Despite modern marvels such as the space toilet, much of the world still endures a medieval level of sanitation. Nearly 2.6 billion people live without basic services, forced to defecate on the ground or line up to pay for the use of soiled latrines.
Some historians give the flush toilet mythological origins in the court of King Minos of Crete. Queen Elizabeth I had one as well, built by her godson in 1596. In the nineteenth century, architects started to incorporate water closet innovations into their designs and the modern toilet was born. Thomas Crapper, a British plumber, had a hand in perfecting the cistern to make flushing quieter and more polite.
Royal provenance aside, today's urban slum residents are far from acquiring thrones of their own. Across the developing world, slums often have one latrine for every 5,000 people, if any outlet at all.
In China, internal migrants squeeze into shantytowns without sanitation or running water. The Associated Press reported last year that the rapidly industrializing city of Chongqing opened a public "porcelain palace" with an Egyptian facade, calming music, and more than 1,000 toilets. They were gunning for a Guinness Record.
The health burdens of insufficient sanitation are worse for women. Destitute urban women are caught in a bind—expected to uphold standards of modesty while lacking access to private facilities, writes historian Mike Davis in Planet of Slums.
"The absence of toilets is devastating for women. It severely affects their dignity, health, safety and sense of privacy, and indirectly their literacy and productivity," writes Frontline Special Correspondent Asha Krishnakumar.
According to a report by the Centre for Science and Environment, "Women and girls have to wait until dark before they can answer the call of nature. At times this exposes them to harassment and even sexual assault."
In India, medical discrimination against women can exacerbate the problem. Male children and adults often receive immediate attention for diseases (including waterborne disease), while female children and adults are considered secondary patients. Women experience higher rates of morbidity and mortality as a result.
Proper sanitation plays a major role in preventing cholera and other diarrheal diseases—a conclusion recognized in the Millennium Development Goals, which aim to decrease by half the number of people without access to basic sanitation by the year 2015. According to David Douglas, president of Water Advocates, "Each day 4,500 children die around the world due to mostly preventable water and sanitation-related diseases."
One of the most successful sanitation initiatives is the Orangi Pilot Project, led by Akhtar Hameed Khan in Karachi, Pakistan. Community-owned and community-managed, the program has upgraded infrastructure to improve sanitation for more than one million people. The project encourages and strengthens local initiatives through social and technical guidance, credit for micro-enterprise, and development partnerships with government. The project's strategy is to "minimize external support and help households achieve their own local development needs."
The Orangi Pilot Project was created in 1980 in response to government failures to bring basic services to squatter settlements. Sewerage was determined as the highest priority for the settlements, and the OPP argued that the local government should install the system free of charge. The government refused because of "Orangi's unauthorized status," so the Orangi Pilot Project designed an "innovative low-cost sewerage system that was financed and constructed completely by the community." The success of this project attracted international donors, and similar projects developed in the Sukker Municipality, Province of Sindh.
Orangi's Low Cost Sanitation Program enables thousands of low-income families to finance, manage, and maintain sanitary latrines in their homes. The program covers 338 settlements in Karachi, and 65 cities and villages across the Sindh and Punjab provinces. The program has "evolved from a lane to the city," and these policy successes are being adopted at the national level.
To highlight the issues surrounding sanitation, the UN General Assembly declared 2008 the International Year of Sanitation—a watershed year dedicated to improving access. The estimated annual cost to reach the Millennium Development Goal for sanitation is $10 billion. If continued beyond 2015, this same level of investment could achieve basic sanitation for the entire world within the next 20 years. This annual expenditure equates to less than 1 percent of world military spending, about one-third of global spending on bottled water, and about how much Europeans spend on ice cream every year.
Despite this gulf between rich and poor, the developed world has its own water and sanitation problems. Flush toilets are one of the largest indoor users of water and a major source of water degradation. Toilets built before 1983 use 5 to 7 gallons per flush. Multiply by the number of flushes per day and the population of the United States and the volume of water degraded daily adds up fast.
In 2000, the National Water Quality Inventory found that about 40 percent of streams, 45 percent of lakes, and 50 percent of estuaries in the United States that were assessed were not clean enough to support uses such as fishing and swimming. The leading causes of impairment include bacteria, nutrients, metals (primarily mercury), and siltation that stem from agricultural runoff, municipal point sources (sewage treatment plants), and hydrologic modifications (channelization, flow regulation, and dredging).
To reduce the degradation of water at the household level, Kara Nelson, a civil and environmental engineer from the University of California–Berkeley, suggests providing collection, treatment, and disposal of fecal waste through reduced water volume flush toilets and septic tanks at each house, and localized community sewer systems and treatment plants. To conserve water, the maximum permissible water use per flushing cycle is now 1.6 gallons.
The world is facing a sanitation challenge, but it is manageable. Universal and efficient sanitation coverage can be achieved over the next ten years for roughly "0.03 percent of global GDP," said Nicolas Apostolidis, leader of the Sanitation Challenge for the World Business Council for Sustainable Development. "That's 6 cents per day per person only counting the G7 countries."
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