Looking for life, destroying life: Well, shit

Poop. It’s gross, smelly and no one really wants to talk about it. It’s not the kind of heart-wrenching cause that has billionaires ready to drop a few million. But here’s the thing: lack of access to proper toilets has profound effects on the health, economies and well-being of global populations.

In public health, this is called a “WASH-related” issue. WASH stands for water, sanitation and hygiene. These three distinct topics are inextricably intertwined even though many researchers focus their efforts on one of these fields. For example, without toilets people defecate into the environment. When this occurs,  sanitation is affected. Then people have contaminated water, and hygiene cannot be maintained.

Open defecation is the practice of defecating on the streets, into the bushes, or really in any place other than a toilet. This occurs frequently when people lack access to a toilet. This issue is most prevalent in India, where 626 million people openly defecate. WASH infrastructure is absolutely necessary to address this issue.

There are many reasons why this problem puts humans in danger. First of all, open defecation poses a unique challenge for women and children. When defecating in the open, these populations are susceptible to snake bites and physical attacks like sexual assault. Additionally, out of fear of losing their dignity or being seen, women often wait until nightfall to relieve themselves. Unfortunately, this timing only increases their likelihood of being attacked.

This practice also exacerbates the rates of disease in low and middle-income countries (LMICs). According to UNICEF India, one gram of human feces contains 10 million viruses, 1 million bacteria and 1,000 parasitic cysts. The likelihood of contracting diarrheal disease is directly impacted by insufficient sanitation.

For example, take a person infected with hookworm in a LMIC. That person then defecates outside, and the helminth eggs in their body are then deposited into the environment. Those eggs mature and hatch to form hookworm larvae. These baby parasites can then penetrate the skin of humans, so a barefoot child walking along a path covered in human feces would then contract hookworm. The accumulation of intestinal worms then causes diarrheal disease across populations.

Additionally, the practice of open defecation has an enormous economic cost. After accounting for costs associated with mortality and morbidity, decreases in productivity, losses in tourism and lower rates of education, the World Bank deemed that improper sanitation cost India 6.4 percent of its entire GDP in 2010. For context, that is the equivalent of $53.8 billion.

The construction of toilets in communities requires investment. But there is surely a return on this investment. Coined as the ‘sanitation market,’ building WASH infrastructure can not only improve health but also increase the job market in LMICs.

Open defecation most significantly affects the poorest urban households. As of now, there are 1 billion people around the world who are forced to defecate in the open due to extreme poverty. This is more than just a health issue: it’s an issue of human dignity.


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