Toilets: A simple solution to world health issues

Share via

While keeping in mind that this is a family newspaper, let’s talk about poop.

When you flush your toilet here in Los Angeles, the waste is likely to end up at the Hyperion Treatment Plant in El Segundo, which every day receives enough raw sewage to fill the Rose Bowl several times over. At Hyperion, the sewage is processed via a series of pipes and giant tanks until the solid waste is sufficiently pathogen free to be trucked off as fertilizer. There isn’t even any odor, for that too is captured in pipes and processed.

Barring a serious home plumbing catastrophe, or the presence of infants or toddlers, most of us don’t come in contact with human fecal matter that isn’t our own.

We are extremely lucky. According to the World Health Organization and UNICEF, 40% of the world — 2.6 billion people — engages in open defecation. This lack of toilets is the cause of an estimated 2 million preventable deaths a year, mostly in children killed by a variety of dysentery-like intestinal ailments that result from ingesting human fecal matter. When large numbers of people are defecating outdoors, it’s extremely difficult to avoid ingesting human waste, either because it’s entered the food or water supplies or because it has been spread by flies and dust.


Nonetheless, open defecation is a relatively low-profile public health issue. This is ironic because unlike other world health crises such as malnutrition or malaria, the solution isn’t necessarily expensive. It begins simply by discussing the problem. Yet we don’t. Partly that’s the taboo of discussing defecation, and partly that’s because the practice is invisible … sort of.

Having worked in 68 countries, I can vouch that it’s certainly not invisible if you’re not used to seeing human fecal matter in the streets or fields. But you can quickly get used to it.

This March, I was in India with two colleagues shooting a documentary for Current TV on open defecation. The first morning, a local Delhi water activist took us on a boat ride along the Yamuna River, into which Delhi’s raw sewage flows. The water is black and almost tar-like, bubbling with methane. The odor is intense. When we made landfall on a bank that hundreds of people use as a toilet, correspondent Adam Yamaguchi promptly threw up. But a couple of days later, we were touring a Delhi slum where raw sewage flows in shallow gutters, and Yamaguchi and the rest us had stopped worrying about finding a clean spot to step. By the end of our visit, we were out in a farmer’s field, with villagers who were showing us where they defecated, and it was easy to agree with the local schoolteacher who said that he could see why women and girls might have modesty issues, but that open defecation was good at least for the men and boys because it provided fresh air and exercise. In a week and a half, we had gone through the entire cycle from revulsion to acceptance, thereby illustrating the crux of the problem. It had become invisible.

When people don’t see the problem, they don’t push for solutions. That means there’s little incentive for governments to provide sewer systems and septic tanks to city dwellers, or for people in the country to dig and maintain outhouses.

In India, it is said that more people have access to cellphones than to toilets. The World Bank has provided toilets in rural areas, only to find that people don’t necessarily see why they should be used for defecation as opposed to storage sheds. Two hours north of New Delhi, we visited a two-story brick home where the owner had a washing machine, a stove and a television set, yet in the predawn and again after sunset, she walked a mile with her teenaged daughter to use a field as a toilet.

Health organizations worldwide are realizing they must create a demand for toilets before the problem can be solved. The goal is to link the lack of toilets to health problems. In a part of India’s Haryana state, a campaign called “No toilet, no bride” sends the message that a man without a toilet should not be considered successful enough to marry your daughter.


A Singapore businessman, Jack Sim, founded the World Toilet Organization to break the taboo about discussing the issue. Now, he says, he’s looking for “the Angelina Jolie of toilets” to be a spokesperson for the cause.

Unlike many other world health issues, which require the developed world to cough up billions in aid, Sim believes that if there is demand, people without toilets will buy their own, even if they choose simple composting pit toilets. Sim estimates local cottage industries providing toilets could be a trillion-dollar business for locals, so it would be not only a health boom but an economic one as well.

But first, we have to be willing to talk about poop.

Mitchell Koss is an executive producer at Current TV. “The World’s Toilet Crisis” premieres on Current on Wednesday, June 9, at 10 p.m.