Lack of Toilets Harming Health of Billions, UN Report Says

Kelly Hearn
for National Geographic News
November 15, 2006
A lack of toilets is severely jeopardizing the health of 2.6 billion people in the developing world who are forced to discard their excrement in bags, buckets, fields, and ditches, according to a new study.

"The lack of a safe, private, and convenient toilet is a daily source of indignity and undermines health, education, and income generation," according to Beyond Scarcity: Power, Poverty, and the Global Water Crisis, a report commissioned by the United Nations Development Programme (UNDP).

Much of Europe and North America built sanitation systems in the 1800s to keep humans and their drinking water away from pathogen-bearing fecal matter that can transmit cholera, diarrhea, typhoid, and parasites.

But nearly every other person in the developing world today lacks access to improved sanitation, and 1.1 billion people—one-sixth of the world's population—get their water from sources contaminated by human and animal feces, the report says.

The costs of the global "sanitation deficit" are severe.

The UN study says 1.8 million children die annually from diarrhea that could have been prevented simply by having a clean place to go to the bathroom.

The study also reports that roughly half of all people in developing countries have an illness related to sanitation and water quality. (Related: "UN Highlights World Water Crisis" [June 5, 2003].)

The report follows up on the UN's Millennium Development Goals, which include a pledge to bring sanitation to 120 million additional people every year between now and 2015.

Raising the Issue

UN officials hope that the report will raise the profile of an issue that often is buried for political and cultural reasons.

The report comes on the eve of "World Toilet Day"—November 19—which was designated by several toilet organizations in 2001 to increase awareness of sanitation issues.

"We hope this report puts the issue on the international agenda," said Marisol Sanjines, a UNDP outreach advisor.

"Sanitation is not on the political agenda, because it impacts poor people and not decision makers," Sanjines said. "The other problem is that people do not want to talk about excreta and human waste. It is taboo."

Those issues put women in many countries at particular risk.

"For women who become 'prisoners of daylight,' having a safe place to defecate and urinate is a priority," said Belinda U. Calaguas, a policy expert at WaterAid, a London-based nongovernmental organization. "Lack of sanitation affects women's reproductive health and exposes them to physical risks of sexual assault."

Some experts say an attitudinal change is necessary.

"Until we can talk about toilets comfortably, recognizing that dealing with human waste is a key priority of public health and hygiene the world over, we are not going to even get close to achieving the Millennium Development Goals," said Lauren Gelfand, media advisor for the nonprofit Oxfam GB in West Africa.

Promise to Help

Completing the UN development goals means moving people up what the report calls the "sanitation ladder," a progressive technology hierarchy that begins with open defecation and advances from "lower rung" technologies such as basic pit latrines to "pour-flush facilities" that operate with septic tanks.

The top rung is the developed world's model of pipe-fed flush toilets with adjoining sinks. But if this model is counted as the benchmark, the report says, the global sanitation deficit "would soar from 2.6 billion people to about 4 billion."

Improvements are expensive—it costs 20 times more to connect a household to a modern sewer system than to purchase a basic pit latrine.

But public health experts say the payoffs will be enormous.

"The transition from unimproved sanitation is accompanied by a more than 30 percent reduction in child mortality," the report says.

In urban areas of Peru, for instance, having a pit latrine in the home lowers diarrhea rates by half. Having a flush toilet drops the risk by 70 percent, the study says.

Intertwined Problems

Poverty, however, remains a big impediment.

Though clean water, hygiene, and sanitation are intertwined components of public health, experts say, sanitation lags behind water services.

"For people in poverty, their first priority is to get access to reliable, clean water," WaterAid's Calaguas said. "Sanitation is a distant demand when compared to the top demands of food, livelihoods, and water."

More than 660 million people without sanitation live on less than two U.S. dollars a day, and some 385 million get by on a dollar or less, according to the UN.

Even when basic upgrades such as pit latrines begin to move waste out of homes, poor nations oftentimes lack the infrastructure to move and process the waste safely.

Some 13 percent of latrines in Kibera, Nairobi, for example, can't be used because they are too full, the report says (Kenya map).

In Brazil and Mexico large numbers of the population are connected to the sewage systems, but low treatment capacity means less than a fifth of the wastewater is treated. (Related video: "Sewer Diver in Mexico City, World's Worst Job?".)

In Delhi, India, a city with "the trappings of a modern sanitation system," less than a fifth of the city's waste is treated before being dumped into the Yamuna River, the report says (India map).

Experts say meeting the UN sanitation goal with the cheapest technologies would cost $10 billion (U.S.).

"The $10 billion price tag for the [Millennium Development Goals] seems a large sum, but it has to be put in context," the report authors write. "It represents less than five days' worth of global military spending and less than half what rich countries spend each year on mineral water."

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