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The Politics of Toilets

By Rose George

On Earth Day, let's not forget the dirt. The planet is soiled with sewage, on land and sea. Our waste is the biggest marine pollutant there is, according to the United Nations Environment Program. In the developing world, ninety percent of sewage is discharged untreated into oceans and rivers, where its high nutrient content can suffocate the life out of seas, contributing to dead zones (405 worldwide and counting).

There are dead zones on land, too. Human waste contaminates environments all over the world, rich and poor. Imagine getting up at 4 a.m. in darkness, trekking to a nearby bush or field, and going to the bathroom out in the open. Imagine then being hit by a farmer who doesn't like you toileting in his field, or being raped by someone taking advantage of the dark, which you need to preserve your modesty. The quarter of the world's population without access to sanitation - not even a bucket nor a box - don't have to imagine this. It's their daily reality. What's more, all that excrement lying around has deadly consequences. More children - up to 2 million a year, or one every 15 seconds or so - die of diarrhea, 90 percent of which is due to fecal contamination in food or liquid, than of TB, malaria or HIV/AIDS. Diarrhea is the world's most effective weapon of mass destruction.

That's the gloom. The good news is that it's solvable. And solving the world's sewage mess would be such a bargain that it should appeal to politicians holding the purse strings even in these straitened times. Investing $1 in sanitation reaps $8 in health costs averted and labor days saved. Look at it another way: not investing $1 in sanitation loses you $7. Last year the World Bank calculated that poor sanitation cost Cambodia, Indonesia, the Philippines and Vietnam between 1.4 and 7.2 percent of their GDP. When Peru had a cholera outbreak in 1991, losses from tourism and agricultural revenue were three times greater than the total money spent on sanitation in the previous decade.

If numbers are too technical, let's get practical: Installing latrines and clean water supply in a typical village has dramatic effects.

In the far reaches of Orissa, India, I visited the leader of a village named Samiapalli, which until recently had no sanitation and endemic open defecation in nearby woods and along roadsides. Of course, those weren't the villagers' only problems: they also faced rampant alcohol abuse, domestic violence, and persistent caste discrimination. Today is different. Although it took 162 meetings to get everyone to agree to install one (and to contribute to the cost), everybody has a latrine, bathing room and running water. With the confidence gained through those 162 meetings, women had kicked out the illegal alcohol brewers (and tied the most persistently violent men to a lamp-post). Eighty percent more girl children now went to school, the leader told me. Women were earning money growing peanuts and selling other goods at market, with the free time they had gained from not having to spend hours finding somewhere private to do their business, or to fetch cripplingly heavy water. Diarrhea had dropped dramatically (a latrine can reduce disease by 40 percent; a clean water supply reduces it by 20 percent.)

Sanitation isn't a symptom of development. It can trigger it. "It's the hardest entry point," says Joe Madiath, whose NGO Gram Vikas had helped bring the toilet revolution to Samiapalli. "But once you succeed with sanitation, you can do anything."

Samiapalli's story, and those of other sanitation success stories, makes the lack of international resources for sanitation baffling. A target of the United Nations' Millennium Development Goals (though it was included late and against great opposition), sanitation continues to lag far behind access to clean water, an easier topic to sell and publicize. Celebrities happily promote a village's shiny new faucets, preferably with a photogenic child nearby, but fail to make the logical step over to the new latrines that have lengthened that child's life and enabled her to go to school.

These priorities persist behind the cameras. The United Nations Human Development Report noted in 2006 noted that water and sanitation budgets in most countries are less than 0.5% of GDP; and of that pittance, 90% goes on clean water supply. Things may be improving, but slowly: The times when much of the U.S.'s overseas water and sanitation budget went toward restoring infrastructure in places it had helped destroy - notably Iraq and Afghanistan - are thankfully over. Paul Simon's Water for the Poor Act has actually been allocated proper money ($300 million), and the Reports to Congress about the act laudably mention "sanitation." But there are still 994 references to water in the report, and only 249 mentions of "sanitation."

This is understandable, given how long sanitation has been in water's shadow. And the fact that sanitation is mentioned at all is cheering. But we must not let that semantic imbalance translate into an imbalance of funds allocated for sanitation -- the most off-track target, after all, of all the targets in the Millennium Development Goals.

The International Year of Sanitation ended in December, but our pressure on politicians and donor agencies should not. Funds that have long gushed away to the cause of clean water, at the expense of sanitation, should be diverted back. In financially straitened times, it makes economic sense to invest in the most cost-effective health prevention mechanism we have. With a new Global Sanitation Fund up and running, it couldn't be easier. Earth Day is as good a day as any to remember that sewage may be dirt, but sanitation shouldn't be treated like it.

Rose George is a freelance journalist and author of The Big Necessity , an eye-opening report on the shocking realities of the world's sanitation crisis.

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Comments (7)

RSArunKumar Author Profile Page:

Thank you Rose George, for another commendable article.
Like the village of Samiapalli, there are thousands of such villages and such initiatives, which have gained momentum. Specifically in India, the Government's Total Sanitation Campaign, National Urban Sanitation Policy, Sustainable School Sanitation Campaign, etc. are sending a strong message - Ignorance to Sanitation will not be continued.
Yes, funds are required to mobilize communities, to allow organizations like Gram Vikas to carry out 162 meetings. This investment on the soft component of sanitation will go a long way, and donor agencies need to come out of the notion that civil construction alone does not mean achievement.

JackSimWorldToiletOrganization Author Profile Page:

Rose George's passion in addressing the taboo of Sanitation is admirable. The world ignores this issue because it is not glamorous. Almost million children dies each year of diarrhea due to poor sanitation and hygiene. But unfortunately, diarrhea is seen as unspeakable and what we don't discuss, we can't improve.

HIV AIDS has Elizabeth Taylor as a champ. Malaria has Melinda and Bill Gates. Diarrhea is waiting for a champion. If you are out there, please come forward and let's stop these unnecessary deaths and loss of human dignity forever.

World Toilet Organization has devoted 19 November each year as World Toilet Day. This day is celebrated globally. Google for it and you'll see the traction is gaining momentum.

see www.worldtoilet.org

MarlaSmith-Nilson Author Profile Page:

To WorldCup - Unfortunately, Rose George is not mistaken. Projects to improve access to clean water should always include sanitation, but making sense isn't always a criteria in development projects.

Clean water and sanitation are so important to that in 2007 they were voted the most important medical advance since 1840 by the British Medical Journal, ranking higher than antibiotics, vaccines, anesthesia, the discovery of DNA.

So, how much are we investing in this proven cure for the world’s top public health problem? The answer, sadly, is not nearly enough. Global aid spending on health and education has increased at a far greater rate since 1990 than the share allocated to water and sanitation. Even though spending on water projects is far ahead of spending on sanitation, we actually need to increase spending for both if we want other important developments projects to succeed.

There are vital links between water and sanitation and poverty. We need to act appropriately to ensure that the lack of attention to water and sanitation does not undermine all other development goals.

It makes no sense to invest in education in a community with no toilets or accessible, safe water supplies. It makes no sense to build a health clinic in a community without toilets or water either, because 80% of the illnesses that will come into that clinic will be caused by the lack of water and toilets. I just posted my own blog about this topic at:

Read Rose George's book, if you haven't already!

datdamwuf2 Author Profile Page:

I agree with the author, however water based sanitation systems should not be the norm. They are wasteful, especially in places without abundant water supplies - and most places are going to be in this predicament sooner or later. There are excellent and low cost sanitation and sewage treatment facilities available now. There are even some solid waste treatment facilities that use human waste to provide clean energy. Let's talk about these innovations!

WorldCup Author Profile Page:

Could Rose George be mistaken? It seems to me that the terms "access to clean water" and "clean water supply" automatically infer sanitation efforts. If sewage is contaminating the clean water supply, it makes sense that initiatives and budgets to improve "access to clean water" would include a clean up of the dirty water that is contaminating the clean. No?

_virginian_ Author Profile Page:

Why doesn't the rest of the world take care of this problem on its own? America---a very young country by comparison---manages to have indoor, sanitary plumbing in nearly every home. Africa, I'm looking at you.

MikeLicht Author Profile Page:

Earth Day 2009: our long global cow flatulence nightmare is over.



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