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Water and sanitary improvement rose to international prominence when health in the industrializing cities of the 19th century was far worse than in their rural surrounds, and reformers claimed to have found the means to counter this urban penalty: clean piped water and sewered toilets. While there have been enormous improvements since the mid 19th century, according to the most recent global burden of disease assessment, unsafe water, sanitation, and hygiene still account for almost 6% of the burden of disease in “high-mortality developing regions,” exceeding all but two other risk factors. 1 Unsafe water and sanitation is still closely associated with poverty, and eliminating water and sanitation deficiencies is also still central to the development goals and targets that have been adopted internationally, including most notably the Millennium Development Goals, a blueprint for action to meet the needs of the world’s poorest agreed to by all the world’s countries and its leading development institutions. Although the urban penalty is no longer evident, eliminating urban deficiencies in Africa, Asia, and Latin America remains a major part of the challenge. In this chapter, we review the international statistics on existing deficiencies in urban water and sanitation provision, reexamine the standards used to assess progress in eliminating these deficiencies, discuss some of the underlying data problems, and describe how better information of water and sanitation deficiencies could help to motivate improvements and thereby improve health. We argue that the international statistics being used to monitor progress toward the Millennium Development …