Introduction
In "The Big Necessity," Rose George tackles a subject that most people prefer to avoid: human waste and sanitation. This eye-opening book explores the often overlooked but crucial issue of how we deal with our bodily waste and its far-reaching implications for global health, economics, and the environment. George takes readers on a journey around the world, examining different approaches to sanitation and the consequences of inadequate waste management.
The Global Sanitation Crisis
A Hidden Problem
Many of us take toilets and sewage systems for granted, but for a staggering 2.6 billion people worldwide, proper sanitation is a luxury they don't have access to. These individuals are forced to relieve themselves in public spaces, forests, or even plastic bags that end up discarded in overcrowded slums. The result is a world where four out of ten people live surrounded by human excrement, leading to severe health and environmental consequences.
The Deadly Impact
The lack of proper sanitation is a silent killer. One gram of feces can contain millions of viruses, bacteria, parasites, and worm eggs. In areas without adequate sanitation, people may unknowingly consume up to ten grams of fecal matter daily. This contamination leads to widespread disease, with one out of every ten illnesses globally linked to poor sanitation.
The most vulnerable victims are children. Every 15 seconds, a child dies from diarrhea, a condition that is 90% attributable to fecally contaminated food or water. In fact, more children have died from diarrhea in the past decade than the combined death toll of all armed conflicts since World War II. UNICEF considers diarrhea a greater threat to child survival in developing countries than AIDS, tuberculosis, or malaria.
The Power of Proper Sanitation
Investing in sanitation is one of the most effective ways to save lives and improve public health. When the British Medical Journal asked its readers to choose the most important medical innovation in history, sanitation came out on top – surpassing even antibiotics and vaccines.
The impact of proper sanitation is dramatic. In 19th century London, one out of every two children died prematurely. The introduction of toilets, sewers, and hand-washing practices led to a 20% decrease in child mortality – the most significant drop in British history. Today, experts estimate that having access to a toilet can add 20 years to the average human life, making it the single most important factor in longevity.
Economic Benefits
Beyond the health implications, investing in sanitation makes economic sense. For every dollar spent on sanitation, there's an average return of seven dollars through increased productivity and reduced healthcare costs. If the world invested $95 billion to achieve global sanitation coverage, it could save an estimated $660 billion.
A stark example of the economic impact of poor sanitation is Peru's 1991 cholera outbreak. The country spent $1 billion to contain the epidemic, which could have been prevented with a $100 million investment in better sanitation infrastructure. Moreover, in just ten weeks, Peru's losses in agriculture and tourism revenue were three times greater than what had been spent on sanitation over the previous decade.
The Taboo of Sanitation
A Difficult Conversation
Despite its critical importance, sanitation remains a taboo subject in many cultures. The English language itself reflects our discomfort with the topic, lacking a neutral term for bodily waste that's appropriate for polite conversation. We resort to euphemisms or medical jargon, further distancing ourselves from the reality of human waste management.
Historical Shifts
Our attitudes towards defecation have changed dramatically over time. Anthropologist Norbert Elias studied this evolution in his book "The Civilizing Process." He noted that in earlier times, it was considered an honor to greet a king while he sat on his chamber pot. Today, we prefer to conduct our business behind closed doors, reflecting a broader societal shift towards privacy and discretion in matters of bodily functions.
Policy Implications
The taboo nature of sanitation has real-world consequences. In international policy discussions, people often use sanitized language, referring to "water-related diseases" instead of directly addressing fecal contamination. This reluctance to confront the issue head-on contributes to sanitation being overlooked in government budgets and aid programs.
For instance, Pakistan spends 47 times more on its military than on clean water and sanitation, despite losing 120,000 people annually to diarrhea. Similarly, the US foreign aid agency USAID allocates 90% of its water and sanitation budget to water supply, even though improved sanitation could have a much greater impact on reducing diarrhea rates.
Changing Habits and Attitudes
The Challenge of Implementation
Simply providing toilets and latrines isn't enough to solve the sanitation crisis. Between 1986 and 1999, India's Central Rural Sanitation Program installed 9.45 million latrines, increasing their availability by 15%. However, many of these facilities went unused or were misused. Some people preferred open defecation to using latrines that lacked a nearby water source.
Community-Led Total Sanitation (CLTS)
Recognizing the limitations of top-down approaches, activists have developed more effective strategies that focus on community engagement and behavior change. One such approach is Community-Led Total Sanitation (CLTS), pioneered by Kamal Kar, an Indian consultant for the non-profit organization WaterAid.
In 1991, Kar visited the Bangladeshi village of Mosmoil to address the issue of open defecation. Instead of simply building latrines, he engaged the villagers in a process of self-discovery. Together, they calculated the enormous amount of excrement surrounding their community – about 120,000 tons. This shocking realization prompted some villagers to vomit and sparked a village-wide initiative to improve their sanitation practices.
The CLTS approach has since been widely adopted in India and other countries. By focusing on changing attitudes and behaviors rather than just providing infrastructure, CLTS has proven more effective in creating lasting improvements in sanitation.
Sanitation: A Global Issue
Developed Countries Aren't Immune
While the sanitation crisis is most acute in developing countries, even wealthy nations face significant challenges. In the United States, often considered the world's most powerful country, 1.7 million people still lack access to proper sanitation.
The American Society of Civil Engineers regularly grades US infrastructure, and the country's wastewater system has consistently received poor marks. In 2000, it earned a D grade, which slipped to a D- in 2005. The US Environmental Protection Agency estimated that by 2020, half of the country's sewage pipes would be in danger of collapse.
New York City's Sewage Woes
Even major cities like New York struggle with outdated and overwhelmed sewage systems. New York's system combines rainwater runoff with wastewater from homes and businesses. While this design works under normal conditions, it becomes problematic during heavy rainfall.
On August 8, 2007, a severe rainstorm in New York City caused the sewage system to overflow, flooding the subway system and disrupting public transportation. Moreover, the city's sewer system is designed to discharge excess waste into nearby bodies of water when overwhelmed. According to the environmental group Riverkeeper, these discharges occur weekly, releasing an average of 500 million gallons of sewage into local waterways.
A National Problem
The issue extends far beyond New York City. Across the United States, the wastewater industry discharges 1.46 trillion gallons of sewage into various waterways and oceans annually. This massive amount of pollution poses significant environmental and public health risks.
The Potential of Human Waste
Rethinking "Waste"
While the challenges of managing human waste are daunting, there's growing recognition that feces can be a valuable resource rather than mere waste. Throughout history, some have recognized this potential. Martin Luther, the 16th-century Protestant reformer, reportedly consumed a spoonful of his own excrement daily, believing it had medicinal properties.
Modern Applications
Today, we're discovering numerous ways to put human waste to good use:
Construction materials: Feces can be transformed into bricks and used in road construction.
Agricultural fertilizer: The nitrogen and phosphates in human waste make it an excellent plant fertilizer.
Medical treatments: Fecal transplants have shown a 90% recovery rate in patients with severe bacterial infections.
Energy production: Human waste can be converted into biogas, a renewable energy source.
China's Biogas Revolution
China has been at the forefront of harnessing the potential of human waste, particularly in rural areas. As of the last count, 15.4 million rural Chinese households have biogas digesters connected to their toilets. These systems convert feces into energy used for heating and lighting.
The benefits of this approach are numerous:
Reduced energy costs: One cubic meter of biogas can provide six hours of light from a 60 to 100-watt bulb.
Fertilizer production: The byproduct of the biogas conversion process can be used as fertilizer, eliminating the need for expensive artificial alternatives.
Increased crop yields: China's Research Institute of Medical Military Scientists claims that vegetables fertilized with biogas byproducts show a 50-60% increase in yield.
Forest conservation: By providing an alternative fuel source, biogas reduces reliance on wood for cooking and heating, helping to preserve forests.
Time savings: Meals cooked using biogas stoves can be ready in 20 minutes, compared to two hours when using traditional wood-burning stoves.
Challenges in Waste Recycling
Implementation Hurdles
While the potential of human waste recycling is promising, implementing these solutions on a large scale comes with numerous challenges. China's experience with biogas digesters illustrates some of these difficulties:
Maintenance issues: Many farmers in rural China rejected biogas systems due to the complexity of maintaining the new toilets. Lacking proper training, some reverted to using unsanitary, hole-in-the-ground latrines.
Behavioral change: Despite the benefits of biogas, some people returned to using wood for fuel, leading to increased deforestation rates that alarmed the federal government in Beijing.
Safety concerns: The use of biogas slurry as fertilizer has sparked debates among experts. While some argue that harmful pathogens are eliminated during the four-week digestion process, others worry about potential health risks from using human waste-derived fertilizers.
The Need for Open Discussion
Addressing these challenges requires open and honest dialogue about sanitation and waste management. However, societal taboos often hinder productive conversations on these topics.
The reality is that everyone produces waste, and the average person spends about three years of their life using the toilet. By normalizing discussions about sanitation, we can foster innovation and find more effective solutions to global waste management problems.
Some notable figures have recognized the importance and even beauty of sanitation infrastructure. French architect Le Corbusier considered the toilet "one of the most beautiful objects industry has ever invented," while author Rudyard Kipling found sewers more compelling than literature.
Dr. Bindeshwar Pathak, an Indian sanitation expert, argues that discussions about sanitation are inherently linked to broader societal issues, including national economies, politics, media, and cultural preferences. By engaging in these conversations, we can begin to address the complex web of factors that contribute to the global sanitation crisis.
Conclusion: A Call to Action
"The Big Necessity" serves as a wake-up call, urging readers to reconsider their attitudes towards human waste and sanitation. The book highlights the urgent need for action on multiple fronts:
Increased investment: Governments and international organizations must prioritize sanitation in their budgets and development programs. The potential return on investment, both in terms of lives saved and economic benefits, is too significant to ignore.
Innovation: We need to continue developing and implementing new technologies and approaches to waste management, from more efficient sewage systems to creative ways of recycling human waste.
Behavior change: Efforts like Community-Led Total Sanitation demonstrate the importance of engaging communities and changing attitudes towards sanitation. These approaches should be expanded and adapted to different cultural contexts.
Policy reform: Policymakers must address the systemic issues that contribute to poor sanitation, including inadequate urban planning, lack of regulation, and insufficient funding for infrastructure maintenance.
Education: Improving public understanding of the importance of sanitation and proper hygiene practices is crucial for long-term change.
Breaking taboos: We need to foster more open and constructive dialogue about human waste and sanitation, removing the stigma that often surrounds these topics.
By addressing the global sanitation crisis, we have the opportunity to dramatically improve public health, boost economic productivity, and create more sustainable communities. The challenges are significant, but the potential benefits are enormous. As Rose George demonstrates in "The Big Necessity," it's time to confront the unmentionable and transform our relationship with human waste. Our lives and our planet depend on it.