective of Policy Tool Selection

Sanitary toilets are an important infrastructure for improving disease prevention in rural China and for protecting the health rights and interests of the people. Accordingly, the toilet revolution policy will improve the rural living environment and farmers' health. Specifically, toilet revolution policies can reduce the vulnerability of rural residents to infectious diseases by blocking the transmission of bacteria that contaminate the drinking water and spread through the air. However, there is little literature on the impact of the rural “toilet revolution” on the health of low-income people. Therefore, in the macro context of connecting the stage of poverty alleviation to the stage of rural revitalization, it is necessary to conduct a scientific assessment of whether the toilet revolution policy has improved the health of the low-income population, to determine the impact of the rural toilet revolution policy, and finally to provide policy references for government departments to understand the policy results and improve the future allocation of policy resources. This paper utilizes the micro-tracking database of poor households registered in Jingdezhen prefectural-level cities in central China from 2013 to 2022 to evaluate the impact of the rural “toilet revolution” on the health of the poor population, employing a multi-stage difference-in-differences method. The study finds the following: First, the toilet revolution policy improved the health of low-income people. The quantitative results show that the toilet revolution policy significantly improved the health of low-income people by 4.01 percent. This policy primarily reduced the likelihood of low-income individuals developing chronic diseases rather than developing more severe illnesses. Second, the analytical results show that ensuring safe drinking water, installing qualified septic tanks, safely disposing of human waste, building safe toilet facilities, installing qualified toilet fixtures, and installing qualified pipes are six ways in which the toilet revolution policy will improve the health of low-income people. Third, financial subsidies play a more obvious role than engineering subsidies in terms of health improvement effects. Fourth, the results of the heterogeneity analysis show that the toilet revolution policy has a greater impact on the health of female rural low-income people than on that of male rural low-income people, a greater effect on the health of elderly rural low-income people than on that of young and middle-aged rural low-income people, and a greater impact on the health of low-income people due to illness than due to other reasons. Compared with the existing literature, the marginal contribution of this paper is mainly reflected in three areas. First, based on health capital theory, this paper systematically discusses the health improvement effects of the toilet revolution policy on low-income groups, supplementing the application scenarios of health capital theory. Second, this paper is one of the few studies that utilizes individual-level panel full-sample tracking data to empirically evaluate the effectiveness of the toilet revolution policy, thereby further strengthening the credibility of the relationship between the construction of sanitation infrastructure and the health of rural residents. Third, this paper provides policy insights on how to design small toilets more effectively to improve the people's livelihood, offering policy references for the planning of future rural health infrastructure.