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| Last Updated:22/04/2014

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Why sanitation should be sacred

The Economist, 21 April 2014



THE first decade of this century brought a surge in aid for health, particularly for HIV and malaria. Now health officials and wonks are debating how to fight a broader range of diseases. The World Bank has set a goal of universal health-coverage by 2030.


This is an important, complex endeavour. But in the effort to improve health-care, it is worth remembering a simple, albeit unsavoury truth: poop matters.


In the history of public health, few events are as important as a discovery made not far from the site of The Economist’s London offices in the mid-19th century. A doctor named John Snow reported that a contaminated water pump was helping to spread cholera. Subsequent investment in sewage systems helped banish the scourge from London and much of the world. Today proper water and sanitation systems are as crucial as ever to avoid crippling infectious diarrhoeal diseases, such as cholera and salmonellosis. Every dollar spent on sanitation brings a return of $5.50, in the form of lower health costs and improved productivity, according to the World Health Organisation.


Worryingly, however, 14% of the world still practises what health types politely call “open defecation”. In poor countries that share is 21% and, interestingly, in lower-middle income countries the share rises to 32%. India is becoming an economic giant. But 48% of its population relieve themselves outdoors. There are efforts to change this. Most of the 86 countries surveyed in a new report have plans to improve water and sanitation. But less than one-third have implemented them. Insufficient funds is one problem, but money has also been spent poorly. Donations for water and sanitation have risen in the past three years, but spending has remained flat. Countries blame complex procedures for procurement. Donors blame poor management within countries.


There is some hope that this will change. Finance ministers and the heads of the World Bank and the United Nations met in Washington, DC, this month to discuss the issue. UNICEF has launched a campaign in India to end the practice of open defecation. A web video informatively titled “Take the poo to the loo” features dancing brown mounds. Disgusting, perhaps, but better that than an epidemic of infectious, deadly diarrhoeal disease.