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Author: Pam Furniss

Waste products; wasted time; wasted lives: What does a lack of access to sanitation mean?

Updated Wednesday, 8th June 2011

Over two and half billion people have no access to sanitation - and that means a lot of people being exposed to health risks. What can be done?

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During the Thinking Allowed discussion at Wellcome Collection, Laurie Taylor cited the statistic that 2.6 billion people in the world do not have access to sanitation.

But have you ever paused to think about what 'no access to sanitation' actually means?

For many it means having to use very basic facilities but for more than a billion people it means no access to a toilet – at all. So not just nipping behind a bush for a pee but having to do a poo, take a dump, have a shit (call it what you will) in the open.

This may be in a field, on waste ground, on a river bank, in a bucket or in a plastic bag to be thrown out on to the street.

It means no privacy, along with hundreds or even thousands of other people having to do the same thing in the same place. Defecation may be a taboo subject, but for billions of people there is no possibility of keeping that most private of functions out of the public eye.

The formal definition of sanitation is the separation of human waste from human contact for disease prevention. But we’re not talking about sophisticated flush toilets here.

A simple pit latrine with a concrete slab to cover the pit, like the one shown here, is classed as improved sanitation. Users of this latrine are not included in the 2.6 billion.

A pit latrine
An example of improved sanitation – a pit latrine with slab. This one also has vent pipe, foot rests, lid (to cover the hole) and surrounding walls of branches and leaves.

The impact of having no access to sanitation goes far beyond the effect on human dignity. Following the definition above, the lack of sanitation means that there is contact between people and their bodily wastes.

Waste that is not contained or disposed of hygienically can easily get into rivers, lakes and groundwater. These same rivers, ponds and groundwater are the sources of water for drinking, cooking and washing for many millions of people.

If the waste comes from people infected with certain diseases, then the people using the water are likely to become infected themselves, leading to a repeating cycle of disease from people to water and back again.

The link between disease and contaminated water was first recognised by John Snow whose story is currently featured in the Dirt exhibition at the Wellcome Collection.

In 1854, he famously traced the source of a cholera outbreak in London to a specific water pump and, despite scepticism and disbelief of his theory of cause and effect, he successfully campaigned for the pump to be closed.

The causal connection between faecal contamination and disease may now be fully understood but that does not mean the problem is solved everywhere in the world. Globally, more than 4 billion cases of diarrhoea occur every year and 88 per cent of them can be attributed to unsafe water supply, inadequate sanitation and poor hygiene. About 1.5 million children under the age of five die from diarrhoea every year.

These connections between water and sanitation are examined in several short films that form part of The Open University module Environment: journeys through a changing world.

The module visits Ethiopia to highlight the issues around access to safe water and sanitation, especially focussing on the impact on women’s lives. (The films are also available as free downloads on iTunesU.)

Yeshiemebet is a mother living in rural Ethiopia whose daily life is dominated by these issues. She collects water from an unprotected spring in a jerry can and carries it on her back to her home for the daily needs of her husband, five children and herself.

It’s a two kilometre round trip, uphill on the way back when the can is full, that she does six or seven times every day.

Their toilet, and that of their neighbours, is the fields around them. She sees no prospect of ever having a water supply to her house.

Another woman, Binegrish, is more fortunate. In her village, they have pit latrines and a well with handpump that provides clean safe water close to home. Binegrish talks about the change the pump has made to her life:

Before the pump was built, the community suffered a lot from waterborne diseases, especially the children, they got diarrhoea all the time. Since we’ve had the pump I can’t imagine how we lived without it. In the past we spent so much time and trouble getting down to the river and queuing up to fetch water. It was like being a prisoner. What we have now is absolute bliss; it’s like we died and went to heaven.
Binegrish using a pump
Binegrish using the handpump that provides plentiful safe water in her village.

So what else is being done in Ethiopia to improve the situation? One initiative is the Ethiopian government’s programme to improve health services by training more than 30,000 community healthworkers and deploying them into every village throughout rural Ethiopia.

The Open University is proud to be a partner in this programme by providing distance learning expertise for the preparation of teaching materials. In collaboration with Ethiopian expert authors, the university’s Health Education and Training in Africa (HEAT) team have produced thirteen modules that are currently being piloted in several regions in Ethiopia and are available online as open educational resources.

The connectivity between water, sanitation and health is an integral part of the Hygiene and Environmental Health Module which equips healthworkers with the knowledge and skills to promote and advise their communities on safe water supply, domestic water treatment, and latrine construction and utilisation.

Cover of HEAT learner's guide
The HEAT programme module on Hygiene and Environmental Health, produced in partnership between the Ethiopian Federal Ministry of Health, UNICEF, African Medical and Research Foundation and The Open University.

Throughout the world, despite many improvements and development programmes, the growing global population and migration towards cities means that the figure of 2.6 billion without access to sanitation is actually on the increase.

Next time you’re sitting in the comfort and privacy of your lavatory, you might like to consider that statistic and ask yourself: Is that acceptable in this day and age? Do distaste and taboo affect our attitude to the problem? What more could be done to improve the situation?

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