Courtesy Thinglink

Toilets are the unfashionable part of human development. People avoid talking about them. Sanitation and hygiene were the worst performing Millennium Development Goals. In 2017, many more people use mobile phones than a toilet. A staggering thirty two per cent of people (2.3 billion) worldwide lack even basic access to a toilet, and only the top 27 per cent (1.9 billion) use a private toilet connected to a sewer from which waste water is treated. Coupled with a growing global population, poor sanitation means that environmental contamination is getting worse in many places.

Take India for example.  Every day 620 million Indians deposit 100,000 tons of human waste next to roads, rail tracks, rivers and in fields. That is 180 people per square kilometer. Roughly speaking, a gram of poop has 10 million viruses, one million bacteria, 1,000 parasite cysts and 100 parasite eggs. Multiply these figures by 1000 for a calculation per kilo, times 1000 for a ton, times 100,000 tons per day. Every day.

 

But what is the link with our children’s brain development? Strong development and economic progress is retarded if children survive but don’t thrive. And for a child to thrive she must keep free of infection as well as be properly fed. Poor nutrition in the womb or during the critical eighteen months of infancy makes children’s bodies visibly thin and stunted. Stunted height often hides a stunted brain. Babies are not born with fully formed brains. In the first three years of a child’s life, her brain will undergo the most important development. An explosion of ‘synaptogenesis’ happens, nerve cells making hundreds of millions of connections. These connections computerize the child to see and hear, learn language, develop speech, numeracy and literacy, and form prolific social relationships. This process continues until late adolescence. Early malnutrition and infection not only interrupts synaptogenesis but also ‘myelination’, the insulation of nerve fibers to make them secure and effective. Stunted children do less well at school, less well in finding employment, and less well in creating wealth.

http://pitt.edu/~strauss/GradInf%20Thompson_Nelson2001.pdf

Contamination of roads, paths and households mean children get infected. Diarrhea, dehydration and all manner of parasitic infections stop infant growth in its tracks. Children become chronically sick, stunted and their brain connections impaired. The core problem for environmental contamination is open defecation and the likelihood of a child ingesting some of the billions of toxic fecal bacteria that it spreads. Data from the latest Indian National Family Health Survey show that 67% of Hindu households reported open defecation, and 42% of poorer Muslim households did so. Unsurprisingly, deaths of Muslim children under the age of five were 18% lower than among Hindus. Muslims were also less stunted by one year of age although the difference disappeared as their child got older when poverty and other social disadvantages kicked in. Further no Indian city has a comprehensive waste water system so that most rivers are effectively sewers.  Many countries face similar problems but collect less data than India.

To tackle stunting and to protect our children’s brains worldwide we’re talking about clean water, toilets, drains, water treatment plants and basic hygiene. We’re also talking about a careful balance between technology and social mobilization. Many organizations have looked at new ways to build low-cost toilets, with solar power and less water dependence. But imported solutions don’t always work.

Toilets illustrate four blind spots in the offices of international and government aid⁠. First, we forget that basic interventions are complex. We must understand the imperfect relationship of knowledge to behavior, and the complexity of group-think and social affairs.  People relate to their environment in intricate ways. Most family units are clean. But often, in traditional societies, a homestead

is only clean up to an imaginary line of ritual pollution, beyond which filth and rubbish is accepted. And villagers are reluctant to converse about sanitation. Gram Vikas, a sanitation charity in India, learnt that it takes up to a year to mobilize villagers before they commit to a programme for clean water and toilet improvement. An elected vigilance group then becomes effective and will monitor the use of toilets and drinking water, imposing penalties for misuse.

Second we imagine what ought to be as the starting point, not what actually is. For example, we should attend more to informal and private providers than just government provision of services. In the west, for example, most toilets were built within private housing and private buildings. Third, we focus too much on supply of units and not on the connections. Paying greater attention to the connections of products like toilets to water supply, to sanitation rules, waste disposal, retail corruption, and women’s safety in a public urban space is essential.  When toilet building programs suffer scams by officials or contractors, without community understanding or ‘connections’, people don’t protest; or when they’re built, toilets aren’t used or maintained.

Copyright: Water For People/Nancy Haws Children Washing Hands at School Handwashing Station in Pahuit, Guatemala

Finally, business as usual will not work. We need political leaders, the media, businesses and civil society to join forces. We need much more finance, better technology, incentives for the local private sector, and the mobilization of communities to make sanitation happen. The World Health Organization estimates that 23% of all global deaths –12.6 million every year – are linked to environment risks such as air, water and soil pollution, chemical exposures, climate change and ultraviolet radiation. The Global Strategy for Every Woman and Every Child, led by UN Secretary General Antonio Guterres, makes thriving in childhood a key goal. And the American philosopher, Deepak Chopra, wrote that sanitation ‘has probably done more to increase human life span than any kind of drug or surgery.’
If toilets are embarrassing, children’s development is certainly not. Let us make the link between toilets and children’s brains, because everyone wants healthy children, and because our national prosperity will depend on the health and talents of the next generation.