Every individual has the fundamental right to access and use proper sanitation facilities; however, significant gaps persist globally, particularly along socio-economic lines. This study emphasizes the disparities in sanitation low- and middle-income countries (LMICs) and low earning communities, which contribute to disproportionate exposure to microbial and parasitic infections and a higher burden of disease and wealthier communities benefit from modern amenities such as sewage systems, flush toilets, and advanced wastewater treatment, underprivileged populations often rely on inadequate facilities that initiate and sustain illness within these communities. To better understand the transmission pathways of microbial contamination, this review draws on recent findings from environmental microbiology and epidemiology, focusing on reservoirs such as water, soil, surfaces, food, air, waste streams, and other fomites. It also explores the growing relationship between the human microbiome and sanitation practices, particularly highlighting children who are more vulnerable to growth retardation and gastrointestinal illnesses in unsanitary environments due to a weak immune system. This study also discusses the importance of climate resilience, behavior modification, and technological innovation in addressing sanitation challenges. It highlights the crucial role of climate-adaptive systems, culturally sensitive approaches, and microbiological research in enhancing sanitation outcomes, particularly in resource-constrained and climate-vulnerable settings worldwide. To mitigate the adverse health effects of sanitation inequality, the analysis concludes by emphasizing the need for equitable infrastructure investment, effective policymaking, legislative reform, and active community engagement at both national and international levels.