In many parts of the world, ocean friendly sanitation policy is either not a priority or is totally absent. The priority is often on the immediate public health need which, while understandable, misses the longer-term negative effects that can result. Defining and enacting policy that addresses both public and environmental health is critical for sustainable solutions. Having more holistic policy strategies can also be more cost effective and support aspirations towards a range of co-benefits that go well beyond public health. Working with policymakers at the local, national, and international level is a critical part of creating enabling conditions for threat mitigation, as well as taking a longer view and more holistic approach to wastewater treatment and management.