When sanitation is practiced successfully, it can promote health and prevent disease. But its effectiveness depends on many factors -- education, behavioral changes, access to clean water, solid and industrial waste management, and the safe disposition of human excreta. But it is the improper management of human excreta that wreaks havoc on people's health in rich and poor countries alike.

Rich Nation, Poor Sanitation

In rich countries, sewers and sewage treatment systems are considered signs of progress, but they are the reason we have toxic sludge. First comes the sewage, a mixture of undifferentiated industrial and household wastes. Then there's the treatment process, which attempts to clean the wastewater that the sewage contains. What's left over -- after the dead cats and cardboard are screened out and hauled away to the dump -- is a concoction of whatever was flushed down the drain: motor oil, dioxin, asbestos, polychlorinated biphenyls (PCBs), heavy metals, bacteria, viruses, industrial solvents, any combination of the 70,000 chemicals used in U.S. industries, and so on. And the better the water at the end of the treatment cycle, the nastier the sludge will be.

At one time, sludge's pungent smell was considered offensive only on aesthetic grounds. But new research in the Journal of Agromedicine confirms that sludge's olfactory assault can have serious physical health consequences as well. So, while it might seem safe and convenient to have our waste whisked out of sight, we're paying the piper at the end of the pipe.

In spite of sludge's poisonous properties, the federal government keeps calling it a fertilizer and putting it on land. The Environmental Protection Agency (EPA) is in charge of regulating the disposal of sewage sludge. Since 1992, when Congress banned the practice of dumping sludge in the ocean, the EPA has geared its regulations and public relations efforts toward one goal: To dump sludge wherever possible, primarily on U.S. farmland. That's the cheapest way to dispose of sludge and launder the toxic waste that goes into sewers. The EPA now goes to great lengths to convince people that sludge makes good fertilizer. For instance, the agency refers to sludge as "biosolids" -- the winning entry in a 1990 contest sponsored by the sewage industry to make its main product more marketable.

Why is the United States so invested in the sewers and sewage treatment plants that produce toxic sludge? Since passage of the Clean Water Act in 1972, many communities have had no choice but to put in sewers and build expensive sewage treatment plants. The resulting multi-billion dollar sewering effort created a powerful wastewater industry. The EPA, while ostensibly charged with protecting the environment, caters to that industry and other corporate interests.

What we do with sludge now is a public health and environmental disaster. Instead, sludge should be treated as a hazardous waste. We need to promote public policies that aim to reduce its production, by not extending existing sewers or building new ones. In addition, source separation should be the mantra of the EPA (and you and me): Keeping waste products separate at the point of production will greatly facilitate safe recycling and reuse.

Sanitation Crisis in the Global South

In the wealthiest country in the world, people's health is threatened by the industrial end product of state-of-the-art sewage treatment systems. In the Global South, where 65% of the population have no sanitation facilities at all, people get sick from exposure to excreta that carries disease.

The state of global sanitation, according to Akhtar Hameed Khan, is "unconscionable." Khan is the director of the Orangi Pilot Project, a low-cost sanitation project that has reached thousands of people in Karachi, Pakistan. "On the brink of the 21st century," he wrote in Progress of Nations, a 1997 UNICEF study, "half the world's people are enduring a medieval level of sanitation. Almost 3 billion individuals do not have access to a decent toilet, and many of them are forced to defecate on the bare ground or queue up to pay for the use of a filthy latrine."

The "medieval level of sanitation," Khan points out, results in a "medieval level of disease." The improper management of human excreta wreaks havoc on people's health in both rich and poor countries. But its consequences are most brutal for poor people in developing nations, where it results in the deaths of 2.2 million children each year. In densely settled areas where there is no containment of human waste, disease-causing organisms -- primarily found in feces -- easily move from one person to the next. (Water is the ideal but by no means the only conduit.) These organisms cause many illnesses, including diarrhoeal diseases, which are responsible for killing the majority of children who die before reaching the age of five. In addition to promulgating disease and degrading water and soil quality, the lack of ecological excreta management is a dignity issue in people's everyday lives.

When it comes to investing in environment sanitation, however, bringing health and dignity to poor people is not high on the list. The lion's share of such investment goes to sewerage in urban areas, subsidizing services for industrial development, the middle class and the rich. According to the United Nations, in 2000, only 34% of rural residents in developing countries had access to sanitation, compared with 80% of urban residents. During the UN-declared International Water and Sanitation Decade (1980-1990), funding for sanitation skyrocketed. But according to Frank Hartvelt, deputy director of the Science and Technology Private Sector Division of the UN Development Programme, 80% of all investment went to "well-off urban areas, for expensive installations." As in wealthy countries, it is those with the most economic clout who decide what kinds of public services will be provided, and who will benefit from the expenditure of public funds.

These same priorities determine what types of solutions the world's sanitation "experts" devise. In 1998, the UN set up the World Water Commission to examine water issues. In its Vision Report, published last year, the Commission identified what it called "a vital need for high tech innovation." As an example of this, the Report suggested "the use of computer chips to control the digestion process in smart-composting toilets." Good for Intel -- bad for the three billion people without any toilet. The digestion process in composting toilets needs carbon -- chopped leaves, wood chips -- not silicon. But then again, they wouldn't be able to add and subtract.

People in the Global South live in a world rich enough to afford a universal level of sanitation that would help to protect their health. But regardless of how much money is available, we will trade one set of problems for another unless we radically rethink how that money is spent.

A New Approach

The truth is, neither sewers nor computer chips in composting toilets are functionally or environmentally sustainable. Instead, what is needed are sanitation systems that keep toxic and human wastes separate, prevent pollution, and return the nutrients in urine and feces to the soil as fertilizers. Small projects have demonstrated systems that accomplish these goals while also being culturally appropriate, locally responsible, affordable, functional, and even beautiful.

Why not just hand out blueprints and leave it at that? It doesn't work. It has been demonstrated over and over again that there is an infinite number of ways to build a composting toilet so that it does not function well. Training and supervision take care of this. Regular maintenance keeps the toilets working. Homeowners need support for these things. Add to this the fact that there is a social change element to the project, and you can see why a blueprint won't do the trick.

Though do-it-yourself construction can be an effective way to get some on-site systems built for low-income households, many other components are needed to bring these efforts to scale. Providing sustainable sanitation technologies for billions of people will require replacing the existing engineering and financial infrastructure that currently supports sewerage with one that supports ecological innovations in waste treatment. And that, in turn, will require massive government and organizational -- for-profit sometimes, nonprofit other times, a combination of both most of the time -- intervention. And whatever the technology, people will have to want it.

What is needed is a new approach consisting of:

• Principles that put source separation first in the decision-making hierarchy;
• People who approach sanitation from both a health and ecological perspective;
• Financing -- both private and public -- to develop production and marketing capabilities;
• Easy access by those who want sustainable sanitation technologies to those who can deliver, install, and maintain them;
• Financial packages to help people pay for toilets; and
• Government policies that punish polluters, reward ecological innovators, and promote and help pay for universal sustainable sanitation coverage.

The fact that half of the people in the world do not have a toilet reflects government priorities that are politically and morally bankrupt. The fact that the other half has little or no access to sustainable sanitation reflects misconceptions about conventional sanitation systems and what they can and cannot do. Under the current system, everyone suffers. But it doesn't have to be that way.

Laura Orlando
Editor

An expanded version of this editorial was published in the May/June 2001 issue of Dollars and Sense magazine. Here is the full text: Sustainable Sanitation: A Global Health Challenge

ReSource Musings Archive