You’ve used a toilet today. We both know it. You did your business, flushed, washed your hands, and forgot about it. And why not? Your waste has been whisked away to who-cares-where, and so long as you don’t have to see or smell it, there’s no second thought to think.
The distance we’re able to maintain from our feces allows us the luxury of forgetting, but four in ten people—that’s 2.6 billion—have no sanitation, not even an outhouse or a pit. There is no choice but to squat in fields, alongside roads, or near doorsteps, a practice known as “open defecation.” This lack of access forces those affected not only to see, smell and walk amongst their own feces, but also to face the health consequences wrought by contaminated food and water. According to Rose George, journalist and author of The Big Necessity: The Unmentionable World of Human Waste (Metropolitan), one gram of human feces can contain 10 million viruses, 1 million bacteria, 1,000 parasite cysts, and 100 worm eggs. Community sanitation advocate Kamal Kar estimates that those living in places where open defecation is common inadvertently ingest more than ten grams of fecal matter every day, and the consequences are clear. Children face the greatest risk; playing in the mud can lead to deadly disease. George highlights statistics that are difficult to stomach: A child dies every 15 seconds as a result of diarrhea—90 percent of which can be attributed to fecal contamination—and the number of children who’ve died of it in the past decade exceeds the number of people killed in armed conflict since World War II.
For those who survive childhood, issues of dignity and risk to personal safety compound the health risks—especially for women and girls with no access to sanitation. The New Internationalist has reported that in the name of modesty, women in India often wait until darkness falls to venture to the fields and forests, risking snake bites, scorpion stings, and sexual assault. Daylight hours are spent holding it in, leading to an increased risk of urinary tract infections and chronic constipation. George writes that the education of young girls in South Africa is severely limited by the capacity of schools to provide privacy and clean toilets. When menstruation begins, educations often end.
These sobering facts are perfect fodder for celebrity advocacy and fundraising—so why isn’t Bono hawking Project(brown) totes and baby tees? An initial investment of $95 billion could achieve universal sanitation by 2015, George writes, and would save $660 billion in averted health costs and increased productivity. George believes a celebrity advocate would do wonders for global sanitation and has hope that Matt Damon will lead the charge. “Damon has started to talk about school latrines, which is great news,” George told Salon. "It’s inevitable because he does a lot of great work on clean water.”
The truth is, governments and NGOs can install shiny new taps in village squares all they like, but access to clean water is temporary at best without effective sanitation. The United Nations dedicated 2008 as the International Year of Sanitation, but it was also the International Year of the Potato. This kind of thing will never be enough, and due in no small part to the broad swath of cultures affected by the problem, one-size-fits-all solutions won’t be enough either—solutions will have to be tailor made. Stanford reports on a research project in Tanzania that aims to determine the most effective ways to convince people to alter their hygiene habits. With expenses like food, clothing, and cell phones to contend with, health considerations alone are not enough to compel those with limited incomes to invest in latrines. “When you ask people about the importance of [water] treatment,” says researcher Agnes Lwitiko, “they say they know, but it’s expensive and my grandfather and grandmother didn’t do it that way.”