A staggering 2.4 billion people worldwide, or one third of global population, lack improved sanitation
Perhaps most of us don't know that today is World Toilet Day, meaning this is a day in a year dedicated to toilet since United Nations' official designation of November 19th as such in 2013. In other words, it is a day to remind ourselves that: 1) still about a billion people worldwide lack toilets and have to relieve themselves in open areas—forest, bush, roadside, riverbank, fields, alleyways or whatever is available and accessible at a moment; and 2) toilet is a vital sanitation technology and ensuring peoples' access to it can bring about better health outcomes.According to 2015 joint report of UNICEF and World Health Organization, a staggering 2.4 billion people worldwide—one third of global population—lack improved sanitation, which means they either defecate in the open or their excreta is not properly disposed of.
In January 2007, British Medical Journal (BMJ) released the results of a poll it conducted to find out the greatest medical advance since 1840, when the journal was first published. The poll put sanitation—particularly piped water and sewer technology—ahead of antibiotics and anesthesia as the greatest medical advance in the past 150 years.
One may wonder why the 'greatest medical advance' of the past one and half centuries was such a neglected topic in development and public policy worlds until a decade ago. And there is no short-cut and clear answer to it. One of the reasons why international development organizations and agencies working in developing countries overlooked sanitation crisis for so long is because of their own presumption about sanitation.
For many Europeans and Americans today, open defecation as we in Nepal understand does not make sense at all. It is hard for them to imagine the risks of losing life or discontinuing school or experiencing harassment simply due to inadequate or lack of sanitation. Their taken-for-granted knowledge of sanitation—more particularly toilet—as clean, private, safe and connected to flush system and sewer blinds them from internalizing that the sanitation system they have now was a thing beyond imagination even until the early 19th century.
Sanitation and nutrition
This year the United Nations' theme for World Toilet Day is sanitation and nutrition. Their website reads: "This year, World Toilet Day is focusing on the link between sanitation and nutrition, drawing the world's attention to the importance of toilets in supporting better nutrition and improved health. Lack of access to clean drinking water and sanitation, along with the absence of good hygiene practices, are among the underlying causes of poor nutrition."
New researches demonstrate the link between sanitation and stunted growth. Stunting is more than a matter of appearance as it involves a range of development problems—including psychological and mental. In his 2014 article, Charles W. Schmidt quotes Reynaldo Martorell, a professor of international nutrition at Emory University, as saying, "the more stunted the child is, the more likely it is that the brain, kidneys, and other organ systems will be affected."
As studies have shown, stunting affects human capital and productivity. Recent findings argue that to address the issue of malnutrition, the conventional approach of dietary improvements are important but not sufficient. They urge to focus on lack of or poor sanitation and hygiene as an impediment to adequate growth of children. Addressing malnutrition thus requires solving the sanitation crisis, among others.
Real costs
Beyond malnutrition, sanitation is also linked to people's social and psychological experiences of privacy, safety, dignity, embarrassment and harassment. For example, the provision of toilets and adequate sanitation infrastructure can avoid thousands of preventable deaths of children, harassment and rape cases of women and girls, school dropouts and absenteeism particularly among female students, and the dangers of human and animal attacks.
Moreover, better sanitation and hygiene means saving billions of dollars in health expenditures caused by waterborne diseases like diarrhea, cholera, and typhoid. According to World Bank's Water and Sanitation Program report, inadequate sanitation caused India about US $54 billion losses in 2006 alone—equivalent to 6.4 percent of India's GDP in that year. Considering these economic, social, psychological and physical costs due to poor sanitation, investment in sanitation infrastructure and network seems to be a smart move for any government of developing countries.
Inclusive toilets
Unfortunately in Nepal, when it comes to infrastructure, roads, bridges, communication technologies and buildings (for offices, businesses, education and medical practices) get way more priority over sanitation system. Even big public buildings have toilets in pathetic condition. The long stretches of highways and all major cities have extremely low numbers of public toilets than required for the populations. Those that exist are stinky, foul, and in some cases, without running water. In the first place, a large numbers of toilets need to be built so as to meet the sanitation and hygiene needs of the people.
However, the building of toilets alone does not solve the sanitation crisis unless people start to continuously use it. The continuous use depends partly on how safe, inviting, clean, accessible and affordable the toilets are. Further, until the equal and unhindered access of all people to sanitation is guaranteed, the job of solving sanitation crisis remains incomplete. As Nepal is yet to earnestly start reconstruction program in the aftermath of the ravaging earthquakes, there is an opportunity to build inclusive sanitation infrastructure to which all sections of population—children, elderly, pregnant women, disabled, ill—have equal access.
The inclusiveness of infrastructure can only be met when the designs and architectures of it are appropriate and accessible to all people. The debate of how to make toilets inclusive seems to have already started as a few weeks ago, news had surfaced that some disabled-friendly toilets would be installed in Ratna Park of Kathmandu. Let's hope the discourse comes into practice soon.
The author is a PhD Candidate in Anthropology at Simon Fraser University, Canada and currently researching on sanitation campaigns in Nepal
br.kavyi@gmail.com