To improve global health, reinvent the toilet
by Bloomberg editorial
The toilet is a magnificent thing. Invented at the turn of the 19th century, the flush version has vastly improved human life.
The toilet has been credited with adding a decade to our longevity. The sanitation system to which it is attached was voted the greatest medical advance in 150 years by readers of the British Medical Journal.
Unfortunately, it is an impractical luxury for about two-thirds of the world's seven billion people because it relies on connections to water and sewerage systems that must be built and maintained at great expense.
About 40 per cent of all people, an estimated 2.6 billion of them, have no access to even a minimally sanitary facility, according to the World Health Organization (WHO).
The result is illness and early death. Diarrhoeal diseases, including those linked to improper sanitation, are the second-largest killer in the developing world, taking two million lives annually.
A cholera outbreak in Haiti, which has so far killed more than 7,000, apparently began when sewage from a base housing Nepalese peacekeepers contaminated a water source.
NEW DESIGNS REQUIRED
Vaccines and medicines against these diseases help. But the ultimate solution is to address the problem at its root, and doing so requires reimagining the toilet. New designs are required for toilets that are hygienic, pleasant and cheap to make and use, and that work without being connected to a grid.
As such a facility would have to be periodically emptied, ideally excretions should be treated not as waste but either recycled on site or turned into profitable resources.
Among the designs being developed by eight university teams funded by the Bill & Melinda Gates Foundation are several that divert and capture urine, from which water can be recovered. Others produce energy by turning excrement into charcoal or gas.
Governments and universities should fund similar grants aimed at encouraging additional innovative toilet redesigns.
The Gates Foundation requires that the overall cost of a future toilet, including maintenance, should not exceed 5 US cents (6.3 Singapore cents) a user a day - a price developing-world consumers can afford. That would enable the private sector to step up production and distribution once practical new models have emerged.
Cities would have to build a new generation of waste-processing centres, but the investment would quickly pay for itself.
ADVOCACY EFFORTS NEEDED
A WHO study suggests that every dollar devoted to improving sanitation and drinking water produces economic benefits ranging from US$3 to US$34 because of healthcare savings, deaths averted, and improved productivity and school attendance.
As operating a toilet will cost individuals a little money, the uninitiated - the 1.1 billion people who defecate in the open - will have to be persuaded of the benefits. This will require huge education and advocacy efforts, for which United Nations agencies and non-government organisations that deal with the world's poor have proved to be well-suited, based on their rollout of HIV drugs, for instance.
For gridless sanitation to be economical, commerce needs to flourish around the collection and treatment of excrement. Government agencies and charitable business associations could help by offering local businesses small grants, loans and expert guidance to encourage this enterprise.
One model is the US-based Acumen Fund, which offers loans to, or equity in, companies that provide consumers in the developing world with essential needs. In 2004, the fund invested US$600,000 in WaterHealth International, established to bring safe drinking water to rural Indians, and today the company serves more than five million people.
More than anything, these potentially helpful actors must go beyond recognising sanitation as an issue and embrace it. So far, squeamishness has been an impediment. As a result, other public-health causes have claimed greater attention and funding.
According to an annual report by the George Institute for Global Health, of the money spent on research and development of new products for diseases that disproportionately affect the developing world, AIDS accounts for 39 per cent, malaria 18 per cent and tuberculosis 15 per cent.
Diarrhoeal diseases get 5 per cent, though they cause more morbidity and mortality than anything but lower respiratory infections, mostly pneumonia (which attracts a lousy 3 per cent of the research total).
Bad sanitation is a problem not so hard to solve, if only we devote ourselves to spreading the wonders of the toilet.