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This article was published in the May/June 2001 issue of Dollars and Sense magazine.

Sustainable Sanitation: A Global Health Challenge

By Laura Orlando

In late October 1995, in the small town of Greenland, New Hampshire, Wheelabrator Water Technologies, Inc. dumped 650 tons of sewage sludge on Rosamond Hughes' field. The sludge contained not only the dregs left over from sewage treatment but also 700 pounds of a nitrogen-based polymer (used to remove water from sludge) and 24,000 pounds of lime. After sitting for several days, the sludge was chain-dragged across the field's surface with a tractor, and then spread repeatedly for the next three weeks. As it dried, it was blown by steady winds toward the home of 26-year-old Shayne Conner, just 300 feet away.

Almost immediately, Conner, his family, and their neighbors began to get sick. Overcome by the stench, they started vomiting. They felt burning sensations in their eyes, throats, and lungs. They experienced nosebleeds, headaches, congestion, fever, and nausea, and they had difficulty breathing. And then, on a quiet day in November -- less than one month after the sludge was dumped on the Hughes'property -- Shayne Conner died.

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. What happened to Shayne Conner is just one tragic example of how, in rich as well as poor countries, improper sanitation can cause environmental degradation, illness, and death.

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.

Despite the preponderance of pro-sludge propaganda, however, not everyone is fooled. When Shayne Conner's mother, Joanne Marshall, filed a wrongful death suit against Wheelabrator, Dr. David Lewis -- an EPA microbiologist and whistleblower -- testified in the case. According to Lewis, the symptoms reported by Greenland, New Hampshire, residents were "consistent with a growing number of cases where people have been exposed to airborne contaminants from land-applied sewage sludge." It was well-established in the scientific and medical literature, Lewis noted, that "inhaling of irritant gases and pathogen-contaminated, limed sludge dust" could "lead to infections of respiratory and gastrointestinal systems and serious, life-threatening complications."

Why, then, 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 are dying from 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 are dying 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 Model for Sustainable Sanitation

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. (See sidebar.) Small projects have demonstrated systems that accomplish these goals while also being culturally appropriate, locally responsible, affordable, functional, and even beautiful.

One example can be found on the Caribbean coast of Mexico, a fragile ecosystem that is home to 554,000 people and four million tourists. Since 1993, the ReSource Institute for Low Entropy Systems (RILES), a nonprofit concerned with sanitation, has built about 300 composting toilets in the Yucatan Peninsula. Most are paid for by their owners: maids, gardeners, masons, carpenters, schoolteachers, doctors, editors, tourism operators, hotels, municipalities, and retired Americans, to name a few. All of them are functioning well. Word has spread that they have no smell, do not fill up, can be in the house or outside, and can be hooked to a water toilet or not; that there is somebody around who knows how to maintain them; and that there are people who will gladly take away and use the fertilizer that these systems produce. The fact that these composting toilets are also beautiful is no small part of their success. The first few were built in houses with dirt floors, but soon people with beachfront homes wanted them. Because of their aesthetic appeal, the toilets have won acceptance across class boundaries. In an effort to build a local infrastructure to keep up with demand and maintain quality control, RILES has helped establish three Mexican corporations: a company to prefabricate the composting toilets; a workers' cooperative to maintain them and build the bathrooms that go on top; and a nonprofit organization to carry out education and policy-related work. (The author is director of RILES.)

Another project is in Cuernavaca, in central Mexico, where an architect named Cesar Anorve has been promoting two chamber (double-vault) dry toilets. (One chamber is used until full, then left to dehydrate while the other is used.) Anorve has added an entrepreneurial element to his efforts by designing and selling attractive toilet fixtures. He collaborates with a nonprofit organization, Espacio de Salud, and together they have made the double-vault toilet widely available, with the construction supervision and maintenance necessary to build them correctly and keep them functioning properly.

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.


How Does a Composting Toilet Work?

Human excreta -- urine and feces -- can be treated one of two ways, either aerobically (with oxygen) or anaerobically (without oxygen). The objectives of treatment are to contain this material, eliminate disease-causing organisms (pathogens), and -- in ecological systems like composting toilets -- return the nutrients to the soil.

There are different styles of composting toilets -- some are built on site and others are commercially manufactured -- but all have these objectives in common. For instance, a single chamber composting toilet contains excreta, toilet paper, and even kitchen food waste, in a tank below the bathroom floor. There, biological activity, much like that found in a backyard compost pile, aerobically digests this material. During the treatment process, up to 90% of the volume is driven out of the ventilation stack as carbon dioxide and water. What remains is called humus, a fertilizer that looks and smells like the kind of soil you would find in a greenhouse or on a Lancaster farm.

Time, not heat, kills pathogens in the tank. Pathogens generally need their human host to survive. But it's the highly competitive environment in the tank, where they cannot compete with the composting organisms, that does them in. This takes time, which the composting toilet has because of proper sizing and volume reduction. Compost is not removed for years. The urine, on the other hand, is available in days, after passing through a nitrification process inside the treatment tank. It becomes an odorless, stable, nitrogen-rich fertilizer capable, for instance, of doubling corn yields.

The maintenance involved is simple but necessary for proper functioning. It includes maintaining airflow in the tank, periodically adding a bulking agent like coarse sawdust, and removing and using the compost and liquid fertilizer.

Laura Orlando is a member of the D&S collective and the director of the ReSource Institute for Low Entropy Systems, a nonprofit concerned with public health and the environment. Part of her work for the past 13 years has been to develop composting toilet projects.

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